Anesthesia-E-ssential-December-14-2012

Anesthesia E-ssential

December 14, 2012 

Vital Signs

Board of Directors Approves Updates to Professional Practice Manual Documents
The Board of Directors has recently approved updates to several documents contained within the Professional Practice Manual for the Certified Registered Nurse Anesthetist. These documents include Position Statement Number 2.13 “Safe Practices for Needle and Syringe Use,” Position Statement Number 2.14 “Securing Propofol,” and the “Infection Control Guide for Certified Registered Nurse Anesthetists.” These documents can be accessed on the Professional Practice Division’s Professional Practice Manual webpage.
 
 

 

The Pulse

 
  • Additional Contamination Identified in Medical Products from NECC
  • Boost your Business Savvy at the Business of Anesthesia Conference
  • Nurse Anesthetists Week Promotional Materials Going Fast—Order Now!
  • AANALearn® - Earn Continuing Education Credits during the Holidays
  • Delegate on the Education Committee: Candidates Sought
  • Well Holidays!
AANA Foundation and Research
  • Support Important Research: Make Your Year-End Donation to the AANA Foundation Today
  • AANA Foundation: Call for Board Members
  • AANA Foundation Seeks Scholarship and Fellowship Sponsors
  • ANA Foundation 2013 Awards: Nominate Someone Today
  • AORN Calls for Comments
PR, Publications and eCommunications
  • Happy Holidays--And See You Next Year! 
News from COA
  • Call for Comments for Revisions to 2004 Standards for Accreditation
 
  • Take Action to Protect My Pain Care in Congress
  • Seeking Your Nominations for AANA Honors
  • Want to Serve on the CRNA-PAC Committee?
  • New Bill Seeks to Address Drug Shortage by Increasing Medicare Drug Payment – but Does Not Address Shortages of Drugs Used in Anesthesia
  • Fungal Meningitis Outbreak Examined at House, Senate Hearings
  • House, Senate Release 2013 Work Calendars
  • Volunteers Wanted: Introducing the AANA State Reimbursement Director (SRD) Program
  • Transition to New Congress Begins
  • 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
Additional Contamination Identified in Medical Products from NECC
The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration have identified additional microbial contamination in unopened vials of betamethasone, cardioplegia, and triamcinolone solutions distributed and recalled from New England Compounding Center (NECC). More information can be found in CDC’s recent Health Alert: http://emergency.cdc.gov/HAN/han00337.asp.
 
Boost your Business Savvy at the Business of Anesthesia Conference
January 26, 2013 at the Waldorf Astoria Hotel in Naples, Florida
Designed by CRNAs, for CRNAs, the popular and informative Business of Anesthesia Conference addresses the business knowledge needs of anesthesia professionals in a variety of settings. Come explore these important topics: financial impact of various practice models, compliance and RAC audits, contract negotiation, legal issues, and more. Register today so you don’t miss out!
 

Nurse Anesthetists Week Promotional Materials Going Fast—Order Now!
CRNAs all across the country are gearing up for the 14th annual National Nurse Anesthetists Week, to be celebrated Jan. 20-26, 2013. Promotional items, including posters, buttons, ink pens, table tents, and the ever-popular Nurse Anesthetists Week logo merchandise, including T-shirts and mugs, are available now for purchase at www.aana.com/nnaw beginning in November. Please note: Ordering is now online-only. Phone, fax, or mail orders will not be accepted.

AANALearn® - Earn Continuing Education Credits during the Holidays
The online courses offered in AANALearn® are available 24/7 at reduced discount prices for AANA members, including weekends and holidays. Were you aware that there are now six courses that provide a total of eight pharmacology credits? Check the sales catalog: A new two-credit pharmacology course is being offered at a special price reduction of only $28. With over 50-prior approved CE courses to select from, AANALearn® can provide some or the entire CE needed for recertification. New courses will be coming in 2013 - check out the catalogs frequently at www.aanalearn.com. We wish you a Happy Holiday Season.

Delegate on the Education Committee: Candidates Sought
Applications Due January 31, 2013
The AANA Education Committee is seeking candidates who are interested in serving on the committee as a delegate. The deadline for receiving completed candidate packets is Jan. 31, 2013. Click here for further information.
 
 
Well Holidays!
Have a safe and well holiday season! AANA wishes you and your families the best during this joyous time of year. Some basic wellness reminders:
  • Eat well,
  • Get enough sleep,
  • Avoid germs and overspending,
  • Drink wisely in moderation,
  • Carve out time for physical activity,
  • Give back to your community,
  • Savor your family, friends, and holiday traditions.
Holidays, and winter in general, can challenge emotional wellness and are not joyous for everyone; especially if you’re facing seasonal depression, emotional crisis, suffering recent loss, contemplating suicide, battling addiction, or maintaining recovery. Remember, take it one day at a time and reach out to the community of support—a loved one, your healthcare provider, workplace employee assistance program, or peer support group. For help with chemical dependency or addiction, contact AANA Peer Assistance (see Getting Help for Yourself and Others).
 
Best wishes for your wellness and a healthy new year!
 
 

  
 
Support Important Research: Make Your Year-End Donation to the AANA Foundation Today
The AANA Foundation continues to support important research with the help of individuals, state associations and corporations. Evidence provides proof, and proof is power! Take a moment today to make your year-end, tax-deductible gift to AANA Foundation’s Proof is Power campaign – click here to access the Foundation’s secure donation page. To maximize your opportunity for 2012 tax benefits, please submit your gift before 11:59 p.m. on Monday, Dec. 31, 2012. Thank you in advance for your contribution and support of nurse anesthesia through the AANA Foundation!
 
AANA Foundation: Call for Board Members
Application Deadline: February 28, 2013
The mission of the AANA Foundation is to advance the science of anesthesia through education and research. The Foundation is currently looking for candidates interested in playing an active role in supporting these important aspects of the CRNA profession by participating on the AANA Foundation Board of Trustees. For further information about eligibility criteria and how to apply, see below.
 
  • Current CRNA and AANA member in good standing
  • Must be a supporter of the AANA Foundation of time, talent and treasure
  • Must be willing to advocate for the AANA Foundation
  • Must have a history of giving to the AANA Foundation
  • Must have a history of volunteerism
  • Term is for two years (September – August)
 

Submit the following:

  • Cover letter describing why you wish to be an AANA Foundation Board member
  • CV
  • Completed Nomination Application for AANA Foundation Board of Trustees
  • Completed 2013 Nominee Profile Form
If you are interested in applying, visit www.aanafoundation.com to access the application and nominee profile forms. Forward completed forms via email to foundation@aana.com. Please include “Board Trustee Application” in the subject line of your email.
 
If you have any questions, please contact the Foundation at (847) 655-1170 or foundation@aana.com.
 
 
AANA Foundation Seeks Scholarship and Fellowship Sponsors
Deadline: December 31, 2012
The AANA Foundation is seeking sponsors for scholarships and fellowships. The minimum donation is $3,000. Click here to visit the Foundation website and access the Sponsor a Scholarship or Fellowship - Scholarship Sponsor Form. Complete the application along with payment and send to: AANA Foundation; 222 S. Prospect Ave.; Park Ridge, IL 60068. Contact the AANA Foundation at (847) 655-1170 or foundation@aana.com for further information. Thank you in advance for impacting the life of a member of the nurse anesthesia community through financial support.
 
AANA Foundation 2013 Awards: Nominate Someone Today
Nomination Deadline: January 1, 2013
Each year at the AANA Annual Meeting the AANA Foundation presents following awards to individuals who have made a difference in the nurse anesthetist community:
 
  • Advocate of the Year Award
  • John F. Garde Researcher of the Year Award
  • Rita L. LeBlanc Philanthropist of the Year Award
  • Janice Drake CRNA Humanitarian Award
  • Jack Neary Pain Management Award
 
Click here for more information and to access the nomination forms. Complete the application or nomination and email to foundation@aana.com, or mail to the AANA Foundation at 222 S. Prospect Ave., Park Ridge, IL 60068. If you have any questions, contact the AANA Foundation at (847) 655-1170 or foundation@aana.com.
 
 
 

 
 
AORN Calls for Comments
The Association of Perioperative Registered Nurses (AORN) is accepting public comments on Recommended Practices for Sharps Safety through Jan. 13, 2013. To access and submit comments on this document see: http://www.aorn.org/Secondary.aspx?id=23926#axzz2EEzTAIsT.
 
Fungal Meningitis Outbreak Information: Keep Current
The Centers for Disease Control and Prevention (CDC), in collaboration with the Food and Drug Administration (FDA), state public health departments, and state boards of pharmacy, is investigating the outbreak, which has been identified as fungal meningitis. The outbreak does not appear to have been caused by improper infection control practices by healthcare providers who administered the medication. The AANA has compiled resources about the outbreak and other pertinent information regarding infection control practices that are essential to our patients’ safety. To stay informed, visit http://www.aana.com/resources2/professionalpractice/Pages/Outbreak-Information.aspx.
 
 

 
Happy Holidays—And See You Next Year!
Due to the holidays, Anesthesia E-ssential will not come out on Dec. 31, 2012, and will resume publication with the Jan. 15, 2013, issue. The E-ssential staff wishes all of our readers a joyous holiday season, and we look forward to serving you in 2013.
 
 

 

News from COA 

Call for Comments for Revisions to 2004 Standards for Accreditation
The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is soliciting comments from the communities of interest on proposed revisions to the 2004 Standards for Accreditation of Nurse Anesthesia Educational Programs, the COA’s current Standards for master’s degrees. The revisions are being proposed in preparation for the transition to the doctoral Standards. Written comments are being collected via an online tool. The link to the online tool is located on the COA website at home.coa.us.com. Please note that an e-mail containing the link for the call for comments has been sent to all program administrators, onsite reviewers, consultants, COA Directors, AANA senior staff, AANA Board of Directors, NBCRNA Board of Directors, legal counsel, and the AANA archivist. The COA will be collecting comments through Wednesday, Jan. 2, 2013.
 

 
 
Take Action to Protect My Pain Care in Congress
With Congress back in session battling on big budget issues, the time is now for AANA members to take action and Protect My Pain Care – namely, to protect the Medicare final rule authorizing Medicare coverage of CRNA services within their state scope of practice from attack on Capitol Hill. AANA members can take action now at www.ProtectMyPainCare.com.
 
The concern is this: with a major budget measure possibly but not yet taking shape behind closed doors, adversaries of the Medicare access to pain care final rule can reasonably be expected to try attaching a brief anti-CRNA “poison pill” provision to any budget bill.  The head of the American Society of Interventional Pain Physicians (ASIPP), Dr. Laxmaiah Manchikanti, stated, “This rule will increase fraud and abuse, controlled substance abuse, addiction and overuse, leading to numerous fatalities.”  And the American Society of Anesthesiologists is on record having “rebuked” the Medicare agency for issuing the Medicare access to pain care rule.
 
The job of the AANA and CRNAs is to deliver the following important message to members of the U.S. House and Senate: the final rule is good for patients and good for healthcare, it was the result of a public notice and comment rulemaking process, and it should not be struck or overturned by Congress.
Keep an eye in your email inbox for CRNAdvocacy action alerts from AANA President Janice Izlar, CRNA, DNAP.  If you’re a Federal Political Director or Key Contact who’s been tasked to contact a critical member of Congress in your state, make it happen and be sure to let AANA know how it went.
 
 
Seeking Your Nominations for AANA Honors
Nomination Deadline: January 15, 2013
The AANA is seeking your nominations for Federal Political Director of the Year and the National Health Leadership Award. If you have excellent candidates in mind, or might be one yourself, please follow the links below:
 
Want to Serve on the CRNA-PAC Committee?
CRNA-PAC Committee nominations are due Jan. 31, 2013. From a slate of member nominees provided by the AANA Board of Directors in February, the CRNA-PAC Committee elects two CRNAs each year for three-year terms and one student nurse anesthetist for a one-year term. Committee member responsibilities include setting and overseeing CRNA-PAC expenditure and income policy, determining funding of open-seat and challenger candidates, fulfilling duties at CRNA-PAC events and AANA national meetings, participation in fundraising duties, and attendance at CRNA-PAC Committee meetings. Candidates should have a strong interest in furthering the profession through federal advocacy. If you are interested in serving on the CRNA-PAC Committee, see http://www.caretobecounted.org/who/how-do-i-join (AANA member login required).
 
 
New Bill Seeks to Address Drug Shortage by Increasing Medicare Drug Payment – but Does Not Address Shortages of Drugs Used in Anesthesia
Legislation introduced by Rep. Bill Cassidy (R-LA) Nov. 29 seeks to address the problem of shortages of sterile injectable drugs by increasing Medicare payment for them under certain circumstances. The issue is important to CRNAs who have reported to AANA that drug shortages are affecting their practice. Read More.
 
The bill, H.R. 6611, is titled the Patient Access to Drugs in Shortage Act, and would seek to reverse reductions in Medicare payments for certain sterile injectable drugs that took effect in 2005 following adoption of the Medicare Modernization Act of 2003.  However, the legislation affects Medicare payment systems for oncology drugs, not for drugs used in anesthesia care which are bundled into hospital and facility payment systems and not paid separately by Medicare.  The measure is not anticipated to move in Congress before the end of 2012, but Rep. Cassidy, a family practice physician, says he would like to take comments on the bill and reintroduce it in 2013.  The bill has drawn the support of U.S. Oncology and the National Patient Advocate Foundation.
 
Read the sponsor’s background materials on the legislation at http://cassidy.house.gov/press-release/cassidy-proposes-drug-shortage-solutions.
 
Fungal Meningitis Outbreak Examined at House, Senate Hearings
Regulation and oversight of compounding pharmacies implicated in the recent fungal meningitis outbreak came under the spotlight at two congressional hearings before Thanksgiving. The issue is critical to CRNAs who are among the healthcare professionals depending on the medications that they administer being safe and efficacious for their patients.
 
Appearing before the House Energy and Commerce Committee Nov. 14 and the Senate HELP Committee Nov. 15, officials representing compounding pharmacies refused to testify under advice of counsel, and officials from the Food and Drug Administration (FDA) came under questioning for their claim that a complex federal-state regulatory environment long hindered federal oversight of compounding pharmacies.
 
Recommended solutions broke down among partisan lines, with both committees’ Democrats urging prompt legislation granting FDA additional authority to regulate and oversee compounding pharmacies, and both panels’ Republicans urging additional investigation of the facts in the fungal meningitis outbreak and whether FDA had fully used the oversight authority the agency already has.  The industry journal Inside Health Policy quoted two leading lawmakers on this issue: Rep. Michael Burgess MD (R-TX) said, “If we just rush to legislate something … we’re going to be back here with the same problem. If they didn’t exercise the authority they already had, new authority is not going to solve the problem.” Rep. Henry Waxman (D-CA) expressed concern about deliberative consideration, saying, “Some of these interest groups are going to gear up and stop legislation.”
 
For further information, see the committee hearing memo from the House Energy and Commerce hearing Nov. 14,  individual testimonya report from the Senate HELP Hearing on Nov. 15, an additional report, and attachments.
 
 
House, Senate Release 2013 Work Calendars
The House and Senate have released their overall Washington work calendars for the year 2013, most notably indicating that they are scheduled to be in session during the AANA’s Mid-Year Assembly meeting in Washington this coming April. Because legislators are in Washington part time and back at home much of the year, AANA Federal Political Directors and Key Contacts are advised to look for ways to build relationships with their members of Congress and their local professional staff in the local community, as well as during the critical Mid-Year Assembly meeting. Your AANA FGA team in Washington is always available to help – email info@aanadc.com to get started. For links to both House and Senate calendars, click here.
 
Volunteers Wanted: Introducing the AANA State Reimbursement Director (SRD) Program
In September, the AANA Board of Directors approved the development of a State Reimbursement Director (SRD) Program. The goal of this program is to establish representation from all 50 state nurse anesthesia associations for effective reimbursement advocacy in each state. With the AANA’s Federal Political Director (FPD) Program as a template, the SRD will be the point person for reimbursement knowledge and advocacy in each individual state. Like the FPD who works with Key Contact CRNAs, the SRD in each state will most likely coordinate the monitoring and advocacy work of the program through a team of involved and engaged individuals. For further information about the objectives, position requirements, and how to apply, click here. (Member login and password required.)
 
Transition to New Congress Begins
Lawmakers who retired or lost their Nov. 6 election are in the process of moving to temporary Capitol offices, making room for 12 new Senators and at least 67 new U.S. representatives, though they will keep their phone numbers and email contact through the end of this congressional session. Transitions of local offices in-state or in-district are also beginning. For CRNAs, this means you will have to be persistent in making your voice heard in Washington during the post-election “lame duck” session of Congress this fall.
 
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.
 
 
 

 
 
 

 
 
 
In a review of patients requiring anesthesia during proton beam therapy between June 2008 and April 2012, researchers found that a well-trained team and strict adherence to rigorous protocols can safely deliver daily sedation/anesthesia (S/A) to children in free-standing proton centers. Proton radiation therapy centers are usually free-standing facilities without specialized pediatric care, which may create issues for children who need anesthesia. Researchers looked at the records of the Indiana University Health Proton Therapy Center, which included a total of 138 children who received daily anesthesia during the study period. In a total of 4,045 S/A procedures, three events occurred, including one fall from a gurney during anesthesia recovery and two aspiration events. All three children did well and none of them required cessation of therapy. This was the largest reported series of repetitive pediatric anesthesia in radiation therapy, the researchers report, and the only available data from the proton environment.
 
From "Repetitive Pediatric Anesthesia in a Non-Hospital Setting"
International Journal of Radiation Oncology, Biology, Physics (11/12) No. 12 Buchsbaum, J.C.; McMullen, K.P.; Douglas, J.G.; et al.
 

Cancer Recurrence Influenced by Opiates Already in Body, Anesthesia: Study
In a finding that has implications for the anesthesia care of cancer patients, University of Chicago researcher Patrick Singleton, PhD, has uncovered more evidence of the role played by mu opioid receptors in cancer cells. Previous observations by his team documented markedly higher numbers of mu opioid receptors in cells from certain classes of human lung cancer compared to normal cells. New laboratory tests have since shown that tumors grew twice as quickly and the cancer was 20 times more likely to spread in mice injected with human lung cancer cells fortified with extra copies of the mu opioid receptor. Conversely, tumors did not grow at all in mice that had no mu opioid receptor; and drugs that block the receptors reduced cancer growth in test subjects and helped prevent further invasion and spread of cancer cells. "If confirmed clinically, this could influence how we do surgical anesthesia for our cancer patients," Singleton said. "There is epidemiological evidence to suggest that the type of anesthesia used during cancer surgery may influence tumor recurrence." Specifically, the findings, which were published in Anesthesiology, could bolster support for a potentially therapeutic application for drugs known as opioid antagonists
 
From "Cancer Recurrence Influenced by Opiates Already in Body, Anesthesia: Study"
Outcome Magazine (12/12/2012)
Return to Headlines
 

Pediatric Regional Anesthesia Network (PRAN): A Multi-Institutional Study of the Use and Incidence of Complications of Pediatric Regional Anesthesia
Regional anesthesia, as it is usually performed in the United States, has a low complication rate in children, new research shows. Researchers collected detailed prospective data on all regional anesthetics performed by anesthesia providers at participating centers. Data included a total of 14,917 regional blocks, performed on 13,725 patients from April 2007 through March 2010. Analysis found no deaths or complications that had consequences that lasted longer than three months. Single-injection blocks generally had fewer adverse events than continuous blocks. Ninety-five percent of blocks occurred when patients were under general anesthesia. Although single-injection caudal blocks were the most frequently performed (at 40 percent), peripheral nerve blocks were also common (at 35 percent), possibly because of the widespread use of ultrasound. The researchers noted that multicenter collaborative networks such as the Pediatric Regional Anesthesia Network can aid the collection of data for research and quality improvement.
 
From "Pediatric Regional Anesthesia Network (PRAN): A Multi-Institutional Study of the Use and Incidence of Complications of Pediatric Regional Anesthesia"
Anesthesia & Analgesia (12/12) Vol. 115, No. 6, P. 1353 Polaner, David M.; Taenzer, Andreas H.; Walker, Benjamin J.;
 et al.
Return to Headlines
 

Can You Hear Me Now? New Device Uses Sound to Monitor Residual Paralysise
It is believed that as many as 40 percent of surgical patients who undergo general anesthesia—or about 10 million people—experience some level of residual paralysis as a result. Part of the reason for the high incidence, according to Thomas Hemmerling, MD, associate professor of anesthesia at Canada's McGill University, is that clinicians rely on visual or tactile monitoring, which can be highly subjective. Using monitors to detect neuromuscular blockade is far less common, according to Hemmerling, who hopes his new Relaxofon device will shift the tide. He says providers shun existing monitoring devices because of their bulky size, high cost, and low availability; but his phonomyography-based product is compact and "user-friendly." The monitor, which collects low-frequency sounds associated with stimulated muscle contractions in order to calculate train-of-four ratios, could be commercially available in a year or two, Hemmerling projects. U.S. anesthesia experts not tied to Relaxofon's development stress the importance of objective, quantitative monitoring for post-operative paralysis in order to assure full neuromuscular recovery before extubation and to avoid adverse outcomes such as pulmonary complications and emergent reintubation.
 
From "Can You Hear Me Now? New Device Uses Sound to Monitor Residual Paralysis"
Anesthesiology News (12/01/12) Vol. 38, No. 12 Wild, David
 
A new study suggests that the Radical-7 Pulse CO-Oximeter, manufactured by Masimo Corp., could be a useful trend monitor in children during surgery, even immediately after the administration of intravascular volume expanders. For their study, researchers compared noninvasive measurements of hemoglobin concentration (SpHb) with simultaneous laboratory measurements of total hemoglobin (tHb) in arterial blood samples taken from children. Investigators analyzed 119 paired samples. The average difference (bias) between tHb and SpHb was 0.90 g/dL and one standard deviation of the difference was 1.35 g/dL. The investigators advise that users of the monitor confirm the baseline hemoglobin level and consider a possible influence of tHb levels on the bias. They also urge caution in using SpHb alone when making transfusion decisions.
 
From "The Accuracy of Noninvasive Hemoglobin Monitoring Using the Radical-7 Pulse CO-Oximeter in Children Undergoing Neurosurgery"
Anesthesia & Analgesia (12/12) Vol. 115, No. 6, P. 1302 Park, Yong-Hee; Lee, Ji-Hyun; Song, Hyun-Gul; et al.
 
Epileptogenic Effect of Sevoflurane: Determination of the Minimal Alveolar Concentration of Sevoflurane Associated With Major Epileptoid Signs
A recent study from France investigated the minimal alveolar concentration (MAC) of sevoflurane associated with major epileptiform signs (MES) in children. The study authors found that, in children premedicated with hydroxyzine, the MAC of MES of sevoflurane calculated in 100 percent oxygen corresponded to 1.75 surgical MAC. The results also showed a moderate effect of nitrous oxide and alfentanil in raising the threshold of MES. For the study, the MAC of MES was determined in 100 percent oxygen and with the addition of 50 percent nitrous oxide or after the injection of alfentanil in 79 children, aged three to 11 years, who were undergoing elective surgery and were premedicated with hydroxyzine. After induction by inhalation and tracheal intubation, there was a 10-minute period with a stable expired fraction of sevoflurane. Three consecutive series were performed: one in 100 percent oxygen, one in 50 percent oxygen and 50 percent nitrous oxide, and one in 100 percent oxygen with a bolus of alfentanil. The MAC of the 100 percent oxygen was an average 4.3, while the others were 4.6.
 
From "Epileptogenic Effect of Sevoflurane: Determination of the Minimal Alveolar Concentration of Sevoflurane Associated With Major Epileptoid Signs"
Anesthesiology (12/12) Vol. 117, No. 6, P. 1253 Gibert, S.; Sabourdin, N.; Louvet, N.; et al.
Return to Headlines
 

Pain Origin Difficult to Diagnose in Patients With Lumbar Spinal Stenosis, Hip Osteoarthritis
A new study confirmed that clinicians often have trouble pinpointing the source of lower leg pain in patients suffering from lumbar spinal disease and hip joint degeneration. This must be taken into consideration, the researchers concluded, when making choices for regional anesthesia. The team assessed leg pain of 420 patients with lumbar spinal stenosis. Four patients with lumbar spinal stenosis and hip osteoarthritis, presented as low back pain or pain around the hip joint, hurt only in the ipsilateral lateral region of the lower leg. The symptoms were relieved after L5 spinal nerve block but persisted following lidocaine infiltration into the hip joint. Overall, the researchers found that lumbar surgery did not resolve leg pain in all patients; however, ipsilateral total hip replacement was performed on all patients, and that did eliminate the symptoms.
 
From "Pain Origin Difficult to Diagnose in Patients With Lumbar Spinal Stenosis, Hip Osteoarthritis"
Orthopedics Today (12/12) Saito, J.
 

Epidural Blood Patches Are Effective for Postdural Puncture Headache in Pediatrics: A 10-Year Experience
An epidural blood patch (EBP) can be a highly effective procedure for children with severe postdural puncture headache (PDPH) for which conservative treatment is ineffective, according to a new study. PDPH is a relatively common complication from lumbar punctures. For their study, researchers looked at the need and effectiveness of EBPs in children and adolescents over a 10-year period at two hospitals in Finland. The review included 42 EBPs performed in 41 patients ranging in ages from three to 18 years. The first EBP provided complete relief of symptoms in 37 children, an initial success rate of 90 percent, and permanent pain relief in 85 percent. There were no serious adverse effects related to EBPs.
 
From "Epidural Blood Patches Are Effective for Postdural Puncture Headache in Pediatrics: A 10-Year Experience"
Paediatric Anaesthesia (12/01/2012) Vol. 22, No. 12, P. 1205 Kokki, M.; Sjovall, S.; Kokki, H.; et al.
 
Hospitals Make Trying Times Easier for Their Youngest Patients
Hospital stays and treatments are stressful for children, which is why Children's National Medical Center in Washington, D.C., employs 16 child life specialists to help make hospitals less traumatic for kids. These specialists do not provide direct medical care but help the kids be kids by guiding them in their play. There are more than 4,000 child life specialists in the United States, employed by every pediatric hospital in the country and some general hospitals with large pediatrics units. Specialists have completed a college degree, classes in child development and psychology, and an internship of at least 12 weeks. Although the number of people seeking certification outnumbers the jobs available, Dennis Reynolds, executive director of the Rockville, Md.-based Child Life Council, says that the field could grow as other hospitals and clinics add child life specialists to their staffs. Rather than being reimbursed by insurers, the cost of child life specialists is part of the hospital’s overhead. Child life specialists may help walk a child through the surgery experience before outpatient surgery, or will give them specially scented anesthesia masks and oils as the children await surgery. Rather than giving a child anesthesia before he or she undergoes an MRI, an hour and a half with a child life specialist can remove the need for anesthesia in some cases.
 
From "Hospitals Make Trying Times Easier for Their Youngest Patients"
Washington Post (12/04/12) P. E4 Gold, Jenny
Return to Headlines
 

IV Lidocaine Useful for Ambulatory Surgery Patients
Intravenous lidocaine, commonly used to curb pain following inpatient surgeries, is also effective in ambulatory applications, based on new research published in Anesthesia and Analgesia. In the Northwestern University study, 63 healthy women undergoing outpatient gynecologic laparoscopy were randomly assigned to receive either IV lidocaine or a saline placebo. The lidocaine group experienced superior quality of recovery compared to the saline group, and those women also were discharged from the hospital nearly half an hour sooner. "When we used lidocaine for outpatient surgery, patients felt much better; they had less pain; they consumed less opioids; and they were able to be more independent on the day after surgery," reported Gildasio De Oliveira Jr., MD, an assistant professor of anesthesiology who helped to conduct the Northwestern research. He said he believes the drug can be used routinely and safely in other outpatient procedures with a similar "pain profile."
 
From "IV Lidocaine Useful for Ambulatory Surgery Patients"
Anesthesiology News (11/01/12) Vol. 38, No. 11 O'Rourke, Kate
 
 

Nitrous Oxide as Labor Analgesia
Nitrous oxide is making a comeback as a labor analgesic—a use that, while still widely practiced in Europe, until now had not been embraced in the United States since the 1970s. Rather, pregnant American women in the decades since then have cultivated a preference for epidural anesthesia. Despite their efficacy, epidurals still pose the possibility of adverse outcomes, including prolonged second stage of labor, slowed uterine contractions, and fever. Nitrous oxide, or "laughing gas," however, produces fewer side effects and prevents maternal desaturation. Additionally, expectant mothers who want fewer interventions during the birthing process and who do not want to be confined to bed, hooked up to an IV, or catheterized may be turned off by epidurals—which also are not feasible for those with hematologic disorders, spine injuries, or anesthetic allergies. With those factors in mind, nitrous oxide use once again is increasing in U.S. labor and delivery wings; but there is concern about availability of the nitrous delivery system as well as certain contraindications, such as pulmonary hypertension and increased intraocular pressure.
 
From "Nitrous Oxide as Labor Analgesia"
Nursing for Women's Health (11/01/12) Vol. 16, No. 5, P. 398 Stewart, Lucinda Steen
 
 

Effects of Etomidate on Complications Related to Intubation and on Mortality in Septic Shock Patients Treated With Hydrocortisone
Researchers conducted a single-center observational study designed to compare outcomes in septic shock patients treated with hydrocortisone, based on whether they received etomidate for endotracheal intubation or a different induction drug. Etomidate has been challenged in the treatment of septic shock because it is known to raise the risk of critical illness-related corticosteroid insufficiency. Indeed, investigators found that the rate of this complication was higher among the 60 patients who received etomidate—79 percent, compared to 52 percent of the 42 patients in the non-etomidate group. The rate of life-threatening complications was the same for both groups, at 36 percent, after intubation. However, in terms of mortality in the intensive care unit, etomidate appeared to have protective traits.
 
From "Effects of Etomidate on Complications Related to Intubation and on Mortality in Septic Shock Patients Treated With Hydrocortisone"
7thSpace (11/21/12) Jung, Boris; Clavieras, Noemie; Nougaret, Stephanie; et al.
 
 
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