Anesthesia E-ssential, April 15, 2013

 
Anesthesia E-ssential

April 15, 2013 

Vital Signs

CRNAs Gather to Advocate for their Profession at Mid-Year Assembly
Right now, a record number of CRNAs and student registered nurse anesthetists from around the country are participating in what may be the nurse anesthesia profession's most important meeting: the AANA Mid-Year Assembly (MYA). Attendees come together to network, strategize, examine key issues and, most importantly, connect with their senators and representatives on Capitol Hill.
 
Even if you couldn't attend this year's MYA, check out this new video to learn more about the importance of connecting with your legislators and making your voice heard on Capitol Hill. In it, Sen. Debbie Stabenow (D-MI) and Congressman Aaron Schock (R-IL) remind CRNAs that yes, they do want to hear what we have to say.
 
Await Your Virtual Mid-Year Assembly
AANA members will receive a Virtual Mid-Year Assembly email message from President Janice Izlar, CRNA, DNAP, asking you to contact your senators and U.S. representative on a critical CRNA issue. Keep an eye on your inbox and be ready to take action!
 
 

 

The Pulse

 
  • AANA Journal Course Examination Open Now
  • Register today for the AANA Jack Neary Advanced Pain Management Workshop Series!
  • CRNA Honored by Health Volunteers Overseas
  • CRNA Joins the Fight against RSD/CRPS
  • Don’t Miss the AANA Comprehensive Ultrasound Guided Peripheral Nerve Block and Vascular Access Workshop
  • Go the Distance in the Las Vegas Fun 5K Walk/Run
  • AANALearn® - New Course Available

 

AANA Foundation and Research
  • AANA Foundation Seeking Closed-Claim Researchers
  • Friends for Life Deadline is June 15
  • Opportunity for a Summer Research Intern
  • May 1 Presentation and Research Deadlines Approaching
 
  • CRNA School Search Engine Available Now
  • Save the Date! COA Doctoral Workshop at AANA Annual Meeting
 
  • AANA, Nursing Groups Urge Medicare Regulatory Reforms in Comments to CMS
  • House Republicans Release New Proposal to Reform Medicare “SGR” Issue
  • President’s 2014 Budget Released April 10 Includes Some Medicare Cuts, Tax Revenues
  • Noridian Medicare Proposes Postop Pain Block Restrictions, Drawing Concern from CRNAs
  • MedPAC Examines Roles of APRNs and Physician Assistants in Medicare
  • AANA Urges WPS Medicare to Resume Payment for CRNA Ultrasound Guidance Services
  • AANA Expresses Concerns with Using Reporting Requirements Developed by Physician Specialties for Medicare Program
  • Senate Panel Holds Confirmation Hearing for Marilyn Tavenner, RN, to Run Medicare Agency
  • FEC REQUIRED LEGAL DISCLAIMER FOR CRNA-PAC
 
 

Healthcare Headlines

Healthcare Headlines is for informational purposes, and its content should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.
 
 

 
 
Inside the Association
 
AANA Journal Course Examination Open Now
AANA members can now obtain six free CE credits by taking the new online Journal Course. This member benefit will be available through July 31, 2013. Log in now!
 

Register today for the AANA Jack Neary Advanced Pain Management Workshop Series!
New this year, we have added the AANA Physical Assessment for Advanced Practice! This hands-on workshop will focus on expanding the physical assessment skills for CRNAs involved in pain management. Each workshop can be registered for individually, but the biggest impact will come from taking them all together as a training plan.
  • AANA Physical Assessment for Advanced Practice – May 3, 2013
  • AANA Jack Neary Advanced Pain Management I Workshop – May 4-5, 2013
  • AANA Jack Neary Advanced Pain Management II Workshop – 6-7, 2013
  • Neuroanatomy Prosection Lab – May 8, 2013
Sign in as a member at www.aana.com to access the registration form.

CRNA Honored by Health Volunteers Overseas
Diana Davidson, CRNA, of Camp Hill, Pa., is a 2013 recipient of the eighth annual Health Volunteers Overseas (HVO) Golden Apple Award for her work in Ethiopia. As part of its World Health Day observances, HVO created this award to recognize the extraordinary educational contributions of volunteers to international program sites. Each HVO volunteer honored with this award has demonstrated a strong commitment to HVO's educational mission by working on curriculum development, teacher training, didactic or clinical training or the enhancement of educational resources. Read more here

 
CRNA Joins the Fight Against RSD/CRPS
Alleviating the pain of patients and others is a crucial part of being a CRNA. To that end, Kim Zweygardt, CRNA, of Kansas, is helping to raise awareness and reasearch funding for Regional Sympathetic Dystrophy/Complex Regional Pain Syndrome (RSD/CRPS), a chronic neurological syndrome that causes severe burning pain, pathological changes in bone and skin, excessive sweating, tissue swelling, and extreme sensitivity to touch. Kansas RSD Awareness is hosting “Walk, Run, & Rock for a Cure” on April 27 at Cheyenne County Fairgrounds, St. Francis, Kan. Find out more about the event on Facebook.

Don’t Miss the AANA Comprehensive Ultrasound Guided Peripheral Nerve Block and Vascular Access Workshop
June 1-2, 2013, Grand America Hotel, Salt Lake City, Utah This workshop provides a comprehensive review of current practices related to peripheral nerve blocks and vascular access. Along with the basic sciences, current literature and latest techniques involving the use of ultrasound in anesthesia practice, this program helps CRNAs enhance their expertise, fill in knowledge gaps, and take their practice to the next level in these important areas. Space is limited, so register today!
Go the Distance in the Las Vegas Fun 5K Walk/Run
During this year’s Annual Meeting in Las Vegas, attendees will again go the distance in supporting Lifebox. Follow this link to more information about the eighth annual fun 5K and the Lifebox mission to improve patient safety worldwide. Come join us! Note: New this year, walk/run registration is on Active.com instead of with meeting registration.
 
AANALearn® - New Course Available
“Intraoperative Glycemic Control – Show Me the Evidence” is a new 1 CE credit clinical topic course now available in the AANALearn® system. This was presented originally as an AANA Annual Meeting lecture and is now being provided to AANA members as a streaming video course with exam and evaluation. AANALearn® online education can now provide members with over 60 CE credits.  When completed, CE credits transfer to the member transcript within the same day—a major advantage for those in the recertification process. 
 
All AANALearn® courses are available 24/7 with discount pricing for AANA members. Now is the time to consider completing the CE credits required for recertification in 2013! Check out the catalogs now at www.aanalearn.com.
 
 

  
 
AANA Foundation Seeking Closed-Claim Researchers

The AANA Foundation is seeking applications for researchers to conduct and analyze closed-claim data.  The expected commitment is three years with two, four-day commitments to collect data per year. If you are interested, please click here to access the application and email the completed form by May 1, 2013, to foundation@aana.com with the subject line "Closed Claims."

 
Friends for Life Deadline is June 15

Friends for Life donors help support the future of the nurse anesthesia profession through meaningful, lasting gifts. Contributions through Friends for Life help fund and sustain programs that further research and education in anesthesia. Friends for Life receive a medallion at the Annual Meeting Opening Ceremonies, an engraved plaque in the AANA Park Ridge office and an invitation to the Annual Awards and Recognition Dinner. The submission deadline for recognition at this year’s Annual Meeting in Las Vegas, Nev., is June 15, 2013.

The minimum gift commitment to join Friends for Life is $25,000. Members may fulfill this commitment through a cash gift, but there are many other ways to meet the commitment through planned gifts. Some of the most popular planned gift options for becoming a Friend for Life include:

  • A gift (bequest) in the will for a specific amount or a percentage of the total estate
  • Gift of personal property or real estate
  • Including the Foundation as a beneficiary on a retirement plan or a whole life insurance policy

For further information, please contact Nat Carmichael at (847) 655-1175 or ncarmichael@aana.com

 
Opportunity for a Summer Research Intern

The AANA Foundation is seeking a research intern to work with Foundation staff on closed-claim research and data collection for approximately eight weeks at the AANA Foundation office in Park Ridge, Ill. (June through August 2013). Candidates should have a doctoral degree or be a doctoral student or CRNA interested in research. If you are interested, please send cover letter and CV to Dr. Lorraine Jordan at ljordan@aana.com.

 
May 1 Presentation and Research Deadlines Approaching

Applications for the following are available on the AANA Foundation website, www.aanafoundation.com.

  • “State of the Science” – General Poster Presentation

An opportunity for CRNAs and nurse anesthesia students to present their research findings and innovative educational approaches through a poster presentation at the AANA Annual Meeting. Research, literature reviews and innovative, creative techniques in anesthesia are appropriate topics.

  • Research Grant Proposals

General research grants are awarded to AANA member CRNAs in good standing. Research funding priorities change annually. Please refer to the research priorities on the proposal application for more information. Funding varies.

If you have any questions, please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com

 
 

 
 
CRNA School Search Engine Available Now

The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is proud to announce its new comprehensive CRNA School Search engine, a free database containing the most up-to-date information about each of the 114 accredited nurse anesthesia programs across the country.

The CRNA School Search functionality provides a wealth of information for those interested in learning more about nurse anesthesia programs. Through this easy-to-use database, visitors can gain in-depth knowledge regarding tuition costs, admittance requirements, class size, program length, curriculum and more. The most unique function about this database is that it allows for a side-by-side comparison of up to four programs, eliminating the back-and-forth between school pages to weigh the pros and cons.

Kathy Cook, CRNA, MS, COA chair, said, “CRNA School Search will benefit potential applicants and programs by providing accurate and up-to-date information on nurse anesthesia programs.”

Best of all, the CRNA School Search was created by the COA, which is the sole organization responsible for establishing educational standards for nurse anesthesia programs in the United States and its territories. Each accredited nurse anesthesia program must adhere to the standards set forth by the COA, making it an authoritative source on nurse anesthesia schools. The COA would like to express its appreciation to Whilly Ching, CRNA, for the template and the NBCRNA for its financial assistance in developing this functionality. For more information, please visit the COA website at http://home.coa.us.com.

 
Save the Date! COA Doctoral Workshop at AANA Annual Meeting

The COA is offering The Nuts and Bolts of Developing a Professional Doctoral Degree Offering Friday, Aug. 9, 2013, in Las Vegas, Nev. This one-day workshop provides information on the key activities to establish doctoral degree offerings consistent with the COA’s Additional Criteria for Practice-Oriented Doctoral Degrees contained in the Standards for Accreditation, and COA Policies and Procedures. The content is valuable for programs establishing both entry-level and CRNA post-master’s doctoral degrees. Topics include a dean’s perspective, key considerations in getting started, developing a curriculum that meets national standards for similar degrees, interpreting the COA’s additional criteria for doctoral degrees, and tips for success in the submission and review of doctoral applications.

Who should attend:

  • Nurse anesthesia program administrators
  • Deans of academic units affiliated with nurse anesthesia programs
  • Nurse anesthesia faculty

The fee is $275 per person. CE credits will be available. Registration will open soon. Registration is limited, so register early to avoid getting closed out! 

Program details and registration information will be posted soon on the COA website at http://home.coa.us.com.

 

 
 
 
 
AANA, Nursing Groups Urge Medicare Regulatory Reforms in Comments to CMS
The Medicare agency should eliminate unnecessary supervision requirements in hospitals, critical access hospitals, and ambulatory surgery centers (ASCs); permit CRNAs to evaluate patients for anesthesia risk immediately before surgery in ASCs; and allow CRNAs to serve as directors of anesthesia services in hospitals according to comment letters submitted to Medicare April 8. The comments from AANA and, on the issue of supervision requirements, from some 25 nursing organizations were submitted in response to a Feb. 7 proposed rule on Medicare conditions of participation and conditions of coverage, regulatory reform, and reduction of regulatory burdens.
 
The nursing organizations’ letter stated in part, “We recommend that the Medicare agency eliminate requirements for physician supervision of APRNs…. Unnecessary requirements for physician supervision of APRNs contribute to duplication and waste in the healthcare delivery system. There is no evidence that supervision requirements contribute to higher quality, lower cost, or greater value or access to healthcare. On the contrary, ample evidence points to the value provided by APRNs.”
 
The AANA letter went into more depth, providing evidence in support of Medicare reforms that reduce regulatory burden and help communities meet local healthcare needs regarding physician supervision of CRNAs, evaluation of anesthesia risk in ASCs, and directing hospital anesthesia services. The supervision issue is well-known to CRNAs; the AANA stated, “Reforming the Conditions for Coverage (CfCs) and the Conditions of Participation (CoPs) to eliminate the costly and unnecessary requirement for physician supervision of CRNA anesthesia services supports delivery of population and community healthcare in a manner allowing states and healthcare facilities nationwide to make their own decisions based on state laws and patient needs, controlling cost, providing access and delivering quality care.” With respect to the ASC matter, current Medicare conditions require immediate preoperative evaluation for anesthesia risk and of the surgical procedure to be conducted by a “physician,” a definition which excludes CRNAs; AANA has requested that the regulation be clarified so that Medicare ASCs may allow evaluation for anesthesia risk to be provided by a CRNA. The AANA has also requested that Medicare allow hospitals to name CRNAs as directors of anesthesia services in hospitals; current Medicare regulations require that person to be a “doctor of medicine or of osteopathy.”
 
With respect to the same proposed rule, Becker’s ASC reported April 10 that “ASA (American Society of Anesthesiologists) Applauds Proposed Rule to Mandate Nurse Anesthetist Supervision,” and linked to the society’s comments. The headline is inaccurate; rather, the proposed rule at issue said nothing for or against nurse anesthetist supervision, and invited regulatory reforms and burden reduction proposals not otherwise contained in the proposed rule, which the AANA and the nursing organizations provided. The ASA said in its comment that it “commends CMS for maintaining (the) physician supervision safety standard;” again, CMS no more “maintained” the supervision requirement in the proposed rule than it “maintained” any other unreferenced aspect of the Medicare program.
 
APRN supervision was the subject of a May 25 Washington Post article. Read the ASA’s comment here.
 
House Republicans Release New Proposal to Reform Medicare “SGR” Issue
The Republican chairs of two House health committees issued April 3 a second iteration of their proposal to repeal the flawed Medicare “sustainable growth rate” (SGR) funding formula, and to reform the Medicare Part B payment system in general. The issue is important to CRNAs since under current law Medicare payment for CRNA and physician services will decline 24 percent Jan. 1, 2014, unless Congress acts.
 
Action in Congress is accelerating on the SGR reform issue because the Congressional Budget Office (CBO) has significantly reduced the cost estimate of a permanent fix. In February, the CBO said that the 10-year cost of eliminating the SGR problem was $134 billion, down from the $300 billion pricetag it had previously. However, the proposal from House Ways & Means Committee Chairman Dave Camp (R-MI) and House Energy & Commerce Committee Chairman Fred Upton (R-MI) does not identify a revenue source for the new, reduced pricetag on SGR reform. Nor does the new draft identify other critical numbers, such as the potential size of rewards or penalties associated with achieving unspecified quality outcomes measures.
 
At press time, the AANA was reviewing this draft and developing a comment for submission by the panels’ April 15 deadline.
 
The AANA’s comments to a previous 2013 draft are here, and the AANA’s comments to a 2012 request for comments are here (comments require AANA member login and password).
 
President’s 2014 Budget Released April 10 Includes Some Medicare Cuts, Tax Revenues
The president’s $3.78 trillion Fiscal Year 2014 budget proposal was released April 10, two months late owing to the “fiscal cliff” and “budget sequestration” issues earlier this year. Of CRNA interest, it contains some cuts to the Medicare program, boosts funding for Title 8 nurse workforce development programs, and tax proposals.
 
The president’s budget proposal is part of the annual federal process for Congress’ consideration in writing appropriations and tax legislation. Among its requests is for $251 million for Title 8 nurse workforce development programs, the same as AANA requested in its appropriations request for FY 2014.
 
AANA is reviewing the 2014 budget in detail to gauge its impact on key CRNA interests and will report to membership further details shortly. Read the U.S. Department of Health and Human Services budget here and the detailed Health Resources and Services Administration budget here.
 
Noridian Medicare Proposes Postop Pain Block Restrictions, Drawing Concern from CRNAs
The Medicare contractor serving 10 Western states proposed severely reducing eligibility for Medicare reimbursement for postoperative pain blocks, a service frequently provided by CRNAs, drawing concern from the AANA and CRNAs, coverage in industry publications, and a possibility that the contractor, Noridian Medicare, may reconsider.
 
The Noridian Medicare proposal was published as a draft “local coverage determination” (LCD) for public comment due by early July 2013. However, AANA members, first from Montana and then from other states, expressed concern that Noridian’s proposal appeared to require Medicare patients to suffer pain needlessly in order for their postoperative pain block to be covered by Medicare. The proposal was also inconsistent with other Medicare payment policy described in the National Correct Coding Initiative (NCCI) manual, which says that while immediate postoperative pain care is part of the bundled surgical payment, Medicare may cover the separate postoperative pain block if the separate service is ordered and documented by the surgeon, and the anesthesia professional receiving the order also documents the need for the additional service.
 
The AANA has expressed concern about the Noridian Medicare LCD to the contractor medical director, and is continuing to receive expressions of concern from AANA members on the issue. By rule, Noridian Medicare is restricted from altering the draft LCD until the comment period on the initial draft ends July 11. The issue was also addressed online in the industry publication Outpatient Surgery. A conference call is scheduled for April 22 at 8 p.m. Eastern time for State Reimbursement Specialists and State Presidents in Noridian’s jurisdiction to provide a detailed briefing and action plan.
 
Read the Noridian LCD here, and the Outpatient Surgery article from April 9 here.
 
MedPAC Examines Roles of APRNs and Physician Assistants in Medicare
The Medicare Payment Advisory Commission (MedPAC) meeting in Washington April 3 examined the role of APRNs, including CRNAs, in light of the Institute of Medicine report “The Future of Nursing: Leading Change, Advancing Health.”
 
In a discussion prompted by Commissioner Mary Naylor, RN, PhD, the MedPAC conducted a brief examination of Medicare coverage of services by APRNs and physician assistants, focusing the majority of the discussion on primary care. The AANA has provided the MedPAC additional information on the role and value of CRNAs to Medicare patients.
 
For further information, read the MedPAC staff brief on the subject, the IOM Future of Nursing report summary recommendations, and the MedPAC meeting transcript (APRN section starts on p. 418).
 
AANA Urges WPS Medicare to Resume Payment for CRNA Ultrasound Guidance Services
In a letter to the Contractor Medical Director (CMS) of Wisconsin Physicians Service Medicare (WPS), the AANA requested that WPS resume payment for ultrasound guidance billed by CRNAs, noting that nothing on the WPS Medicare website describes this policy. The action by WPS affects the CRNAs in the states of Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, and Wisconsin, and AANA members from several of those states have fielded denials and reported them to the AANA. The AANA has alerted AANA Board members and AANA the State President in these affected states. Members who receive such denials are urged to appeal these denials with WPS Medicare. The AANA will provide an update regarding the situation as events evolve.
 
AANA Expresses Concerns with Using Reporting Requirements Developed by Physician Specialties for Medicare Program
In a comment letter to the Centers for Medicare & Medicaid Services (CMS) April 8 regarding its request for information on the use of clinical quality measures in Medicare programs such as the Physician Quality Reporting Program (PQRS), the AANA expressed concern with reporting requirements established for American Board of Medical Specialty (ABMS) boards in that they are not subject to the same scrutiny as entities like the National Quality Forum (NQF) and that they do not include APRNs in their measures development process.
 
In the letter signed by President Janice Izlar, CRNA, DNAP, “The AANA is concerned that the reporting requirements established for ABMS boards are representative of specialty physician practice and do not consistently represent the contribution of excellence in practice of other advanced practitioners. First, not all the measures developed by the ABMS boards are subject to the same scrutiny as entities like the National Quality Forum, a consensus-based organization that develops rigorous, evidence-based measures. Second, the measures development process by these boards does not include APRNs.... When medical societies advise CMS on issues vital to other practitioners, but prohibit the inclusion of those affected by their rules from the development process, the validity of the entire process is called into question.” In the comment letter, the AANA also:
  • expressed concerns with third-party entities to report quality data that do not provide access to their quality data to all providers;
  • requested that quality reporting programs be modernized and streamlined, ideally in the form of a unified set of clinical quality measures that align CMS and private health plan quality reporting; and
  • supported measures that are endorsed by the NQF, which includes a wide variety of healthcare stakeholders and employs a rigorous process of accountability to assure validity and reliability.
 
Senate Panel Holds Confirmation Hearing for Marilyn Tavenner, RN, to Run Medicare Agency
The Senate Finance Committee hearing April 9 to confirm Marilyn Tavenner, RN, MHA, FACHE, as administrator of the Medicare agency featured accolades for her professional background as a registered nurse and healthcare executive, a focus on constituent and Medicare oversight interests, and no vote yet scheduled on her confirmation. Chaired by Sen. Max Baucus (D-MT), the hearing for Tavenner drew bipartisan support, being introduced by House Majority Leader Eric Cantor (R-VA), and Sens. Tim Kaine (D-VA) and Mark Warner (D-VA), both former governors of her home state of Virginia. Her confirmation is also supported by the AANA and several leading healthcare organizations. Neither a committee nor a full Senate vote on her confirmation has been scheduled, but they are anticipated to take place before summer. If she is confirmed to the post, Tavenner would be the first registered nurse to serve as administrator of the Centers for Medicare & Medicaid Services (CMS), and the first administrator with the full Senate-confirmed authority of the position since 2006. Read more coverage of the hearing here, and the AANA’s letter supporting her confirmation here.
 
FEC-Required Legal Notification for CRNA-PAC
 
Gifts to political action committees are not tax deductible. Contributions to CRNA-PAC are for political purposes. All contributions to CRNA-PAC are voluntary. You may refuse to contribute without reprisal. The guidelines are merely suggestions. You are free to contribute more or less than the guidelines suggest and the association will not favor or disadvantage you by reason of the amount contributed or the decision not to contribute. Federal law requires CRNA-PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. Each contributor must be a US citizen.
 
 

 
 
 

 
 
 
Medical Study First to Pinpoint Best 'Nerve Block' Treatments for Patients Needing Surgery for Hip Fractures
After performing a network meta-analysis of studies on nerve block techniques, a research team at the University of Alberta believes it has singled out the methods that are most effective for surgery to repair a broken hip. "We can get all these treatments together, put them in order now from best to worst and approximate how much better each is compared with the others," explained lead researcher Saifee Rashiq of the school's Department of Anesthesiology & Pain Medicine. For the purpose of broken-hip operations, the team identified two variations of nerve block—both fairly simple to perform—as superior to the others. Of the two, one proved better at curbing postoperative pain while the other reduced the odds of the patient developing a potentially life-threatening complication: delirium. The investigators, who reported the findings in the Canadian Journal of Anesthesia, conceded that additional research, including head-to-head trials, must be conducted to further compare the techniques. For now, however, Rashiq hopes anesthesia providers will start using one of the top two methods to repair hip fractures. "If everybody used these techniques all the time you could make the business of having your hip fixed a lot less unpleasant," he said. "You could probably prevent a large number of people from having delirium, and I'm sure that would save healthcare dollars."
 
From "Medical Study First to Pinpoint Best 'Nerve Block' Treatments for Patients Needing Surgery for Hip Fractures"
Medicalxpress (04/04/2013)
 

Intubation Times Longer for Video Than DL in Patients With Difficult Airways
There are both pros and cons to using a video device instead of performing direct laryngoscopy (DL) during intubation of patients with difficult airways, Canadian researchers report. The University of Toronto team, led by Department of Anesthesia fellow Daniel Cordovani, MD, studied 44 surgical patients who had at least one risk factor for a difficult airway. Two dozen subjects were randomized to receive laryngoscopies with a Macintosh blade followed by use of a GlideScope video device, and 20 were assigned to DL with the Macintosh only. Cordovani and colleagues discovered that the video technique offered a much better view than DL in 55 percent of patients, had an intubation failure rate about half that of DL, and required external laryngeal pressure less often than the traditional approach. However, while earlier research showed that video laryngoscopy required markedly less overall force in patients with normal airways, that requirement was higher and on par with DL when treating patients with difficult airways. Perhaps most significant, the investigators calculated that video laryngoscopy took a median 30 seconds compared to 18 seconds for DL. "A prolonged laryngoscopy is probably more likely to generate a sympathetic response, which could be detrimental in patients with cardiovascular risk factors," said Cordovani.
 
From "Intubation Times Longer for Video Than DL in Patients With Difficult Airways"
Anesthesiology News (04/01/13) Vol. 39, No. 4 Wild, David
 

Dental Anesthesia Appears to Affect the Development of Wisdom Tooth
There is a statistical association between local dental anesthesia given to children ages two to six and evidence of missing lower wisdom teeth, according to researchers from Tufts University School of Dental Medicine. The findings, published in The Journal of the American Dental Association, suggest that anesthesia injected into the gums of young children could interrupt lower wisdom-tooth development. The researchers identified records of patients who had received treatment in the Tufts pediatric dental clinic between the ages of two and six and who also had a dental x-ray taken three or more years after the initial treatment. After eliminating confounding factors such as delayed dental development, they analyzed 220 records for a total of 439 sites where wisdom teeth could develop in the lower jaw. A control group of 376 sites contained x-rays of children who had not received anesthesia where wisdom teeth could develop, and a comparison group of 63 sites contained x-rays from patients who had received anesthesia. In the control group, 1.9 percent of the sites did not have x-ray evidence of wisdom tooth buds, compared to 7.9 percent of the sites in the comparison group, making the comparison group 4.35 times more likely to have missing wisdom tooth buds.
 
From "Dental Anesthesia Appears to Affect the Development of Wisdom Tooth"
News-Medical.net (04/04/2013)
 

General Anesthesia With Sevoflurane Decreases Myocardial Blood Volume and Hyperemic Blood Flow in Healthy Humans
Although the body of evidence to support the theory is lacking, researchers believe myocardial perfusion must be maintained during general anesthesia in patients who are at risk of experiencing cardiac complications during surgery. A small study out of the Netherlands measured myocardial blood flow (MBF) in 13 healthy patients at rest, during hyperemia, and after sympathetic stimulation. The subjects, whose responses were gathered while under sevoflurane anesthesia and immediately before surgical simulation, maintained MBF at rest and following sympathetic stimulation even though myocardial blood volume dropped. At the same time, the general anesthetic caused hyperemic MBF to decline and, as a result, MBF reserve.
 
From "General Anesthesia With Sevoflurane Decreases Myocardial Blood Volume and Hyperemic Blood Flow in Healthy Humans"
Anesthesia & Analgesia (04/13) Vol. 116, No. 4, P. 767 Bulte, Carolien S.E.; Slikkerveer, Jeroen; Kamp, Otto; et al.
 
 
Study Provides Detail on Cellular-Level Effects of Anesthetics on Developing Brain in Newborn Mouse
Although the implications for human subjects is not known, new research has found that newborn mice exposed to isoflurane experienced a high rate of programmed cell death in the brain. This condition, known as apoptosis, was at least 11 times more prevalent in the superficial cortex of young mice exposed to the inhaled anesthetic than normal levels of cell loss that occur as the brain matures. The researchers did not determine whether the increase in cell death would cause permanent damage, but earlier studies have suggested that it would not. Reporting in Anesthesia & Analgesia, Dr. George Istaphanous and colleagues at Cincinnati Children's Hospital Medical Center stress that the findings of cellular damage in mice do not necessarily apply to humans. Some research has claimed a correlation between early-life anesthesia exposure and the development of behavioral and learning problems later, while other studies have shown no negative outcomes in children exposed to anesthetics while their brains are in a critical stage of development.
 
From "Study Provides Detail on Cellular-Level Effects of Anesthetics on Developing Brain in Newborn Mouse"
News-Medical.net (04/08/2013)
 
Study: Pre-Op Warming Is Ineffective
Although more and more clinicians are applying the technique, research suggests that pre-warming patients before an operation may not make a meaningful difference in post-operative temperatures. Investigators randomly assigned 128 patients to receive either forced-air warming prior to surgery or no pre-op warming at all. The results showed comparable post-op temperatures for both groups. When pre-op warming does take place, according to a separate study, warmed cotton blankets appear to be just as effective as forced-air warming gowns for maintaining normothermia. The researchers concluded that pre-warming may contribute to a safe body temperature in the period immediately following surgery, but it did not lower the share of patients who subsequently developed hypothermia.
 
From "Study: Pre-Op Warming Is Ineffective"
Outpatient Surgery (04/09/13) Wasek, Stephanie
 

Study Finds Nerve Blocks After TKA, THA Associated With Falls
Researchers say preoperative education on how to walk following a total knee or hip replacement lowers the number of postoperative falls suffered by patients who had a nerve block as part of their procedure. In a presentation to the annual meeting of the American Academy of Orthopaedic Surgeons in late March, Brian Klatt, MD, reported the results of a retrospective study covering more than 7,000 consecutive patients—5,000 of whom received nerve blocks for total joint arthroplasty. He and his colleagues counted 131 falls that took place over the course of about four years at a single institution, and they identified nerve blocks as an independent predictor of falls following total knee or hip replacement. With some falls serious enough that patients had to undergo surgery again, Klatt told the gathering that the issue is an important one for patient safety. "Hospitals are all looking at this," he said, "and it has become a national safety goal."
 
From "Study Finds Nerve Blocks After TKA, THA Associated With Falls"
Healio (03/22/2013)
 

Focus on Anemia May Alter Transfusion Practices
Anemia that develops during surgery typically is treated with blood transfusions, which bear a number of risks. A panel of specialists addressing the 2012 PostGraduate Assembly in Anesthesiology (PGA) said that, given those potential complications—some of which may be tied to the age of the blood being transfused—the time has come to change the way anemia is managed in the operating room. Session moderator Linda J. Shore-Lesserson, MD, professor of anesthesiology and chief of cardiothoracic anesthesiology at New York City's Montefiore Medical Center, said that while the use of citrate-phosphate-dextrose-adenine-1 now allows red blood cells to be stored for as long as 42 days, this still "may be too long." She recommended further study, saying "I think it's worth taking the time to really investigate this question further [...as] it is clear that there is morbidity associated with blood transfusion." The consensus of the panel was that the goal for the patient group in question should be the prevention of transfusion without incurring risk for anemia. Panelist Keyvan Karkouti, MD—associate professor of anesthesiology and health policy, management, and evaluation at the University of Toronto, Canada—has explored a possible alternative approach called prophylactic transfusion. He and his team published a study in Anesthesiology that showed patients who received prophylactic transfusions of red blood cells prior to cardiac surgery were less likely to have perioperative anemia or to require additional transfusions. Aryeh Shander, MD, chief of the Departments of Anesthesiology, Critical Care Medicine, Pain Medicine and Hyperbaric Medicine at Englewood Hospital and Medical Center in New Jersey, said Karkouti's study suggests that, when it comes to anemia, clinicians are missing an "opportunity to diagnose an underlying disease [...] before these patients enter the surgical arena." The Society for the Advancement of Blood Management and the American Society of Anesthesiologists are working to develop new criteria for the diagnosis and treatment of anemia in patients undergoing elective surgery and to position anesthesia providers to be the "gatekeepers" for the management of this patient group.
 
From "Focus on Anemia May Alter Transfusion Practices"
Anesthesiology News (04/01/13) Vol. 39, No. 4 Dunleavy, Brian P. 
 
Fallout From Fungal Meningitis Crisis Continues
Hundreds of people have taken ill and 51 have died due to a fungal meningitis outbreak that began last fall, but the crisis is not over. Although a mystery at first, the outbreak now has been traced to tainted steroid injections produced at the New England Compounding Center in Framingham, Mass., where unsanitary conditions were exposed—including microbial growth in vials of the steroids. Patients receiving the commonplace epidural steroid injections to relieve pain instead were contaminated with a fungus that attacked their bodies and presented all the symptoms of bacterial meningitis. The injections resulted not just in meningitis, spinal, and paraspinal infections but also joint infections and strokes. According to the federal Centers for Disease Control and Prevention, the last case nationally was reported on March 22—although patients continue to develop epidural abscesses and other infections in and around the spine. Dr. Thomas Chiller, deputy chief of the mycotic diseases branch of the CDC, has stated that he would not be surprised if new fungal illnesses were developing up to a year from the last tainted shot, although he said "I think that will be the exception, not the rule."
 
From "Fallout From Fungal Meningitis Crisis Continues"
USA Today (03/31/13) Zaniewski, Ann
 
 

Steps for Surgical Patients to Fight Infection
Hospitals in 10 states are participating in Project Joints (Joining Organizations in Tackling SSIs), a free, federally funded effort led by the Institute for Healthcare Improvement (IHI). The initiative was started amid the introduction of new financial penalties from Medicare for preventable hospital infections and mounting concern about hospital infections and their increasing resistance to antibiotics. Project Joints seeks to prevent surgical-site inflections at incisions made during two of the most commonly performed surgeries: knee and hip replacements. Infection rates range as high as 1.6 percent for knees and 2.4 percent for hips. However, because joint surgery involves placing a foreign object in the body, when infections do occur they almost always require device removal, a minimum six weeks of antibiotics, and a new prosthetic joint. Project Joints includes two strategies previously shown to curb infection: giving antibiotics before surgery and removing body hair with clippers instead of shaving, to avoid nicks that could become a gateway for bacteria to enter the bloodstream. But Don Goldmann, IHI's chief medical and scientific officer, says new evidence has emerged that three other practices are effective when added to the regimen. They include prepping skin with an alcohol-based antiseptic before surgery, having patients use a cleansing agent including the antiseptic chlorhexidine for three days prior to their operation, and testing patients for Staph colonizations. One study found that staph carriers who were treated with five days of the antibiotic mupirocin, administered as a nasal ointment prior to surgery, and who washed with chlorhexidine, had a 60 percent lower rate of surgical site infections. So far, IHI has held three call-in sessions where participating hospitals shared tips for program implementation. The formal IHI Joints Project is scheduled to end in June 2013.
 
From "Steps for Surgical Patients to Fight Infection"
Wall Street Journal (03/12/13) P. D2 Landro, Laura
 
 
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