Anesthesia E-ssential April 30, 2014

Anesthesia E-ssential

April 30, 2014


Board of Directors Update

Vote Now!
The AANA Board of Directors is excited to announce the start of the 2014 AANA Election. Voting started April 22 and runs through May 20. This is an opportunity for AANA members to exercise their right to choose the leaders and direction of their association.
By now, you should have received your ballot materials, including election passcode 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 vote online and view candidates’ biographical information and position statements, visit the election site at enter your member number and the election passcode provided to you by SBS.
If you do not have your election login information, click on the “Email my login information?” link on the login page. SBS can be reached by phone at (952) 974-2339 (Monday through Friday, 8 a.m. to 5 p.m. CDT) 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.
To View Board Candidates’ Video Speeches
Board candidates’ speeches presented at the April Mid-Year Assembly are available here on the AANA website. (AANA member login and password required.)
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 March, this un-moderated forum is located in the members-only section of the AANA website at The forum will be available until May 20 (the voting cut-off date).


The Pulse

  • FDA Requires Label Changes to Warn of Rare but Serious Neurologic Problems after Epidural Corticosteroid Injections for Pain
  • Online Forum for Board of Directors Candidates Open Now
  • Interested in Serving on a Committee This Year?
  • USA Today Addresses Drug Diversion Issue


State Government Affairs
  • Massachusetts Governor Can't Ban New Painkiller
  • Court Restores South Carolina Certificate of Need Program Over Governor's Veto


Meetings and Workshops
  • Meet Your Educational Needs
  • Earn up to 28 Continuing Education Credits in Orlando at the AANA 2014 Nurse Anesthesia Annual Congress
  • Spend the weekend in Chicago at the AANA Business of Anesthesia Conference
  • Save $50 by registering today for the Upper and Lower Extremity Nerve Block Workshop
  • Save the Date for the AANA’s Fall Leadership Academy 


  • Friends for Life Deadline -- July 15, 2014
  • Orlando -- The Stars Come Out Again -- Register Now and Last Call for Talent Applications
  • 900 AANA Members Speak Out for CRNA Practice at Mid-Year Assembly
  • VHA Process for Recognizing CRNAs to their Full Practice Authority Affirmed by Key House Panel
  • Medicare Posts Part B Providers’ 2012 Aggregate Billing Data, Including That of CRNAs
  • Health Secretary Sebelius Resigns; President Obama to Nominate OMB’s Burwell
  • U.S. Senators Support AANA Request for Nurse Workforce Development Funding
  • Know Your Strength: See Your 2013 CRNA-PAC Annual Report
  • Medicare Agency Proposes Rules on Fire Safety

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
FDA Requires Label Changes to Warn of Rare but Serious Neurologic Problems after Epidural Corticosteroid Injections for Pain
The U.S. Food and Drug Administration (FDA) is warning that injection of corticosteroids into the epidural space of the spine may result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death. The injections are given to treat neck and back pain, and radiating pain in the arms and legs. The FDA is requiring the addition of a Warning to the drug labels of injectable corticosteroids to describe these risks. Healthcare professionals should discuss the benefits and risks of epidural corticosteroid injections with their patients and advise patients to seek emergency medical attention immediately if they experience symptoms after receiving an epidural corticosteroid injection, such as loss of vision or vision changes; tingling in their arms or legs; sudden weakness or numbness in their face, arm, or leg on one or both sides of the body; dizziness; severe headache; or seizures. Read the FDA Drug Safety Alert for more information.


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 March, this un-moderated forum is located in the members-only section of the AANA website at The forum will be available until May 20 (the voting cut-off date).


Interested in Serving on a Committee in the Coming Year?
President-elect Sharon Pearce, CRNA, MSN, is looking for CRNAs and SRNAs who are interested in serving on an AANA committee during Fiscal Year 2015. (See AANA March NewsBulletin, page 10.) Application deadline is May 15, 2014.
CRNA information and the submission form may be found here. SRNA information and submission form may be found here.
USA Today Addresses Drug Diversion Issue
An article titled “Doctors, Medical Staff on Drugs Put Patients at Risk” was published in USA Today’s print and online editions April 16, 2014. The impetus for the article was the recently formed Drug Diversion Prevention Committee’s (DDPC) work to bring awareness to the topic with the goal for broad-based nationwide improvements in preventing diversion. Learn more.


State Government Affairs

Massachusetts Governor Can't Ban New Painkiller
On March 27, Massachusetts Governor Deval Patrick issued an executive order banning the dispensing or prescribing of the new painkiller Zohydro, stating concerns that the drug’s availability could exacerbate prescription drug abuse problems. On April 15, a federal judge overturned the order, saying that the governor’s ban of a drug that has been declared safe by the FDA is unconstitutional. The governor responded that the ruling places commercial interests over public health, while the chief executive of the company that manufactures the drug said that they “invite concerned officials to engage with us to discuss fair and appropriate safeguards for pain medications … rather than seeking to ban or restrict one specific treatment.”
Court Restores South Carolina Certificate of Need Program Over Governor’s Veto
South Carolina Governor Nikki Haley’s attempt to eradicate the state’s Certificate of Need (CON) requirement by using a line item budget veto has been rejected by the South Carolina Supreme Court. While state law requires a CON for hospitals and other healthcare facilities to build or expand, the governor attempted to wipe out the portion of the budget of the Department of Health and Environmental Control used for issuing and enforcing the CONs, rendering the law effectively moot. The court ruled that a governor’s veto cannot act to rescind an existing state law; only an act of the legislature can do so.


Meetings and Workshops

Meet Your Educational Needs
AANA has meetings and workshops designed to meet your educational needs. Click here to find out more.
Earn up to 28 Continuing Education Credits in Orlando at the AANA 2014 Nurse Anesthesia Annual Congress
The nurse anesthesia field is rapidly changing and the 2014 AANA Nurse Anesthesia Annual Congress offers CRNAs and SRNAs comprehensive sessions focusing on pediatrics, pharmacology, crisis management, rare complications, and the latest hands-on techniques. Join us in Orlando. Register today.
Spend the Weekend in Chicago at the AANA 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 in the heart of downtown Chicago 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.
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.
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.


Friends for Life Deadline – June 15, 2014
Friends for Life 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 AANA Annual Congress Opening Ceremonies, an engraved plaque in the AANA Park Ridge office, and an invitation to the Annual Awards and Recognition Event.
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.comThe Friends for Life submission deadline for recognition at this year’s Annual Congress in Orlando, Fla., is June 15, 2014.
Orlando – The Stars Come Out Again
Register Now and Last Call for Talent Applications
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.
Last call for talent…so submit a Talent Application today. The deadline is May 1, 2014. Click here to visit our event webpage, learn more about the event, and access the application.
If you have any questions, please contact Luanne Irvin at the AANA Foundation at (847) 655-1173 or

900 AANA Members Speak Out for CRNA Practice at Mid-Year Assembly
A record 900 AANA members learned about CRNA issues and principles of professional advocacy then took what they learned to the offices of their members of Congress on Capitol Hill April 8-9. Thousands more AANA members had their voices heard on Capitol Hill through participation in the AANA’s “Virtual Mid-Year Assembly” advocacy campaign online.
Several prominent speakers gave talks at Mid-Year Assembly. The Leapfrog Group’s Leah Binder discussed the future of transparency and public reporting in healthcare reform. George Washington University’s David Rehr outlined effective advocacy methods. Medicare Chief Deputy Administrator Jonathan Blum examined delivery system reform and quality improvement. The Cook Political Report’s Amy Walter described the political outlook, and AANA elected leadership and staff reviewed key CRNA issues. At the end of the conference, AANA members brought important CRNA issues to legislators. Those issues included supporting Veterans Health Administration (VHA) recognition of CRNAs and other APRNs to their full practice, encouraging strong implementation of the provider nondiscrimination law that advances competition and consumer choice, urging Congress to enact permanent relief from debilitating “sustainable growth rate” Medicare cuts, and backing nurse workforce development appropriations.
AANA members also heard from two leading members of Congress: AANA National Health Policy Leadership Award-winner Rep. David Joyce (R-OH), and Rep. Jan Schakowsky (D-IL), the hometown representative for AANA’s Park Ridge headquarters who is also a member of the House Democratic Leadership. The winner of the Daniel D. Vigness Federal Political Director Award, Andy Griffin, CRNA, PhD, of Illinois, had a video presentation in his honor delivered by Rep. Rodney Davis (R-IL).
Mid-Year Assembly attendees should be sure to complete their lobby reports online and post their best pictures on Facebook and Twitter with hashtags #AANA #CRNA and #safeanesthesia. Email your best pictures to with the names of people in each photo listed left to right.
VHA Process for Recognizing CRNAs to their Full Practice Authority Affirmed by Key House Panel
The Veterans Health Administration’s (VHA’s) process for recognizing CRNAs and other advanced practice registered nurses (APRNs) to their full practice authority was affirmed in advisory report language adopted by the House Appropriations Committee April 9, with the involvement and participation of the AANA and CRNAs.
Reps. John Culberson (R-TX) and Sanford Bishop (D-GA) offered the report language provision as part of a “manager’s amendment” to the FY 2015 Military Construction and Veterans Affairs Appropriations bill (not yet numbered).  The language states: “ The Committee understands that the VHA Nursing Handbook is currently under review. The Committee encourages the VHA to seek input from internal VA program offices and external professional stakeholders, prior to possible regulatory action and submission to the Under Secretary for Health for final approval. The Committee believes all possible outreach efforts should be used to communicate the proposed changes, to gather public comment, and to collaborate with Congress, stakeholders, VA nursing staff, and external organizations. Finally, the Committee requests that the VHA ensure that any changes to handbooks within the VHA do not conflict with other handbooks already in place within the VHA.”
Already, the VHA is considering the views of internal and external stakeholders. Moreover, the recommendation to recognize CRNAs and other APRNs as full practice providers does not conflict with the VHA anesthesia handbook or any other handbook.
Medicare Posts Part B Providers’ 2012 Aggregate Billing Data, Including That of CRNAs
Thanks to a historic public information release from the Centers for Medicare & Medicaid Services (CMS) April 9, aggregate data showing how CRNA services are billed and for how much is now available publicly for the first time for CRNA and other Part B provider services performed during the year 2012, representing a significant advancement toward greater public transparency of price, cost, and quality information for America’s $2.9 trillion healthcare system.
From the $77 billion that Medicare paid for Part B services in 2012, the data show:
  • Anesthesiologists billed Medicare for twice as many services per patient as CRNAs did.
  • The amounts that providers charged Medicare were about seven times what Medicare paid according to its fixed fee schedule.
  • As a share of overall anesthesia professional compensation reported through surveys, Medicare payments represent less than 10 percent of overall pay for an average CRNA or anesthesiologist, even though Medicare patients represent about a third of anesthesia cases.
Health Secretary Sebelius Resigns; President Obama to Nominate OMB’s Burwell
Health and Human Services secretary Kathleen Sebelius submitted her resignation to President Obama April 11, who said he would nominate Sylvia Mathews Burwell, director of the White House Office of Management and Budget (OMB), to succeed Sebelius.
Sebelius served as HHS secretary for nearly five years and was tasked with advocating for and then implementing the Affordable Care Act. Of particular interest to CRNAs, Sebelius was a two-term Kansas governor who opted out of the Medicare physician supervision requirement for CRNAs in 2003.
Burwell was unanimously confirmed as head of OMB a year ago, following a decade of service with the Bill & Melinda Gates Foundation and the Walmart Foundation. She served in the Clinton Administration with the Council of Economic Advisors and as chief of staff to Treasury Secretary Robert Rubin. Originally from Hinton, W.V., where her mother served as mayor for a time, she has a close familial link to healthcare in that her father is a retired optometrist.
The HHS secretary requires Senate confirmation; Burwell will serve in an acting role for a time pending her confirmation later this spring.
See the President’s statement announcing Sec. Sebelius’ resignation and Ms. Mathews’ nomination at
U.S. Senators Support AANA Request for Nurse Workforce Development Funding
The AANA’s request for $251 million in Title 8 nurse workforce development funding has been backed by the voice of some 29 U.S. Senators in a letter dated April 4.
“We respectfully request that the Nurse Workforce Development Programs receive $251 million in Fiscal Year 2015 through the Labor, Health and Human Services and Related Agencies appropriations bill,” stated the letter signed by Sens. Jeff Merkley (D-OR), Brian Schatz (D-HI), and 27 others. “An investment in our nursing workforce today is a commitment to America’s healthcare now and into the future.”
Know Your Strength: See Your 2013 CRNA-PAC Annual Report
With the CRNA-PAC’s new 2014 development campaign getting under way, AANA members want to know: What is the CRNA-PAC exactly, why is it important, what has it been doing, and why should I support it with my voluntary contribution?
All of these important member questions and more are answered in the new CRNA-PAC 2013 Annual Report, published by the AANA and the CRNA-PAC Committee and available to AANA members online. To read it yourself, click here.
Medicare Agency Proposes Rules on Fire Safety
On April 16, the Centers for Medicare and Medicaid Services (CMS) proposed rules on fire safety requirements for certain healthcare facilities. CMS issued this proposed rule to adopt the 2012 editions of the Life Safety Code (LSC) and Health Care Facilities Code developed by the National Fire Protection Association (NFPA), though with some exceptions including those for anesthetizing locations. Under the ambulatory surgical services Conditions of Coverage for the environment and the CAH and hospital Conditions of Participation (CoPs) for physical environment, CMS is proposing that in windowless anesthetizing locations, the facility “must have a supply and exhaust system that i) automatically vents smoke and products of combustion, ii) prevents recirculation of smoke originating within the surgical suite, and iii) prevents the circulation of smoke entering the system intake.”
Requirements related to anesthesia that are in the 2012 edition of the Health Care Facilities Code, which CMS is proposing to adopt include:
  • Administration of Electric System (p. 21,560): Where hospital-grade receptacles are required at patient bed locations and in locations where deep sedation or general anesthesia is administered, testing must be performed after initial installation, replacement, or servicing of the device. Receptacles not listed as hospital-grade must be tested in intervals not exceeding 12 months.
  • Waste Gas (p. 21,561): Requires the removal of gases vented from the patient breathing circuit during the normal operation of gas anesthesia or analgesia equipment by a waste anesthetic gas disposal (WAGD) system or by an active or passive scavenging ventilation system.
The proposed rule is under review by the AANA, and is subject to comment by June 16. 
The following is an 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.

Featured Career Opportunities
CRNA - Western Maine Health
Norway, ME
We have an opening for a full-time CRNA to complement our team of dedicated and friendly professionals at Stephens Memorial Hospital. No call, no weekends.
Read more about this position (URL):
Visit the CRNA Career Center

FDA Panel Gives Combo Opioid Thumbs Down
A panel of the Food and Drug Administration (FDA) has declined to support an application for the use of Moxduo, a combination capsule of morphine sulfate and oxycodone, to treat moderate to severe acute pain. Manufacturer QRxPharma had presented research findings that it said proved the drug consistently lowered the rate and occurrence of more severe cases of hypoxia, or deep oxygen desaturations. However, the 14 voting members of FDA's Anesthetic and Analgesic Drug Products Advisory Committee concurred that the study failed to show Moxduo as safer than morphine and/or oxycodone used alone at similar doses. Panel chairman Randall Flick, MD, an associate professor of anesthesiology at the Mayo Clinic Children's Center, said the study design was flawed and recommended "more appropriately designed studies."
From "FDA Panel Gives Combo Opioid Thumbs Down"
Medscape (04/23/14) Anderson, Pauline
IV-Administered Ketamine Effective in Patients With Chronic PTSD
A double-blind crossover study, published online in JAMA Psychiatry, concluded that a single dose of intravenous ketamine was associated with the rapid reduction of symptoms in patients diagnosed with chronic post-traumatic stress disorder (PTSD). For two weeks before they were randomized to receive either a single IV infusion of ketamine hydrochloride or midazolam administered over 40 minutes, all study participants were free of concomitant psychotropic medications. The order of the injections, which were administered two weeks apart in sub-anesthetic doses, was randomly assigned. The primary outcome was PTSD symptom severity 24 hours after infusion, which researchers assessed using the Impact of Event Scale—Revised (IES-R). They found that total IES-R scores 24 hours after infusion showed significant improvement with ketamine compared to midazolam. Additionally, seven patients randomly assigned to ketamine first experienced symptoms that remained significantly reduced two weeks after the infusion period, while the same was true of only patient who had first been assigned to receive midazolam. The study, undertaken by researchers at the Icahn School of Medicine at Mount Sinai in New York City, could be the first step toward developing new interventions for PTSD. However, emphasized lead study author Adriana Feder, MD, longer-term clinical trials are needed.
From "IV-Administered Ketamine Effective in Patients With Chronic PTSD" (04/21/2014)
Block Nurses Improve RA Care
Hospitals nationwide are beginning to embrace the concept of block nursing both as a tool for enhanced patient care and satisfaction and as a way to streamline the process of providing regional anesthesia. Block nurses have numerous responsibilities before, during, and after a surgery in which a nerve block has been used. In addition to setting up the room and equipment, it is their job to educate patients about the procedure. They also position patients for the block, connect them to monitoring equipment, and complete the time-out procedure with the full block team. Following placement of the block, the block nurse monitors oxygen saturation, respiratory rate, and sedation level and also assesses the block for any abnormalities, which are reported to the anesthesia provider if needed. Post-surgery, he or she is then in charge of clearing the area and preparing it for the next patient. "In addition to expertise at administering meds, monitoring vitals and troubleshooting acute care problems, nurses are often much more skilled than doctors at listening and responding to patients' questions, and taking time to explain exactly what to expect," says Jeff Gadsen, MD, director of regional anesthesia at St. Luke's-Roosevelt Hospital in New York City.
From "Block Nurses Improve RA Care"
Anesthesiology News (04/01/14) Vol. 40, No. 4 Vlessides, Michael
Magnetic Anesthesia: Delivering Nerve Blocks Locally With a Targeted Approach
A report appearing in Anesthesia & Analgesia details a proof-of-concept rat study showing that magnetic nanoparticles may be used to target delivery of the anesthetic ropivacaine. The team from the University of Pittsburgh injected the animals with iron oxide nanoparticles and used magnets attached to their ankles to attract the nanoparticles to the area, effectively numbing the nerves in that specific location without affecting the other paw. The study results suggest that a higher dose of ropivacaine could be used if it was able to be targeted in this way. For the study, a dosage that could have been fatal for the rats was administered; but with the targeting system, none of the rodents presented any adverse effects from the 14-fold dose increase. Additional animal testing is planned to prove the safety of this procedure before moving on to trials in humans.
From "Magnetic Anesthesia: Delivering Nerve Blocks Locally With a Targeted Approach"
Fierce Drug Delivery (04/16/14) Gibney, Michael
Children's Pain Undertreated in Hospital ERs, Research Suggests
Hospital emergency departments may not be doing enough to help children in pain, new research suggests. A survey conducted in nurse managers and medical directors from 72 hospitals in Alberta found major deficiencies in assessing and treating pain in emergency pediatric patients. There were inconsistent standards in routine procedures, such as prepping for an IV insertion or performing a spinal tap. Topical anesthetics on the skin are widely recommended before performing such procedures on children, but they were used in only 70 percent of IV insertions and 30 percent of spinal taps. In addition, although the American Academy of Pediatrics recommends the use of sugar water for children under six months of age, this method was consistently used less than 5 percent of the time for procedures such as lumbar puncture and urinary catheterization. According to researcher Dr. Samina Ali of the University of Alberta, parents should trust their gut instincts when it comes to their kids' pain. They can advocate for their children by asking for pain medications or by distracting their children with music or games during a painful procedure.
From "Children's Pain Undertreated in Hospital ERs, Research Suggests"
Toronto Globe & Mail (Canada) (04/15/14) Pearce, Tralee

A Supplemental Sedative Can Reduce Anesthesia Amounts
Research shows that when patients had their anesthesia supplemented with dexmedetomidine, they required less remifentanil or propofol for their surgery. For the randomized study, reported in Anesthesia & Analgesia, 60 patients received their sedative either with a supplement of dexmedetomidine or with a placebo. Those given propofol and the additional sedative needed about 30 percent less sedative to achieve induction and anesthesia maintenance, while those who were given supplemented remifentanil needed about 25 percent less for induction but about the same amount for maintenance. The effects of administering the supplement were noticeable into recovery, as those patients who had their anesthesia supplemented with dexmedetomidine experienced significantly longer post-operative analgesia than those who had received the placebo.
From "A Supplemental Sedative Can Reduce Anesthesia Amounts"
Outpatient Surgery (04/14/14) Burger, Jim
Surge in Narcotic Prescriptions for Pregnant Women
According to a study that was recently published in Obstetrics & Gynecology, nearly 23 percent of the 1.1 million pregnant women enrolled in Medicaid nationally filled an opioid prescription in 2007—a jump from 18.5 percent in 2000. Another study published in Anesthesiology in February found that while the share of expectant mothers who were prescribed opioids dipped slightly from 2005 to 2011, that percentage was greater than 12 percent for each of those years. Some doctors and scientists have expressed concern that recent research has shown a correlation between the use of opioids by women in the first trimester of pregnancy and the occurrence of neural tube defects in their offspring. A study published in JAMA in 2012 showed that "neonatal abstinence syndrome," in which the baby becomes addicted to an opioid used by its mother for a prolonged period at the end of gestation, is occurring more frequently. Although pregnancy has always involved a level of discomfort for mothers, Dr. Cresta Jones, an assistant professor of maternal-fetal medicine at the Medical College of Wisconsin, said that in the United States "it's taboo to tell a patient, 'It's normal for you to be uncomfortable in pregnancy'" as there is a "societal expectation" in this country that pain can be, and will be, immediately resolved.
From "Surge in Narcotic Prescriptions for Pregnant Women"
New York Times (NY) (04/13/14) Saint Louis, Catherine
Inpatients Account for Most Canceled Operating Room Time
Researchers investigating the causes behind frequent late changes in operating room schedules—within a day or two of planned procedures—discovered that hospitalized patients account for at least half of cancelled OR time. The study, led by Dr. Franklin Dexter from the University of Iowa's anesthesia department, compared cancelled OR time for inpatients versus outpatients. The results showed that inpatients accounted for at least half and as much as 70 percent of canceled OR time—significantly more than the amount of canceled outpatient minutes—with about half of the total inpatient canceled minutes stemming from cases scheduled within one workday before the surgery. Understanding the reasons behind OR cancellations is vital to efforts to improve the efficiency of OR scheduling—particularly for late cancellations, as these generally open up blocks of time that are unable to be rescheduled, resulting in significant costs and inefficiency. The researchers recommended that earlier preoperative assessments of hospitalized patients could be performed and that "statistical forecasts" could be used with OR schedules as a way to reduce the impact of cancellations.
From "Inpatients Account for Most Canceled Operating Room Time"
Newswise (04/11/14)
Ketamine Offers Opioid-Sparing in Pediatric Patients
Children undergoing scoliosis surgery may require less morphine if they also receive ketamine. A team of researchers from Keio University School of Medicine in Tokyo looked at 74 patients, ages seven to 19 years, who underwent scoliosis surgery with propofol and either low- or high-dose remifentanil. Patients also received IV morphine, and some also received a continuous infusion of ketamine at 1 mcg/kg per minute for 48 hours after surgery. The researchers report that patients were comparable regarding the duration of anesthesia and dose of propofol, but postoperative morphine consumption was significantly lower in patients who received ketamine and low-dose remifentanil. Experts who were not involved with the study note that the findings indicate that high-dose remifentanil increases postoperative morphine consumption, regardless of the use of ketamine.
From "Ketamine Offers Opioid-Sparing in Pediatric Patients"
Anesthesiology News (04/01/14) Vol. 40, No. 4 Vlessides, Michael
Dual Anesthetics Preferred by Most U.S. Dentist Anesthesiologists
Research on the blended use of general and local anesthesia in children is inconclusive, but some dentists prefer using the combined approach. A survey published in the journal Anesthesia Progress found a range of practices and motivations for anesthesia decisions. The survey found that 90 percent of responding dental anesthesia providers prefer the combined approach when treating some or most of their young patients, noting that the strategy makes it easier to stabilize children's vital signs while lowering the depth of general anesthesia. Children also experience less pain and recover more quickly with dual anesthetics, they say. Half of the providers said they decide on the approach based on the patient, and 40 percent supplement general with local anesthesia in all but a few cases. Local anesthesia is most often added when dentists were preparing to extract permanent or primary teeth. The survey authors noted that no prospective double-blind studies conclusively advocate either for or against the approach.
From "Dual Anesthetics Preferred by Most U.S. Dentist Anesthesiologists"
Dentistry IQ (04/08/2014)
Algorithm Aims for Safer, Smarter Codeine Use in Pediatric Patients
A new algorithm could help healthcare providers better determine which children can safely receive codeine. Clinicians at St. Jude Children's Research Hospital in Memphis created the algorithm to avoid administering codeine to pediatric patients whose livers convert codeine to morphine quickly enough to be fatal. Before ordering codeine, the hospital's electronic health records system prompts doctors to request CYP2D6 genotyping, which has been shown to distinguish ultra-rapid or poor metabolizers from other patients. If there is no genotype on file, the algorithm reminds physicians to order a test and suggests other analgesics to use instead. Kristine Crews, PharmD, co-director of the pharmacokinetics research center at St. Jude, said that about 10 percent of patients are poor metabolizers and another 2 percent are ultra-rapid metabolizers.
From "Algorithm Aims for Safer, Smarter Codeine Use in Pediatric Patients"
Pain Medicine News (04/01/2014) Vol. 12, No. 4 Guarino, Ben
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