Anesthesia E-ssential April 15, 2014

Anesthesia E-ssential

April 15, 2014


Vital Signs

Comprehensive Communications Strategy Approved
During a packed open session of the April 5 AANA Board of Directors meeting, the Board accepted a comprehensive communications strategy from the international PR consulting firm FleishmanHillard (FH) for an integrated marketing campaign to promote the role of CRNAs and the benefits they provide. The proposed campaign is designed to gracefully yet powerfully convince healthcare providers and policymakers to support the AANA’s goal of enabling CRNAs to practice to “their full scope of education and skills.”
Integrated marketing utilizes a wide variety of interconnected marketing and communications tactics and channels to deliver a consistent message to key audiences of interest. Target audiences identified by FH include legislators, hospital administrators, surgeons, and other members of a patient’s healthcare team as well as engaging AANA members themselves.
The report to the Board was the culmination of six months of teamwork between FH and AANA staff highlighted by situation analysis, qualitative and quantitative research with hospital administrators and legislators, and audits of AANA’s social and traditional media presence.
Next steps include resource considerations and development of a strategic plan for selecting and implementing the marketing tactics proposed by FH. Your AANA Board and staff will continue to update you on this important and exciting initiative.


The Pulse

  • Members: Receive 6 Free CE Credits by taking the AANA Journal Course Examination Now
  • Assessed CE Presentation Available Online
  • Register for Free Upcoming Webinar: Exploring the Impact of Health IT on Consumer Engagement and Empowerment for Communities of Color
  • Discounted "Opt-Out" Course on AANALearn
  • Orlando – The Stars Come Out Again: Register Now!
  • Apply Now – May 1 Deadlines
  • Frequently Asked Questions Answered on the COA Website
  • Notification of Accreditation Actions
  • Option Sessions at COA Meetings—Change in Meeting Dates
  • Summer in Chicago - Business of Anesthesia Conference
  • NEW AANA Workshop: Foundations of Advanced Pain Management
  • Explore New Techniques and Expand Your Knowledge by Registering for One of the Pre-Congress Workshops in Orlando
  • Save the Date for the AANA's Fall Leadership Academy
  • Save $50 by Registering Today for the Upper and Lower Extremity Nerve Block Workshop
State Government Affairs
  • Indiana Enacts a Bill that Recognizes CRNAs as APNs and Licenses AAs
  • California Lawmakers in Trouble

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
Members: Receive 6 Free CE Credits by taking the AANA Journal Course Examination Now
As a benefit of AANA membership, you can earn 6 free CE credits from the comfort of your home by taking the online AANA Journal Course Examination today. The exam may only be taken online from April 1, 2014, through July 31, 2014. While taking the exam, you are permitted to refer to the original articles. The correct answers to the exam will be published in the August 2014 print edition of the Journal. By keeping a copy of your answers, you will be able to see how you scored. Members automatically have their 6 free CE credits recorded for them upon successful completion of the exam.
This course has been prior-approved by the American Association of Nurse Anesthetists for 6 CE credits; AANA code number: 1028801, expiration date: July 31, 2014.
Assessed CE Presentation Available Online
The joint AANA-NBCRNA webinar on Assessed Continuing Education is now available online. FAQs and the PowerPoint presentation also are available. Click here.

Register for free upcoming webinar: Exploring the Impact of Health IT on Consumer Engagement and Empowerment for Communities of Color
Please join the Office of the National Coordinator for Health IT and the Office of Minority Health at the U.S. Department of Health and Human Services for a webinar titled, “Exploring the Impact of Health IT on Consumer Engagement and Empowerment for Communities of Color” on April 24, from 2 to 3:30 p.m. ET. Transforming the nation’s healthcare system will not happen without addressing health equity and health disparities that persist in our healthcare system. Health IT offers significant opportunities to improve healthcare access and quality in a way that can promote improved health outcomes and equity for all. During this webinar participants will hear from national experts on scalable examples of ways in which we can maximize the benefit of Health IT for all. Click here to register.


Discounted “Opt-Out” Course on AANALearn
April brings cherry blossoms to our nation’s capital as we turn our focus to the ongoing importance of our advocacy efforts for the nurse anesthesia profession. In support of these efforts, AANALearn is featuring The Opt-Out Story for CRNAs at a 40 percent discount now through April 30.
You’ve heard some of the history, but would you be able to explain this issue to a student, a physician, other healthcare providers, or a legislator? Do you know how many states are currently listed as “opt-out” states? Do you understand how the past can influence or affect the future for CRNAs?
The Opt-Out Story for CRNAs (1 CE credit) provides a clear and concise review of the historical events surrounding decisions made by two previous presidential administrations. The speaker, Sandra Larson, CRNA, PhD, APN, provides an engaging historical description of the time period from the late 1990s through the early 2000s. This is an interesting and thorough account of the socio-political and policy issues that surrounded the AANA’s efforts with Health Care Financing Administration (now Center for Medicare and & Medicaid Services) to repeal the unnecessary supervision requirements for nurse anesthesia services contained in Medicare Part A.
Click here for more information about The Opt-Out Story for CRNAs.

Orlando – The Stars Come Out Again: Register Now!
Talent Application Deadline Extended until May 1
Plan to attend a fabulous and fun event on Sunday, Sept. 14, 2014. Orlando – The Stars Come Out Again, will feature CRNAs and SRNAs showcasing their talent and creativity, competing for fabulous prizes, and supporting the AANA Foundation’s mission of advancing the science of anesthesia through education and research. Registration is now open—be sure to buy your ticket when you register for the AANA 2014 Nurse Anesthesia Annual Congress at
Do you have a talent you’d like to share? If so, submit a Talent Application today. Click here to visit our event webpage, learn more about the event, and access the application. Contact Luanne Irvin at the AANA Foundation at (847) 655-1173 or with any questions.
Apply Now – May 1 Deadlines
Applications for the following are due May 1, 2014, and are currently available on the AANA Foundation website at
“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 Nurse Anesthesia Annual Congress. 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

Frequently Asked Questions Answered on the COA Website
The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) recently developed a list of responses to frequently asked questions regarding changes to the standards and other accreditation matters. This list will be updated periodically and is now available on the COA website at Please direct any questions regarding the frequently asked questions list to the COA at or (847) 655-1160.
Notification of Accreditation Actions
Newly Accredited Program
Quinnipiac University
Nurse Anesthesia Program
275 Mt. Carmel Ave.
Hamden, CT, 06518-1942
Initial accreditation granted Jan. 24, 2014
Open Sessions at COA Meetings – Change in Meeting dates
Please note the COA’s May meeting has been changed from a three-day to a two-day meeting. New meeting date: May 29-30, 2014.
The business portion of Council on Accreditation of Nurse Anesthesia Educational Programs (COA) meeting is open to the public. The meetings are open to program representatives and others who are interested in observing the proceedings, however, the meeting will be closed to observers while the COA deliberates on accreditation decisions.
The meetings are held at the AANA Headquarters, 222 S. Prospect Avenue, Park Ridge, IL 60068. Please notify the COA of your proposed attendance. Call the COA office (847) 655-1161 for further information, specific times, and directions if needed. 

Summer in Chicago - Business of Anesthesia Conference
Join your colleagues on July 12 in Chicago for the AANA Business of Anesthesia Conference. The AANA’s Business of Anesthesia Conference is in the heart of downtown Chicago in the River North area and will provide you with the knowledge you need to effectively address may of the business challenges that face an anesthesia practice. Save $50. Register today

Explore New Techniques and Expand Your Knowledge by Registering for One of the Pre-Congress Workshops in Orlando
New Beginnings-A Continued Professional Certification (CPC) Update and Neuraxial Regional Anesthesia Hands-On Workshop – Epidural are the two pre-conference workshops offered at the AANA 2014 Nurse Anesthesia Annual Congress in Orlando. These concurrent workshops will be held on Friday, Sept. 12. The Preliminary Program is online. Register today.
Save the Date for the AANA’s Fall Leadership Academy
Mark your calendars for AANA’s Fall Leadership Academy. The Fall Leadership Academy will be held Nov. 7-9 in Rosemont, Ill. Registration opens in July.
Save $50 by Registering Today for the Upper and Lower Extremity Nerve Block Workshop
AANA’s Upper and Lower Extremity Nerve Block Workshop, Aug. 2-4, at AANA’s offices, is designed to expand your skills and expertise in using upper and lower extremity nerve block anesthesia. Register today for this hands-on workshop.


State Government Affairs

Indiana Enacts a Bill that Recognizes CRNAs as APNs and Licenses AAs
An Indiana bill that recognizes CRNAs as advanced practice nurses and licenses anesthesiologist assistants (AAs) has been enacted.
Currently, CRNAs are not recognized in Indiana as APNs, and the Indiana Association of Nurse Anesthetists has been actively lobbying for APN recognition. With the passage of this bill, CRNAs are included in the definition of “advanced practice nurses” (this definition currently includes nurse practitioners, certified nurse midwives, and clinical nurse specialists). APN recognition is a very positive step for Indiana CRNAs. With the addition of Indiana, 37 states and the District of Columbia recognize CRNAs as either APNs or advanced practice registered nurses.
Including Indiana, AAs are explicitly recognized in state laws or regulations in 14 states and the District of Columbia. This was the second time an AA bill had been proposed in Indiana.
The bill’s effective date is July 1, 2014. A copy of the final enacted bill is available here
California Lawmakers in Trouble
California State Senator Leland Yee, who has been heavily involved in state healthcare legislation (including introducing anesthesiologist assistant legislation in 2013) has been suspended, pending criminal charges. Senator Yee is accused of accepting bribes and attempting to facilitate an international gun-running operation. Ironically, the senator has long been an advocate of gun control and an opponent of video game violence. Two other California state senators have also been suspended on unrelated corruption and voter fraud charges.

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Norway, ME
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Visit the CRNA Career Center

Analgesia-Sedation in PICU and Neurological Outcome
Children who are admitted to the pediatric intensive-care unit (PICU) for meningococcal septic shock may be at greater risk of long-term neuropsychological problems if they receive opioids, no matter how sick they are when admitted. This does not mean, however, that opioids should be avoided in children with sepsis, as that could lead to undertreatment of pain. Researchers analyzed 77 patients with septic shock and purpura who were treated at the Erasmus MC-Sophia Children's Hospital PICU between 1988 and 2001. At least four years after their PICU admission, many children showed impairments in neuropsychological functioning. Twenty-three of these patients received opioids during PICU admission. The use and dose of opioids were significantly associated with poor outcomes on tests of intelligence, visual attention, and executive functioning. The researchers, who report their findings in Pediatric Critical Care Medicine, note the importance of conducting-term follow-up of drug effects and safety to minimize the risks of analgesic or sedative use.
From "Analgesia-Sedation in PICU and Neurological Outcome"
Medscape (04/10/14) van Zellem, Lennart; Utens, Elisabeth M.; de Wildt, Saskia N.; et al.
New Labor, Delivery Option: Nitrous Oxide for Pain
Several U.S. hospitals are using nitrous oxide, also known as laughing gas, to help pregnant women manage pain during labor. MedStar Washington Hospital Center in Washington, D.C., uses nitrous oxide in its midwife program at the mother's request, though they can still receive an epidural after the gas is administered. "Women are becoming more informed about their choices as far as pain management while they are in labor," says Dr. Hassan Adeniji-Adele, director of obstetric anesthesiology at MedStar Washington Hospital Center. While nitrous oxide can dull the pain, it can also cause dizziness and nausea in some patients. The use of nitrous oxide during labor is currently being reviewed by the American College of Obstetricians and Gynecologists.
From "New Labor, Delivery Option: Nitrous Oxide for Pain" (04/07/14) Martin, Randi
Stroke Registry: Better Outcomes With Local Rather Than General Anesthesia in Mechanical Embolectomy
Patients undergoing mechanical embolectomy for acute stroke experience poorer clinical outcomes and lower survival rates when administered general anesthesia instead of local anesthesia, according to research published online in Stroke. Not only did local anesthesia correlate with good 90-day neurological outcomes and a three-fold lower risk of mortality, the retrospective review also refuted earlier concern that local anesthesia elevates the potential for symptomatic intracranial hemorrhage or other adverse events. The rate of symptomatic intracranial hemorrhage was 7.1 percent for local anesthesia, compared to 11.2 percent for general anesthesia. Alex Abou-Chebl, MD, of the Texas Stroke Institute and fellow researchers say the precise reason general anesthesia causes worse outcomes is not known, although that it may lower blood pressure is one explanation. Another is that it prevents neurological assessment during the procedure. The operator is unable to discern worsening conditions or adverse events, whereas during local anesthesia, operators have altered their endovascular technique because of patient-reported headache or suspected ischemia.
From "Stroke Registry: Better Outcomes With Local Rather Than General Anesthesia in Mechanical Embolectomy"
tctmd (04/07/2014) Lucy, Meghann
No Link Between Ketamine Use and Cognitive Dysfunction
The results of a small-scale study suggest no association between repeat ketamine infusions and cognitive dysfunction. The research involved nine outpatients who received a total of 81 infusions to treat chronic neuropathic pain. Each was tested for cognitive dysfunction, both before and after each infusion as well as at follow-up visits two to four weeks following the final infusion, using the proven Manos 10-point clock test method. Pain scores also were recorded at the same intervals. There were no significant differences in clock scores in the patients after repeated ketamine infusions. Higher ketamine doses, however, yielded better cognitive results. The average pain score, meanwhile, was 6.8 at preinfusion and 4.6 at follow-up. Asked why there was less cognitive dysfunction with higher ketamine doses, lead researcher Dr. Ramon Go said, "It's possible that if pain is better controlled the patients think better." He also speculated that the Manos clock score may be less accurate after repeated uses, asking, "Are our patients learning to perform the test better with multiple attempts?" Go, a resident in anesthesiology and critical care at George Washington University Hospital, acknowledged the limitations presented by the study's small size. "We need more data on more patients," he conceded.
From "No Link Between Ketamine Use and Cognitive Dysfunction"
Pain Medicine News (04/03/2014) Ochoa, George
Patients Rate Pain Care Differently Depending on Locale
When patients were asked to what extent they felt their pain was well-managed during a hospital stay, answers varied depending in part on where the respondent lived. Lead author Dr. Patrick Tighe, an assistant professor of anesthesiology at the University of Florida, said the findings could result in system-level changes in patient experience with pain control that would be based on regional differences. Data from the 2011 Hospital Consumer Assessment of Healthcare Providers and Systems survey was used for the study by Tighe and co-authors Roger Fillingim, director of the UF Pain Research and Intervention Center of Excellence, and Dr. Robert Hurley, an associate professor of anesthesiology in the UF College of Medicine and chief of pain medicine at UF Health. They examined all U.S. hospitals with applicable survey data and developed a composite score for each based on how many patients used each of four answers: "always," "usually," "sometimes" or "never." The researchers discovered that high-scoring "always" hospitals tend to be surrounded by other high-scoring hospitals. The finding suggests that there is a geographical effect on how people answer the question, which may have implications for U.S. hospitals given that the Affordable Care Act uses survey data to help determine how hospitals are reimbursed for care involving Medicare patients. The researchers say further analysis is needed to determine the factors that affect patient responses, in order to identify them so that pain care can continue to be improved. The study was published online ahead of print in the journal PAIN on Feb. 12.
From "Patients Rate Pain Care Differently Depending on Locale"
Medical Xpress (04/03/14)
Potential Hydrocodone-Combination Product Rescheduling Sparks Debate
A push to change the classification of combination products that include the opioid analgesic hydrocodone has spawned debate among some in the healthcare community. First proposed in October 2013, the proposal would label all hydrocodone-combination products as Schedule II controlled substances instead of Schedule III controlled substances. Hydrocodone-acetaminophen and other combination drugs are among the most commonly prescribed medications in the United States for chronic pain, even though there is potential for abuse, misuse, and/or addiction to opioids. Despite these risks, several groups—including the American Academy of Pain Medicine—warn that the proposal could cut off patient access to these products, leading to less effective or even more dangerous drugs being prescribed in place of these combination medications. Others have applauded the proposal. "Changing the schedule hopefully motivates providers to do their due diligence and monitor chronic pain patients for signs of opioid failure, diversion and abuse because they are required to see these patients more often," said Ebby Varghese, MD, medical director of the interventional pain medicine clinic at the University of Missouri-Columbia.
From "Potential Hydrocodone-Combination Product Rescheduling Sparks Debate"
Pain Medicine News (04/01/2014) Vol. 12, No. 4 Dunleavy, Brian P.
Anesthetic Technique Important to Prevent Damage to Brain
A widely used anesthetic technique to lower blood pressure could raise the likelihood of depriving the brain of oxygen, say researchers from the University of Adelaide. Hypotensive anesthesia can slow the arterial blood pressure by up to 40 percent. "However, if the blood pressure is lowered too far this may cause damage to the brain and other organs," says P.J. Wormald at the Queen Elizabeth Hospital in Adelaide, Australia. He says his studies indicate that "the brain can only autoregulate up to a point, and cannot completely adapt to such low blood pressures." In a paper, Wormald has made recommendations for a safer approach to hypotensive anesthesia. The report , which was published in the journal The Laryngoscope, focuses on 32 patients who underwent endoscopic sinus surgery.
From "Anesthetic Technique Important to Prevent Damage to Brain"
Medical Horizons (03/31/2014)
Variation in Anesthetic Techniques for Carotid Endarterectomy
Although data from 1995 points to significant variation in anesthetic techniques used for carotid endarterectomy (CEA), there is little research addressing the relationship between the anesthetic type used and patient risk for perioperative stroke. Researchers from the Seattle area surveyed members of the Society of Cardiovascular Anesthesiologists and the Society of Neuroscience, Anesthesiology, and Critical Care in an effort to fill this knowledge gap. The results, published in the Journal of Cardiothoracic and Vascular Anesthesia, reveal that while the preferences of respondents varied, most—75 percent—were inclined to use general anesthesia for CEA procedures, whereas electroencephalogram for intraoperative neuromonitoring traditionally had been the standard. In addition, 68 percent reported using neuroprotection; now, however, pure oxygen and increase in blood pressure are used in place of the barbiturates used 20 years ago. The survey found that anesthesia providers do appear to agree on several areas of perioperative management of CEA, but some significantly divergent practices remain—which the researchers conclude offers an opportunity for providers to cooperative on the creation of best practices guidelines for CEA.
From "Variation in Anesthetic Techniques for Carotid Endarterectomy"
HCPLive (03/27/14) Wick, Jeannette
New Drug Multiplies Analgesic Effect of Opioids Without Increasing Constipation
Prolonged use of opioids is known to cause severe constipation in patients, but a new drug promises to deliver increased pain relief without exacerbating this common side effect. As reported in The Journal of Pharmacology and Experimental Therapeutics, researchers at the University of Granada have helped to develop S1RA, which they say will pave the way for development of new painkillers with fewer adverse effects. S1RA blocks the sigma-1 receptor, a small protein that binds to other proteins—including opioid receptors—and modifies their function. While opioids usually act directly on the brain and spinal medula, they work through the peripheral nervous system when sigma-1 receptor blockers are in play. Scientists at the university's Institute of Neuroscience suspect that the sigma-1 receptor acts as a biological brake that stops peripheral opioid analgesia and that eliminating the receptor can amplify the potency of painkillers without affecting constipation.
From "New Drug Multiplies Analgesic Effect of Opioids Without Increasing Constipation"
News-Medical (03/27/14)
Despite Progress, Ongoing Efforts Needed to Combat Infections Impacting Hospital Patients
Two new reports from the Centers for Disease Control and Prevention (CDC) show that on any given day, about one in 25 U.S. patients has at least one infection contracted during the course of a hospital stay, contributing to approximately 721,800 infections in 2011. Roughly 75,000 patients with health care-associated infections died during their hospitalizations. The most frequently occurring health care-associated infections were pneumonia (22 percent), surgical-site infections (22 percent), gastrointestinal infections (17 percent), urinary tract infections (13 percent), and bloodstream infections (10 percent). "Although there has been some progress, today and every day, more than 200 Americans with health care-associated infections will die during their hospital stay," says CDC Director Tom Frieden. He stressed that clinicians must prevent infections through basic preventive efforts, such as regular hand hygiene, as outlined in standard infection control practices.
From "Despite Progress, Ongoing Efforts Needed to Combat Infections Impacting Hospital Patients"
CDC News Release (03/26/14)
Following a Surgical Checklist Improves Patient Care
Research presented at the 2013 annual meeting of the International Anesthesia Research Society found that when surgery checklists were used in the operating room just before a procedure, there were significant impacts on patient safety. According to investigators at Georgetown University, nearly half of 233 patients tracked had changes made to their care as a result of the checklist. Georgetown resident Brent Gilmore, MD, and colleagues recorded whether a patient's intraoperative management was altered based on the use of the checklist; what type of changes were made; and how those changes affected postoperative course and patient outcomes. Yiliam Rodriguez, MD, assistant professor of clinical anesthesiology at the University of Miami, commented that one of the study's shortcomings—and a shortcoming of checklists, in general—is that the forms can be filled out without the items being performed and completed. Gilmore countered that the review showed evidence that clinicians were not simply going through the motions and that the checklist helped the clinicians catch issues that might have otherwise been missed.
From "Following a Surgical Checklist Improves Patient Care"
Anesthesiology News (03/01/14) Vol. 40, No. 3 Vlessides, Michael
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