Anesthesia E-ssential, April 30, 2013

Anesthesia E-ssential

April 30, 2013 

Vital Signs

Be Sure to Vote in the AANA 2013 Election!

Voting Ends May 21

The AANA 2013 election started on April 23, 2013, and will continue until May 21, 2013, 12 noon CST. By now, active AANA members should have received their ballot materials, including their E-signature and voting instructions, electronically or in the mail from Survey & Ballot Systems (SBS), the AANA's election coordinator. The email with the voting credentials originates from Please make sure this email did not end up in your spam or junk mail folder.
To access the AANA election site visit and enter your member number and the E-signature provided to you by SBS.
If you do not have your election login information, click on the “Need help logging in?” link on the login page and enter the email address on file with AANA, and your election login information will be emailed to you. SBS can be reached by phone at (952) 974-2339 (Monday-Friday, 8 a.m. - 5 p.m. CST) or by email at
If it’s more convenient, please feel free to contact or, and they will ask SBS to re-send you your voting credentials.
Online Forum for Board of Directors Candidates Open Now
Take advantage of this opportunity to become better acquainted with the candidates seeking election to the AANA Board of Directors. Available since April 15, this un-moderated forum is located in the members-only section of the AANA website at, along with the candidates’ speeches, photos, and position statements. The forum will be available until May 21 (the voting cut-off date).


The Pulse

  • FTC Comments on Illinois Interventional Pain Management Bill
  • Vegas Never Looked Better! Check out the New Annual Meeting Promotional Video
  • Don’t Miss the AANA Comprehensive Ultrasound Guided Peripheral Nerve Block and Vascular Access Workshop
  • Las Vegas Walk/Run Registration
  • ANA Presents Free Webinar on Innovation in Nursing Practice
  • Share your Research through the AANA Research Abstract Repository
  • AANA Research Intern Opportunity
  • May 1 Presentation and Research Deadlines


  • Meeting Scheduled for May 29-31
  • Registration Now Open! COA Doctoral Workshop at AANA Annual Meeting


Professional Practice
  • The Joint Commission Issues Sentinel Event Alert on Alarm Management
  • FDA Announces New MedWatcher Mobile App
  • AANA Brings CRNAs, CRNA Issues to Capitol Hill During Record Mid-Year Assembly
  • CRNAs, APRNs and Allied Health Professionals Are Critical to SGR Fix, AANA Says in Comments to Two House Committees
  • Recognize CRNA Use of Health Information Technology, States AANA Comment to CMS
  • CRNAs Invited to Medicare Open-Door Forums on Exchanges, Health Reform Implementation
  • AANA Increasing Visibility Before the Nation's Governors
  • State Associations Served by Noridian Medicare Are Encouraged to Comment for Coverage of Post-Operative Blocks
  • Finance Committee Chairman Baucus Declines to Run for Re-election in 2014, Will Retire at End of His Term

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
FTC Comments on Illinois Interventional Pain Management Bill
On April 19, 2013, the Federal Trade Commission ((FTC) submitted a letter to the Illinois State Senate commenting on an interventional pain management bill being considered in the state.The FTC’s intervention is seen as a positive, and the letter includes comments echoing the AANA’s concerns with the bill.
For example, the FTC states: “By restricting the provision of services by CRNAs, the Bill may impede price and non-price competition among providers of pain management services and increase costs to Illinois citizens, the State of Illinois, and other third-party payers. It may also exacerbate problems of access to care, especially for rural and other underserved populations.” The bill failed to pass out of the Senate committee for this year but will carry over to next year.
The Illinois Association of Nurse Anesthetists engaged in an active grassroots lobbying effort to defeat this bill and Is continuing to monitor this bill for any further activity. This is the fourth time the FTC has sent a letter regarding a pending state legislative or regulatory issue concerning nurse anesthetists. The FTC's submission of this letter is significant, as the FTC receives numerous requests for comments on proposed bills and rules, and FTC staff is very selective in determining when it will issue comments.
Check out the New Annual Meeting Promotional Video
Watch the new promotional video and see what’s in store for you at the AANA Annual Meeting, August 10-13, 2013, Las Vegas. Then, stop by the Annual Meeting webpage and register online today!
Don’t Miss the AANA Comprehensive Ultrasound Guided Peripheral Nerve Block and Vascular Access Workshop
June 1-2, Grand America Hotel, Salt Lake City
New! The AANA member registration fee has been reduced and a student registration fee has been added! The Grand America is an AAA Five Diamond hotel within walking distance of downtown Salt Lake City. Much planning and preparation have gone into developing this workshop, which 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!
Las Vegas Walk/Run Registration
Come join us for the eighth annual Fun 5K Walk/Run during the Annual Meeting in Las Vegas! Follow this link to more information. The walk/run registration is separate from meeting registration—be sure to sign-up on

ANA Presents Free Webinar on Innovation in Nursing Practice
Thursday, May 9, 1 p.m. EDT
Want to learn how to incorporate innovation into your nursing practice and lead the innovation process in your organization? The American Nurses Association (ANA) is offering a free webinar titled Innovation in Nursing Practice: Are You Leading the Charge? Click here to register.

Share your Research through the AANA Research Abstract Repository
The Research Abstract Repository (member username and password required) is now accessible online for posting and viewing of research abstracts. The AANA Foundation and Research provides this site with the goal of improving the dissemination of knowledge that is critically important to advancing the science, education, and research of anesthesia and the CRNA profession. At no cost to members, all students and CRNAs are encouraged to post published or unpublished abstracts in the Research Abstract Repository. To post an abstract, you must be one of the individuals involved in the research.
AANA Research Intern Opportunity
The AANA Foundation is seeking to hire a research intern to assist with organization and data collection of information in closed claim files. The individual will also assist in executing an outcomes study for the AANA Foundation. The likely candidate will be a graduate nursing student or an individual with basic training in health information privacy and security, and/or responsible for conduct of research and research ethics. This will be a part-time commitment from June to September 2013. If interested, please send CV and cover letter to
May 1 Presentation and Research Deadlines
Applications for the following are available on the AANA Foundation website,
  • “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

Professional Practice

The Joint Commission Issues Sentinel Event Alert on Alarm Management
This April 2013 Joint Commission alert focuses on alarm safety and alarm fatigue.The alert notes that between January 2009 and June 2012, the Commission received 98 voluntary reports of alarm-related events, 80 of which resulted in patient deaths and 13 in serious injuries. The alert explains that healthcare professionals “become desensitized or immune to the sounds, and are overwhelmed by information – in short, they suffer from ‘alarm fatigue.’” As a result, healthcare professionals may decrease the alarm’s volume, turn it off, or adjust the settings to an unsafe level, all of which may lead to devastating consequences. The alert makes a series of joint recommendations from The Joint Commission, the Association for the Advancement of Medical Instrumentation (AAMI), and ECRI Institute, which has consistently identified alarm fatigue as one of its top 10 healthcare technology hazards.
The top five recommendations are: 
  1. Leaders must ensure there is a process for safe alarm management and response in high-risk areas.
  2. Prepare an inventory of alarm-‐equipped medical devices and identify the default alarm settings and appropriate alarm limits.
  3. Develop guidelines for alarm settings including situations when alarm signals are not clinically necessary.
  4. Define when alarm settings and limits can and should be tailored for individual patients.
  5. Implement routine inspections and maintenance of alarm-equipped devices. 
FDA Announces New MedWatcher Mobile App
The FDA has introduced a new mobile device application, MedWatcher, which allows individuals to submit voluntary reports of serious medical device problems to the FDA using a smart phone or tablet. The app, which can be downloaded from the iTunes Store and the Google Play Store, makes it easier and faster for healthcare professionals to send medical device problem reports to the FDA. Although MedWatcher is not intended to fulfill mandatory reporting requirements for manufacturers and facilities, it is a new tool for healthcare professionals to play an important role in patient safety.

Use of this app will help the FDA identify and respond to medical device problems more efficiently and effectively. These reports may provide important information that can lead to improved patient safety. The FDA encourages healthcare professionals, patients and caregivers to report the following types of problems, even when they are not certain that the device caused the problem:

  • Serious adverse events that might be associated with a medical device, especially events that are not listed in the product labeling. "Serious" means fatalities, hospitalizations, and medically significant events.
  • Therapeutic failures where the device failed to work as it should.
    Use errors with devices, including situations where the error may have been due to poor communication, or to ambiguities in product names, directions for use, or packaging.
  • Product quality issues, such as suspected counterfeit products, defective components, potential contamination, device malfunctions and poor packaging.
For more information, including details about confidentiality and privacy, visit the FDA’s MedWatcher Page


Meeting Scheduled for May 29-31
The business portion of the May 29-31 Council on Accreditation of Nurse Anesthesia Educational Programs (COA) meeting is open to the public (i.e., program representatives and others who are interested in observing the proceedings). However, the meeting will be closed to observers while the COA deliberates on program accreditation decisions. The meeting is held at the AANA Headquarters, 222 S. Prospect Avenue, Park Ridge, IL 60068. Call the COA office at (847) 655-1160 for further information.
Registration Now Open! 
COA Doctoral Workshop at AANA Annual Meeting
Don’t miss out on the Council on Accreditation of Nurse Anesthesia Educational Programs’ (COA) one-day workshop, The Nuts and Bolts of Developing a Professional Doctoral Degree Offering, on Friday, Aug. 9, 2013, in Las Vegas, NV. 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 will be covered. 
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. Seven CE credits can be earned. Registration is limited, so register early to avoid getting closed out! 
Program details and registration information are available on the COA website at Online registration also is available at

AANA Brings CRNAs, CRNA Issues to Capitol Hill During Record Mid-Year Assembly
A record number of AANA members met in Washington and brought CRNA issues to Capitol Hill April 14-17 as part of the annual Mid-Year Assembly, which featured speakers from the worlds of health policy, government, politics and advocacy.
The 2013 gathering broke several records for attendance and member participation. Total registration numbered 850, 7 percent more than 2012’s record attendance. The “CRNA-PAC Loves the ‘80s” cruise and silent auction benefiting the association’s political action committee, now in its 30th year, was the PAC’s largest Mid-Year Assembly fundraising event, drawing an enthusiastic crowd of 350 members, a record high. In total, the PAC raised more than $105,000 during the meeting, another record.
Moreover, CRNA voices were heard on a critical nursing workforce issue. AANA members urged members of the House to sign a “Dear Colleague” letter that Reps. Lois Capps (D-CA) and Richard Hanna (R-NY) circulated in support of nurse and APRN workforce development funding. At the beginning of Mid-Year Assembly, 16 legislators had committed to sign the Capps-Hanna letter. By the end of Mid-Year Assembly, following AANA member visits on Capitol Hill, the total signature count had increased to 84.
The speaker lineup included presentations from former Medicare and Food and Drug Administration (FDA) administrator Mark McClellan, MD, PhD, now a scholar at the Brookings Institution; the Medicare agency’s chief medical officer Patrick Conway, MD, MSc, who accepted the 2013 AANA National Health Leadership Award for honoree Marilyn Tavenner, RN, MHA, FACHE, the agency’s acting administrator; U.S. Reps. Renee Ellmers (R-NC) and Bruce Braley (D-IA) from the Medicare-writing House Energy and Commerce Committee; FDA drug shortages office chief Capt. Valerie Jensen, RPh, and leaders from the American Hospital Association and the American Society of Health-System Pharmacists to address the drug shortage issue; professional advocacy training from Amy Showalter; as well as from AANA present and future elected leadership, and AANA D.C. team members on federal CRNA policy issues.
CRNAs, APRNs and Allied Health Professionals Are Critical to SGR Fix, AANA Says in Comments to Two House Committees
Reversing the annual Medicare “sustainable growth rate” (SGR) funding formula cuts requires making more effective use of CRNAs and other APRNs, according to comments that the AANA submitted April 15 to two House committees circulating draft legislative outlines.
“The proposal appears to authorize medical and other specialty societies to develop and propagate quality measures for use in incentive payments. Specialties should develop quality measures as long as they are evidence-based, validated, and transparently developed, taking into account all relevant stakeholders, including non-physician providers, in their development and implementation,” states the AANA letter signed by President Janice Izlar, CRNA, DNAP. “Since there is one standard of care, there should be one standard of measures used to inform payment systems. A system of payment incentives linked to quality measures should not permit different measures, and different incentives and penalties, for the same services delivered by different provider types.”
“It is vitally important that the committees include the full range of non-MD/DO professionals in discussions—and ultimately, a proposal—to replace the SGR,” states the letter signed by the AANA and the Patient Access to Responsible Care Alliance (PARCA). “Members of our organizations provide millions of often unique services to Medicare beneficiaries each year. How the SGR will be replaced will directly impact our members’ ability to provide these services in the coming years.”
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 $300 billion previously. However, the proposal from House Ways and Means Committee Chairman Dave Camp (R-MI) and House Energy and Commerce Committee Chairman Fred Upton (R-MI) does not identify a revenue source for the new, reduced price tag 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.
For further information, read the AANA’s comment, the PARCA comment, and the second SGR reform package from the House Republicans (comments require AANA member login and password).
Recognize CRNA Use of Health Information Technology, States AANA Comment to CMS
The AANA has advised the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) to recognize that CRNAs have not been included in the CMS Electronic Health Records (EHR) incentive programs and that they should be allowed to participate in future incentive programs.
In a letter signed by AANA President Janice Izlar, CRNA, DNAP, the AANA also requested the agency assure the AANA that CRNAs will not be penalized under quality incentive payment systems for not being recognized as an “Eligible Professional” under the Medicare and Medicaid EHR Incentive Program.
For further information, read the AANA comment letter (requires AANA member login and password), and the request for information.

CRNAs Invited to Medicare Open-Door Forums on Exchanges, Health Reform Implementation
During the week of April 29, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) will begin to host state-by-state calls in the 33 states where the federal government is slated to run State-based Exchanges or Marketplaces for health coverage under the Affordable Care Act. CRNAs are invited to participate.
These calls are part of HHS’ plan to encourage public participation in states where Uncle Sam will be operating or partnering in the operation of insurance marketplaces. They exclude those states that have chosen to run their own State-based Marketplaces. During these calls, HHS and CMS regional officials will update participants on policies and the operations of the insurance marketplace, and provide time for stakeholder comments, questions and answers. CMS will use the information and feedback provided by stakeholders in the development of insurance coverage marketplaces. The AANA and CRNAs’ interests in the exchanges lie primarily in ensuring that CRNA services are fairly reimbursed in plans marketed through such exchanges or marketplaces, and that CRNAs have the opportunity to participate in exchange governance.
To view the CMS Open Door Forum page for call and registration details, visit (registration is required). To view information on states that elected to run their own State Based Marketplace, visit See who will be running the health coverage marketplace in your state at
AANA Increasing Visibility Before the Nation’s Governors
Beginning this April, the AANA is taking action to increase our profession’s visibility before national associations of governors in support of our coordinated efforts to strengthen state government affairs and the work of our state associations.
Approved by the AANA Board of Directors for FY 2013, the AANA Federal Government Affairs staff team is representing AANA members at forums bringing together state governors through the Republican Governors Association and the Democratic Governors Association, both based in Washington, D.C. The AANA continues to favor neither party and to bring the voice of nurse anesthetists to the table for the advancement of the nurse anesthesia profession and patient care.
State Associations Served by Noridian Medicare Are Encouraged to Comment for Coverage of Post-Operative Blocks 
The AANA and CRNAs continue working to protect Medicare patient access to post-operative pain care in states served by the Noridian Medicare Administrative Contractor (Noridian Medicare MAC), offering CRNAs an opportunity to take positive action.
During the week of April 22, State Reimbursement Specialists (SRSs) and State Presidents from the Noridian Medicare Administrative Contractor (MAC) region and AANA Region 4 Director Bernadette Henrichs, CRNA, PhD, CCRN, met via phone to discuss the draft local coverage determination (LCD) titled “Nerve Blockade: Somatic, Selective Nerve Root and Epidural.” Contrary to current coverage rules, the draft LCD states in part that “providers should not expect separate payment for the establishment of epidural or other pain blocks unless the block is placed following discharge from PACU due to documented inadequate pain control.” Noridian Medicare administers Medicare Part B claims in the states of Alaska, Ariz., Idaho, Mont., N.D., Ore., S.D., Utah, Wash. and Wyo.
However, Noridian Medicare received strong and immediate feedback from the AANA related to the negative impact of this proposed LCD on patient care and patient pain control. The AANA and state nurse anesthesia associations have contacted Noridian to express these concerns, and Noridian replied by pointing to current Medicare payment policy that does authorize coverage of CRNA post-operative pain blocks when their need is documented by the surgeon and by the CRNA.
By rule, though, Noridian Medicare is restricted from altering the draft LCD until the comment period on the draft ends July 11. The AANA is encouraging all state associations affected by this LCD to prepare to join the AANA in providing written comments opposing restrictions on CRNA patient care and supporting an appropriate patient-centered alternative, and will be providing further guidance to our State Reimbursement Specialists in doing so.

Finance Committee Chairman Baucus Declines to Run for Re-election in 2014, Will Retire at End of His Term
Senate Finance Committee Chairman Max Baucus (D-MT) is planning to retire from Congress at the end of his term, and not run for re-election in 2014, according to numerous April 23 news reports. Baucus, the 2008 winner of the AANA’s National Health Leadership Award and broadly influential in the development and oversight of the Medicare program and the Affordable Care Act, would have been running for his seventh term in the Senate. Candidates for the Senate seat in red Montana include popular two-term Gov. Brian Schweitzer (D-MT) on the Democratic side and several Republicans, including state Rep. Champ Edmunds (R-MT) and former state Sen. Corey Stapleton (R-MT). Read more in the Washington Post.
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.


Using Nitrous Oxide for Anesthesia Doesn't Increase—And May Decrease—Complications and Death, Studies Suggest
A couple of new studies appear to contradict earlier research that draws a correlation between negative outcomes and the use of nitrous oxide (N2O) as an anesthetic agent in some surgeries. Although N2O was shown to be effective for sedation and pain control, the existing study—known as ENIGMA-1—reported greater risk of heart attack in patients when it was included as part of the anesthesia regimen in noncardiac procedures. A recent data analysis by Australian investigators, however, found that the rate of serious complications or death following surgery was similar among patients who received N2O and those who did not. Meanwhile, a second, larger review of nearly 50,000 patients having noncardiac surgery between 2005 and 2009 suggests that N20 actually lowers the risk of post-operative mortality and complications by a significant margin. The Cleveland Clinic research, along with the study from Royal Melbourne Hospital in Australia, appears in the May issue of Anesthesia & Analgesia. Despite the promising results, experts not involved in the new studies point to several limitations of the work—including that neither study was a randomized trial, which is the strongest form of scientific evidence.
From "Using Nitrous Oxide for Anesthesia Doesn't Increase—And May Decrease—Complications and Death, Studies Suggest"
Science Daily (04/22/2013)

Evaluation of Propofol Anesthesia in Morbidly Obese Children and Adolescents
The results of a new study suggest that propofol requirements for morbidly obese (MO) children and adolescents may be overestimated, reflecting the challenges of the use of clinically titrated propofol total intravenous anesthesia (TIVA) in this population. The study included 20 MO children and adolescents, ages nine to 18 years, who were undergoing laparoscopic surgery with clinically titrated propofol TIVA. The investigators recorded propofol doses/infusion rates, hemodynamic variables, times to induction and emergence, and postoperative occurrence of respiratory adverse events (RAEs). According to the data, the patients consistently showed delayed emergence, increased somnolence in the first 30 minutes of anesthesia recovery, and a 30 percent incidence of postoperative RAE. The researchers suggest that, in this setting, it may be best to titrate propofol to targeted Bispectral Index/BIS levels until more accurate weight-appropriate dosing regimens can be developed.
From "Evaluation of Propofol Anesthesia in Morbidly Obese Children and Adolescents"
7thSpace (04/21/13)

Anesthesia Increases Success Rates of Turning Breech Babies, Reduces Delivery Costs, Study Finds
While earlier studies have confirmed that spinal or epidural anesthesia is beneficial when turning a breech baby into the head-down position, many obstetricians still avoid this approach—likely because they believe it will inflate costs. However, new research shows that using anesthesia during what is known as an external cephalic version—or simply, version—actually saves money because it increases the success rate of the procedure and avoids cesarean delivery. The finding, published online in Anesthesia & Analgesia, is based on the results of a mathematical model that factored in previously documented version success rates with and without anesthesia, national data on the cost of the procedure with and without anesthesia, and the costs of cesarean and vaginal deliveries. Using anesthesia was found to improve the average success rate of versions by 22 percent to a success rate of 60 percent. The reduction in C-sections meant that the use of anesthesia decreased the total cost of delivery by an average of $276; however, the researchers determined that the success rate of versions with anesthesia had to be improved by at least 11 percent over versions without for the cost of the anesthesia to be cancelled out completely. Lead author Dr. Brendan Carvalho, associate professor of anesthesia at Stanford University and chief of obstetric anesthesia at Lucile Packard Children's Hospital, said the relaxation of abdominal muscles caused by the anesthesia likely contributes to higher success rates for version procedures, as clinicians may not need to apply as much pressure to turn the baby.
From "Anesthesia Increases Success Rates of Turning Breech Babies, Reduces Delivery Costs, Study Finds" (04/17/13) Digitale, Erin

Intracuff Monitoring Could Prevent Overinflation Injuries
Anesthesiologists Darwin Viernes, MD, and Aaron Joffe, DO, of the University of Washington set out to determine the extent to which overinflation of endotracheal tube cuffs and supraglottic airways are a problem and how to address the issue. Over three months early last year, they evaluated 290 patients undergoing general anesthesia and recorded the intracuff pressure (ICP) readings. Excessive pressure was defined as greater than 30 cm H2O for endotracheal tubes and greater than 60 cm H2O for supraglottic airways. The findings showed that, overall, ICP exceeded the cutoff for 61 percent of the tube airway pressure measurements taken. Viernes said one particular concern was that "nearly one out of four endotracheal tubes, 23 percent in our study, and nearly one out of three supraglottic airways, 30 percent, were inflated to twice the normal recommendations." Several factors could explain the overinflation, Viernes speculated, including the fact that "most providers do not use manometry to measure cuff pressure. Rather, they go by the 'feel' of the distension of the pilot tube." Overinflation also can occur when anesthesia providers, operating room nursing staff, or other clinicians are unaware of the risks associated with overinflation. Viernes suggested that overinflation could be reduced or eliminated if manometry was made standard practice. That strategy was tested by researchers at the University of Toronto's Department of Anesthesia, who found that the use of manometry led to a relative risk reduction of nearly 71 percent. Before this strategy can become widespread, however, Viernes said the issue of cost must be considered.
From "Intracuff Monitoring Could Prevent Overinflation Injuries"
Anesthesiology News (04/01/13) Vol. 39, No. 4 McNamara, Damian
NAPA: Use STOP-BANG Questionnaire for Sleep Apnea Screening
The STOP-BANG (snoring, tiredness, observed apnea, blood pressure, body mass index, age, neck circumference and gender) questionnaire can help anesthesia providers to effectively and consistently identify patients at risk of obstructive sleep apnea. According to a blog post from North American Partners in Anesthesia, clinicians can then avoid opioid treatments in vulnerable patients as well as take other patient-safety precautions. In tandem with the STOP-BANG questionnaire, the report recommends that anesthesia providers be sure to take into account co-existing diseases that could worsen co-morbidities.
From "NAPA: Use STOP-BANG Questionnaire for Sleep Apnea Screening"
Becker's Hospital Review (04/23/13) Linder, Heather
Study Suggests Dexmedetomidine Before Surgery Reduced Remifentanil-Induced Hyperalgesia
According to new research, co-treatment with dexmedetomidine alleviated the symptoms of surgical patients who experienced opioid-induced hyperalgesia (OIH) triggered by high doses of remifentanil administered as an adjunct to anesthesia and as a pain reliever. Lead author Kim Yeon-Dong, MD, a clinical professor of anesthesiology and pain medicine at Wonkwang University Hospital in South Korea, said OIH typically is characterized by "a decreased mechanical hyperalgesia threshold, enhanced pain intensity, shorter time to first postoperative analgesic requirement and greater morphine consumption." The research was performed on 90 patients who underwent laparoscopically assisted vaginal hysterectomy and received a remifentanil infusion. Those patients treated with dexmedetomidine reported less pain and fewer adverse opioid-related effects, used less post-surgical morphine, and went longer before requesting medication for pain relief than patients treated with placebo. According to Kim, patients who are hospitalized for painful conditions or procedures and who have not responded to traditional opioid medication could benefit from treatment with alpha-2 agonists like dexmedetomidine. The study findings were presented at the 29th Annual Meeting of the American Academy of Pain Medicine.
From "Study Suggests Dexmedetomidine Before Surgery Reduced Remifentanil-Induced Hyperalgesia"
RedOrbit (04/12/13)

Haptic Simulator Helps With Epidural Training
In the United Kingdom, medical professionals have teamed up with engineering students to develop a simulator that could help anesthesia providers deliver epidurals with better results and fewer complications. A haptic needle injection device is used in conjunction with a 3D interactive model of the spine—including 26 different vertebrae—and an immersive 3D monitor that shows visualization from different angles. Users can adjust for different heights, body mass indexes, angles, and rotations of the spine. "A high fidelity epidural simulator will help to reduce the learning curve and thereby improve the success of epidurals whilst reducing potential harm to the mothers," said Dr. Michael Wee of Poole Hospital, one of the developers. The project—currently in clinical trials on patients—has attracted global attention and is already on the short list for several awards, including the National Patient Safety Awards 2013.
From "Haptic Simulator Helps With Epidural Training"
The Engineer (United Kingdom) (04/23/13)

A Randomized Controlled Trial Comparing a Multimodal Intervention and Standard Obstetrics Care for Low Back and Pelvic Pain in Pregnancy
A prospective, randomized trial of 169 women was performed to determine whether a multimodal approach of musculoskeletal and obstetric management (MOM) offered a better outcome than standard obstetric care in terms of reducing low back and pelvic pain, impairment and disability in the antepartum period. Baseline assessment occurred at 24 to 28 weeks' gestation, with follow-up at 33 weeks' gestation. Primary results were the Numerical Rating Scale (NRS) for pain and the Quebec Disability Questionnaire (QDQ). Routine obstetric care was provided to both groups, and chiropractic specialists delivered manual therapy, stabilization exercises and patient education to MOM participants. Substantial mean reductions in NRS and QDQ scores were demonstrated in the MOM group, from baseline to follow-up evaluation. No significant improvements were observed in the group that received standard obstetric care.
From "A Randomized Controlled Trial Comparing a Multimodal Intervention and Standard Obstetrics Care for Low Back and Pelvic Pain in Pregnancy"
American Journal of Obstetrics and Gynecology (04/01/2013) Vol. 208, No. 4, P. 295.e1 George, James W.; Skaggs, Clayton D.; Thompson, Paul A.; et al.
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