Anesthesia E-ssential, August 30, 2012

Anesthesia E-ssential

August 30, 2012 

Vital Signs

New Book Provides Guidance on Crises during Anesthesia Care
 
The ability to recognize, prevent when possible, and rapidly treat anesthetic complications and emergencies is essential for all anesthesia professionals. Available now through the AANA Bookstore, Critical Events in Anesthesia: A Clinical Guide for Nurse Anesthetists, by Sass Elisha, CRNA, EdD; Mark Gabot, CRNA, MSN; and Jeremy Heiner, CRNA, MSN, is an indispensable, pocket-sized reference on anesthetic emergencies for practicing clinicians, educators, and learners.
 
Featuring an easy-to-read, uniform, and concise outline format, each chapter of Critical Events in Anesthesia is divided into the following topic areas: treatment, physiology and pathophysiology, signs and symptoms, differential diagnosis, and suggested readings.
 
The book costs $37.50 plus shipping and handling. Dimensions: 5" x 7.5," 225 pages. To order: Visit www.aana.com/aanabookstore; call (847) 692-7050, ext. 8792; or fax: (847) 692-2051. Published by AANA.
 
 

 

The Pulse

 
  • 2012 Compensation and Benefits Report Available!
  • Updated "Certified Registered Nurse Anesthetists at a Glance" Document Available on Website
  • Hands-On Wokrshop on Peripheral Nerve Blocks/Ultrasound Guidance Coming to Detroit
  • New AANALearn Course - Perioperative Neuromuscular Blockade - Time for Another Look
  • HVO Offers Volunteer Opportunities for CRNAs
  • Thanks to All Blood Drive Participants
  • 2012 Wellness Walk/Run News
  • Last Call - Volunteers Sought for Professional Delegation to Cuba
  • AANA Exhibits at NCSL Conference
 
  • The Joint Commission Issues New Sentinel Event Alert: Safe Use of Opioids in Hospitals
  • FDA Warns of Risk of Death with Post-op Codeine in Children
 
  • AANA Journal Now Available as Digital Edition
  •  
  • AANA Members Take Action to Protect My Pain Care - With Just A Few Days Remaining, You Can Too
  • Tips on Sending Your Pain Care Comments Now - and Those of Your Colleagues and Friends
  • Nine in 10 Americans Say Protect CRNA Pain Care
  • GAO Lauds AANA-Backed "One and Only Campaign" in Report on Safe Injection Practices
  • AANA Delegation Represents Profession at Republican National Convention this Week, and Next Week at Democratic National Convention in Charlotte
  • ICD-10 Final Rule Submitted to WHite House for OK
  • Six-Month Spending Extension to Flat-Fund Several Health Programs through March 2013
  • FEC REQUIRED LEGAL DISCLAIMER FOR CRNA-PAC
 
 

Healthcare Headlines

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

 
 
Inside the Association
2012 Compensation and Benefits Report Available!
This one-of-a-kind AANA report contains comprehensive data collected during March-April 2012 from the 2011 CRNA Compensation and Benefits Survey. CRNAs and employers of CRNAs will find the information contained in the 119-page report to be of particular value. Check it out in the AANA Marketplace.
 
Updated "Certified Registered Nurse Anesthetists at a Glance" Document Available on Website
Whenever you need correct, concise, and up-to-the minute facts and figures about the nurse anesthesia profession, you can refer to "Certified Registered Nurse Anesthetists at a Glance" on the AANA website. This document is continually updated with the latest information.
 

Hands-On Workshop on Peripheral Nerve Blocks/Ultrasound Guidance Coming to Detroit
Don’t miss your opportunity to attend a brand new, two-day, hands-on workshop! This is the inaugural course and it will be held at the Greektown Casino Hotel in Detroit, Mich., Saturday and Sunday, Sept. 22-23, 2012. The program offers the basics of peripheral nerve blocks on the first day and then builds on that material to provide hands-on ultrasound guidance training the following day. Included in the cost of the workshop is a comprehensive instructional manual that attendees will not only find helpful during the workshop but also useful when they return to their practice.


Day 1 includes:

  • The review of local anesthetic mechanisms
  • Nerve physiology and stimulation guidance for localization
  • Indications, techniques and complication for approximately 20 different blocks!
 
Day 2 includes:
  • Ultrasound imaging and techniques for peripheral line, central line and arterial line placement
  • Ten of the common regional blocks
  • Indwelling catheter placement
  • Additional imaging and techniques such as the use of ultrasound to detect pneumothorax (content not typically found in other ultrasound courses.)
 
Your tuition includes a beautiful venue with continental breakfast each day, a comprehensive course book for future reference and lecture and hands-on training by experienced CRNAs who practice what they teach. While each day of our two-day course can be taken separately, attending both days provides for the most comprehensive educational experience to translate what you learn into your daily practice.
 

Space is limited so visit the AANA website soon for more details and registration information.

 

New AANALearn® Course - Perioperative Neuromuscular Blockade - Time for Another Look
For the first time, the AANA broadcast two General Sessions presented at the 2012 Annual Meeting in San Francisco. Hundreds of CRNAs registered to view the sessions from their own home or work place. Now, everyone is able to access these recorded sessions for free!

To view the sessions, visit www.prolibraries.com/aana/registration

If you already registered, enter your email address and password. If you have not previously registered, click the link to register and then use your email address and your password to enter the sessions. There is no charge for viewing this content*.

Two CE credits with pharmacology credit are available by purchasing the entire program in the AANALearn® system. The CE credits will be awarded upon completion of the course examination (20 questions with three opportunities to pass) and the course evaluation. The course is being provided at a much-reduced rate for members - $28 for this two-CE-credit course. (Regular price would be $70.)

Check out the Sales Catalog now at www.aanalearn.com

*This educational activity received support from an unrestricted educational grant from Merck, and Co, Inc. The AANA was fully responsible for control, planning, and review of the presentations to assure content integrity.

HVO Offers Volunteer Opportunities for CRNAs
Health Volunteers Overseas (HVO) needs CRNAs and MDs to provide clinical and didactic training to students participating in the Master's of Nurse Anesthesia program in Addis Ababa, Ethiopia. There is an urgent need for September 21 – October 7, 2012. CRNAs and MDs are also needed for one-month assignments in November and December 2012 to provide continuing education and training to local anesthesia providers in Bhutan. Other volunteering opportunities are available in 2013. Contact the HVO program department for more information.

Thanks to All Blood Drive Participants
The second AANA Annual Meeting blood drive on Monday, Aug. 6 in San Francisco proved to be a resounding success. Thanks to all who participated: The Red Cross reported that 51 donors signed up to give blood, and 41 units of lifesaving blood were collected.

2012 Wellness Walk/Run News
The fun 5K at Annual Meeting in San Francisco was a spectacular event in every way. Check out the winners and also the link to participant photos! Thank you all and thanks to CNA’s sponsorship. News on the donation to Lifebox will follow.

Last Call - Volunteers Sought for Professional Delegation to Cuba
CRNA volunteers are invited to be part of a professional delegation of nurse anesthetists led by AANA immediate past president Debra Malina, CRNA, DNSc, MBA, who will travel to Cuba in October 2012 to conduct research. For further information, read the news story on the AANA website.
 
 

  
 
AANA Exhibits at NCSL Conference
The AANA welcomed more than 5,000 state legislators, legislative and executive agency staff, and representatives from trade and professional associations to its booth at the National Conference of State Legislatures (NCSL) Legislative Summit in Chicago, Ill., on Aug. 7-9. The 2012 meeting was an invaluable opportunity for local nurse anesthetists, student registered nurse anesthetists, and AANA state government affairs staff to visit informally with legislators and their staff from all 50 states. An estimated 20 percent of all state legislators attend the NCSL’s Legislative Summit.
 
 

 
 
The Joint Commission Issues New Sentinel Event Alert: Safe Use of Opioids in Hospitals
On Aug. 8, 2012, The Joint Commission issued a Sentinel Event Alert concerning the safe use of opioids in hospitals. The alert urges hospitals to take measures to prevent serious complications and deaths from opioid use and describes specific evidence-based actions to help avoid adverse events associated with opioid use. Read more about the alert here.
 
FDA Warns of Risk of Death with Post-op Codeine in Children
The Food and Drug Administration (FDA) warns of risk of death from codeine use in some children following surgeries. FDA officials urge providers to prescribe the lowest effective dose of codeine for the shortest time possible. Read the FDA’s Drug Safety Communication here.
 
 

 
 
AANA Journal Now Available as Digital Edition
Effective with the August issues, the AANA Journal is now available as a digital edition. Be sure to check out the Special Research Edition, as well!
 
 

 
 
 
AANA Members Take Action to Protect My Pain Care - With Just a Few Days Remaining, You Can Too
At the AANA Annual Meeting, hundreds of CRNAs and student registered nurse anesthetists visited our Federal Government Affairs / CRNA-PAC booth to join the association’s Protect My Pain Care campaign and submit comments to the Medicare agency supporting direct reimbursement of CRNA chronic pain management services.
 
Now that the San Francisco gathering is past, AANA members, friends and colleagues can continue to make their voices heard at the Medicare agency by clicking www.ProtectMyPainCare.com, learning more about the issue, and submitting a comment to the Centers for Medicare & Medicaid Services (CMS).
 
The deadline for the Medicare agency to receive public comments on the issue is Tue., Sept. 4. For CRNAs and their allies to be sure their voices are heard at CMS, they must submit their comments in advance of that date.
 
Tips on Sending your Pain Care Comments Now - and Those of Your Colleagues and Friends
So you’d like to help protect CRNA practice by getting involved in the AANA’s Protect My Pain Care campaign. What do you do?
  • Act on time – comments must be in to Medicare by Sept. 4. Submit your comment no later than noon Sept. 3 to be sure it gets in.
  • See the official campaign website www.ProtectMyPainCare.com, learn about the issue, and use its easy and convenient system to submit a comment on the issue to the Medicare agency and make your voice heard!
  • Your own comments should be in your own words. Though form letters are very convenient to send, a large number of identical form letter comments will be received by the Medicare agency as one form letter. Why would restoring Medicare direct reimbursement of CRNA pain management services make a difference to you and your community? Tell that story, and your voice will be heard.
  • Invite your CRNA and health industry colleagues, your family and friends to get involved! Thoughtful comments from patients, caregivers, nurses, hospital administrators, and physicians are all valuable and important. Be sure to adhere to all rules and laws governing patient and healthcare confidentiality.
 
Nine in 10 Americans Say Protect CRNA Pain Care
Nine in 10 Americans believe that it is crucial that Medicare protect patient access to pain management delivered by CRNAs, according to new survey results released Aug. 15 by the Mellman Group. “The nation’s 45,000 nurse anesthetists play a crucial role in delivering pain care to the 100 million Americans who need it," said AANA President Janice Izlar, CRNA, DNAP. "The American people have spoken — and they support Medicare's efforts to preserve access to CRNAs.”
 
GAO Lauds AANA-Backed "One and Only Campaign" in Report on Safe Injection Practices
The AANA-backed “One and Only Campaign” educating healthcare professionals and the public about safe injection practices is a crucial contributor to increased patient safety and to reducing the incidence of unsafe injection practices, says an Aug. 3 report issued by the Government Accountability Office (GAO).

Requested by House Energy and Commerce Health Subcommittee ranking member Rep. Frank Pallone (D-NJ), the report titled “HHS Has Taken Steps to Address Unsafe Injection Practices, but More Action Is Needed” outlined 18 outbreaks of viral hepatitis attributable to unsafe injection practices in ambulatory settings from 2001-2011.
 
“CDC has developed tools to communicate its evidence-based guidelines to clinicians in ambulatory care settings,” said the GAO report. Referring to work with the AANA and other healthcare groups, “In partnership with other health-care-related organizations, CDC also developed an educational campaign—the One and Only Campaign—that seeks to broadly educate both clinicians and patients about safe injection practices. While the campaign has targeted some types of clinicians and health care settings that have experienced a blood-borne pathogen outbreak related to unsafe injection practices, additional targeted outreach is needed for health care settings not overseen by CMS.”
 
Read a summary of the report  and view the report. See the statement of Rep. Pallone, who requested the report.
 

AANA Delegation Represents Profession at Republican National Convention This Week, and Next Week at Democratic National Convention in Charlotte
A delegation led by AANA President Janice Izlar, CRNA, DNAP, met with legislators and policymakers at the Republican National Convention in Tampa the week of Aug. 27, and was preparing to travel to the Democratic National Convention in Charlotte the following week. Their objective: to represent the nurse anesthesia profession and ensure that CRNA voices are heard during a crucial time in our country’s political process. Pictures from the first two days of the AANA’s presence at the Republican National Convention are available with more updates to follow.

The Association’s activities in the convention cities were headlined by health policy forums that the AANA helped develop for Wednesday afternoon each week. Titled “Innovative Ideas for a Healthy Future,” the AANA drew cosponsorships from the AARP, the American Podiatric Medical Association, Walgreens, Health Diagnostic Laboratories Inc., and media sponsor The Hill, to draw an audience of policymakers and influencers and hear about the next steps in the healthcare industry influential to the profession of nurse anesthesia. Both weeks, the forums are being webcast live at www.thehill.com from 2:30 – 3:30 pm Eastern time, and will be recorded and viewable later.

Stay tuned for more news and information, and get engaged in AANA’s national convention activities on Facebook and Twitter. AANA’s Facebook page is www.facebook.com/AmericanAssociationofNurseAnesthetists and tweets at www.twitter.com/AANAWebUpdates (also @AANAWebUpdates, and hashtags #AANA and #CRNA).
 
ICD-10 Final Rule Submitted to White House for OK
On Aug. 9, the U.S. Department of Health and Human Services (HHS) submitted to the White House Office of Management and Budget (OMB) its final rule for further delaying the transition of ICD-9 healthcare diagnosis coding to the new ICD-10 system. AANA had submitted comments to HHS supporting a delay of at least one year.
 
Six-Month Spending Extensions to Flat-Fund Several Health Programs Through March 2013
Congressional negotiators have tentatively agreed to fund much of the federal government through a “continuing resolution” that lawmakers will take up in September. This continuing resolution will keep Uncle Sam’s lights on from the Oct. 1 beginning of the new federal fiscal year through March 30, 2013, a duration of six months.

The development of a so-called “CR” is required by Congress not having completed action on its FY 2013 appropriations bills, including the Labor-HHS-Education bill that funds Title 8 and other nursing programs, that altogether make up about a third of the U.S. Government budget. If the entire $4 trillion in U.S. Government budget outlays was represented by one dollar, about 23¢ is for Medicare and Medicaid, 20¢ for Social Security, 19¢ for national security, 18¢ for all other programs funded by appropriations, 13¢ for other mandatory spending programs (student aid, crop insurance, etc), and 6¢ for interest on the debt.
 
The action may temporarily forestall the threat of severe cuts to Title 8. In the House subcommittee bill, the Health Professions and Nursing Workforce Development programs (Title 7 & Title 8 of the Public Health Service Act (PHSA)) along with Title 3 of PHSA are provided $623.272 million. While Title 7 and 8 specific funding levels are not available yet, the bill reportedly includes over $100 million in cuts to the health professions, including a 14 percent cut to Title 8, funding the Nursing Workforce Development programs at approximately $197 million. The bill provides $30.6 billion for the National Institutes of Health, including $144.597 million to the National Institute of Nursing Research (both figures represent level funding from FY 2012). Meanwhile, the Senate measure approved by the full Appropriations Committee June 14 (S 3295, S Rept 112-176) that level-funds Title 8 programs continues to await full Senate floor consideration.
 
 
FEC REQUIRED LEGAL DISCLAIMER 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 our 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. I am a U.S. Citizen.
 
 

 
 
 

 
 
 
Redhead Anaesthesia Myth Dispelled
Researchers in Melbourne report that natural redheads are no more resistant to anesthesia than people with blond, brown, or black hair. Prof. Paul Myles from the Alfred Hospital and Monash University led a study of 468 healthy adults undergoing elective surgery to further examine such notions that "redheads are problematic, more troublesome, and need more anesthesia." Myles observed that, "We found, in fact, that redheads behave basically exactly the same as everyone else when they have anaesthesia in surgery." But Myles acknowledged that genetic mechanisms related to hair and skin color are still involved in the way anesthetic drugs work. The gene that creates red hair, the melanocortin receptor gene, also codes parts of the nervous system. The new study reinforces earlier findings by the same researchers that gender plays a role in responses to anesthesia. Myles said that women were found to be more likely than men to be resistant to anesthesia and more sensitive to side effects, such as post-operative nausea and vomiting. The study is published in Anaesthesia and Intensive Care.
 
From "Redhead Anaesthesia Myth Dispelled"
Perth Now (08/27/12) Henderson, Michelle
 

Long-Term Differences in Language and Cognitive Function After Childhood Exposure to Anesthesia
In a new study, investigators looked at exposure to anesthesia in children under age three years and their outcomes in language, cognitive function, motor skills, and behavior at age 10 years. They analyzed the Western Australian Pregnancy Cohort (Raine) Study, which includes 2,868 children born from 1989 to 1992. Of the 2,608 children assessed, 321 were exposed to anesthesia before age three. Generally, the exposed children had lower scores compared to unexposed peers in receptive and expressive language and cognition. After adjustment for demographics, exposure to anesthesia was associated with increased risk of disability in language and cognition. The results suggest that the association between anesthesia and neuropsychological outcome may be restricted to specific domains.
 
From "Long-Term Differences in Language and Cognitive Function After Childhood Exposure to Anesthesia"
Pediatrics (08/12) Ing, Caleb; DiMaggio, Charles; Whitehouse, Andrew; et al.
 

Finding the Evidence to Change Practice for Assessing Pain in Children Who Are Cognitively Impaired
In this study, researchers focused on a quality improvement project that aimed to systematically review behavioral pain assessment tools for cognitively impaired children. The researchers sought to identify a valid and reliable tool for clinical practice. They also worked with parents and/or caregivers to expand their role in pain assessment. The team conducted an extensive synthesis of the literature to examine the availability and quality of published pain assessment tools for use with children with cognitive impairment (CI) or developmental disability. After this was completed, the researchers identified two of the available 10 tools to test in the clinical setting. According to the authors, data from the project support the adoption of the revised Faces, Legs, Activity, ICry, and Consolability pain assessment tool for children with CI into clinical practice.
 
From "Finding the Evidence to Change Practice for Assessing Pain in Children Who Are Cognitively Impaired"
Journal of Pediatric Nursing (08/01/2012) Ely, Elizabeth; Chen-Lim, Mei Lin; Zarnowsky, Colleen; et al.
 

Big Med
Emerging healthcare chains hope to offer high quality, cost-effective care through high levels of standardization and the use of good ideas. At Brigham and Women's Hospital in Boston, for instance, John Wright has led a decade-long experiment in standardizing joint-replacement surgery. A few years ago, he gathered representative from every specialty involved, such as surgery, anesthesia, nursing, and physical therapy, to develop a single default method of doing knee replacements. These individuals examined various aspects to uncover what the best people were doing, figured out a way to standardize it, and attempted to secure others' compliance. The team stipulated plans for anesthesia and postoperative care based on research studies. Wright instructed the hospital to get rid of its continuous passive-motion machines, for example, and to use the money saved ($90,000 annually) to pay for more physical therapy, which is proven to help patient mobility. Wright also convinced surgeons to accept limits on what prostheses they could use, although surgeons can deviate from the default option by demonstrating that the performance of the other device was superior or the price at least as low. Meanwhile at Steward Health Care System, Armin Ernst is responsible for intensive-care-unit operations in the system's 10 hospitals. He attempts to get clinicians to agree on precise standards of care and then make sure they implement them.
 
From "Big Med"
New Yorker (08/13/12) Gawande, Atul
 
 
Columbia's Nursing School Launches 'Keep It Clean for Kids'
Columbia University School of Nursing has received a four-year, $1.2-million grant from the Agency for Healthcare Research and Quality. This grant will be used to research and improve infection-prevention practices in pediatric long-term care facilities, allowing researchers to undertake the "Keep It Clean for Kids" (KICK) Project. KICK will be involved in a study that assesses hand hygiene at three New York-area facilities. Children in pediatric long-term care facilities are at high risk of contracting health-care associated infections (HAIs) such as methicillin-resistant Staphylococcus aureus, influenza, and hepatitis A. This study will provide information about the rates of such infections in these children. "The goal of this study is to reduce HAIs in pediatric long term care facilities with a tailored intervention that combines innovative technology, active participation of leadership and staff, continuous workflow assessments and feedback," said Elaine Larson, RN, PhD, Professor of Pharmaceutical and Therapeutic Research and Associate Dean for Research at Columbia University School of Nursing. The KICK Project will be implemented at St. Mary’s Healthcare System for Children in Bayside, N.Y.; Sunshine Children's Home and Rehab Center in Ossining, N.Y.; and Elizabeth Seton Pediatric Center in New York City. The KICK study will incorporate the DebMed GMS (group monitoring system), which will provide real-time data and feedback about the hand-hygiene performance of staff in these facilities.
 
From "Columbia's Nursing School Launches 'Keep It Clean for Kids'"
Columbia University School of Nursing (08/23/2012)
 
TAVI: No Need for Patients to 'Go Under'
According to research results presented in the July issue of Cardiovascular Revascularization Medicine, percutaneous placement of an aortic valve without general anesthesia may be a safe option for high-risk surgical patients. The approach, known as transcatheter aortic valve implantation (TAVI), also could lead to patients being discharged sooner. TAVI initially was performed under conscious sedation but over time has switched to a general anesthesia protocol. Now, however, there is growing support for the argument that patients do not need to be put under and that TAVI can be administered safely with local anesthesia and conscious sedation when used in conjunction with fluoroscopic guidance. Researchers from Washington Hospital Center in the District of Columbia analyzed 92 elderly subjects with co-morbidities that put them at higher risk with general anesthesia. Of those patients, 70 received monitored anesthesia care without intubation; while the remainder received general anesthesia. No difference was observed in procedural complication rates between the two groups of patients, suggesting that TAVI is a viable alternative to general anesthesia. Besides avoiding the respiratory and other complications associated with general anesthesia, TAVI also allows clinicians to monitor neurological status during a procedure.
 
From "TAVI: No Need for Patients to 'Go Under'"
MedPage Today (07/25/12) Phend, Crystal
 
 

Propofol Scheduled in Alabama
Alabama health authorities have reclassified propofol as a Schedule IV drug, citing a trend of misuse and abuse of the anesthetic. The Schedule IV category includes controlled substances like Valium and Xanax. Under the reclassification, which takes effect on Aug. 27, providers will be required to store propofol in a secure manner. Detailed records of access, administration, and disposal of the drug also be maintained; and providers will be subject to penalties under state law in the event of misuse or diversion. "I'm surprised it took so long" for propofol to be reclassified at the state level, remarked Jay Horowitz, president of Quality Anesthesia Group in Sarasota, Fla. "Maybe this will motivate the DEA to do it all at once." The Drug Enforcement Administration sought to schedule the anesthetic on a nationwide basis two years ago, but the proposal has not come to pass.
 
From "Propofol Scheduled in Alabama"
Outpatient Surgery (07/30/12) Bernard, David
 

New Anesthesia Drugs Developed to Be 'Fast, Clean, and Soft'
A set of papers in the August issue of Anesthesia & Analgesia show how researchers are using new tools to develop and evaluate new anesthetic agents that offer key advantages over existing drugs. In the papers, separate research groups are using combinations of older and newer techniques to allow for "fast, clean, and soft" drug development. The drugs developed through this process are "soft" in that they offer more predictable results and metabolism, and they are "cleaner" because they are not accompanied by adverse side effects. Researchers at Massachusetts General Hospital in Boston have created a new version of etomidate that has been modified to promote hemodynamic stability without suppressing adrenocortical function, as the original version did. A new benzodiazepine-type sedative called remimazolam, meanwhile, is in development by a group of researchers from PAION UK and Johns Hopkins University School of Medicine. This new drug has been created to offer more favorable properties, including "fast onset, a short, predictable duration of sedative action, and a more rapid recovery profile than currently available drugs." These new reports illustrate the work of researchers to develop and introduce new agents that will help make anesthesia safer and more effective for patients.
 
From "New Anesthesia Drugs Developed to Be 'Fast, Clean, and Soft'"
Newswise (07/31/12)
 
 
Better Analgesia From Pelvic Plexus Block in Prostate Biopsy
New research suggests that compared to periprostatic nerve block (PNB), pelvic plexus block (PPB) with Doppler ultrasound guidance provides greater pain relief for men during office-based transrectal ultrasound-guided prostate biopsy. Researchers conducted a single-center, prospective study, which they described in the August issue of The Journal of Urology. The 180 subjects were randomized to receive intrarectal local anesthesia plus either PPB or PNB before the procedure. Local anesthesia included lidocaine 1.5 percent plus nifedipine 0.3 percent cream. PPB included 2.5 mL lidocaine 1 percent plus naropine 0.75 percent, injected on each side of the pelvic neurovascular plexus lateral to the seminal vesicle tip. PNB included the same mixture, but injected on each side of the neurovascular bundles at the prostate-bladder-seminal vesicle. Patients were asked to rate their levels of pain/discomfort afterwards. Results showed no difference in pain perception during probe introduction or administration of either the PPB or PNB. However, during the biopsy, pain was significantly lower for patients who received the PPB, until 30 minutes after the biopsy completion. Patients experienced no major complications.
 
From "Better Analgesia From Pelvic Plexus Block in Prostate Biopsy"
DoctorsLounge (07/26/12)
 
 

Propofol TIVA Not a Blood-Sparing Technique for Sinus Surgery
There is no significant correlation between total intravenous anesthesia (TIVA) with propofol and platelet inhibition in patients undergoing endoscopic sinus surgery (ESS), according to the results of a pilot study. The findings from the Preoperative Anesthesia Clinic at the University of Texas Health Science Center also show that TIVA with propofol does not improve postoperative recovery compared to inhalational anesthesia. ESS under general anesthesia is now the most common approach to such procedures; but surgical-site bleeding is a critical factor, prompting anesthesia providers to seek ways to minimize the problem. In the pilot, 23 ESS patients were randomly assigned to receive either TIVA using propofol and remifentanil or inhalational anesthesia with a combination of sevoflurane and remifentanil. Researchers collected patient blood samples before and after surgery, analyzing the maximum amplitude (MA), signifying clot strength, and the percentage platelet inhibition, defined by the extent of non-response of the platelet ADP or TXA2 receptor to the exogenous ADP and arachidonic acid (AA). Eight patients receiving sevoflurane and four receiving propofol had subtle preoperative MA-ADP alterations; only two of these had significant inhibition of ADP or AA combined. “Originally, we were asking how propofol reduces blood loss,” said lead researcher Davide Cattano, MD. "But by utilizing a promising device that measures mucosal nose blood flow, we actually found that blood flow is increased with propofol. We know from neurosurgery that propofol affords better maintenance of vascular resistance. So if propofol does, indeed, reduce blood loss, it’s likely through a mechanism of vasoregulation. This is a novel finding that we are seeking to better investigate.” In examining postoperative recovery, the team found no significant differences between the TIVA with propofol and the inhalational anesthesia groups with regard to duration of anesthesia, time to discharge from the postanesthesia care unit, and incidence of adverse events.
 
From "Propofol TIVA Not a Blood-Sparing Technique for Sinus Surgery"
Anesthesiology News (07/01/12) Vol. 38, No. 7 Vlessides, Michael
 
 

Orthognathic Surgery and Recovery Have Different Anesthetic Requirements
The journal Anesthesia Progress presented the findings of a retrospective study that looked at the growing use of propofol and remifentanil in orthognathic maxillofacial surgery. Patients receiving intravenous propofol and remifentanil experienced faster recovery times than did those receiving inhalation agents and longer-acting opioids such as morphine but reported comparatively higher pain scores in the four hours immediately following surgery. Researchers also compared heart rate, early postoperative opioid dose, and adverse outcomes such as nausea and vomiting between the two sets of patients; but no statistically significant differences were documented. The findings suggest that while using propofol and remifentanil can curtail the risk for respiratory and gastrointestinal complications following surgical procedures affecting the jaw and face, it also appears to increase postoperative pain for patients. The single-site study involving 51 patients could spur future controlled investigations into the benefits of using propofol and remifentanil to improve intraoperative conditions.
 
From "Orthognathic Surgery and Recovery Have Different Anesthetic Requirements"
SurgiStrategies.com (07/26/2012)
 
 

 
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