Anesthesia E-ssential February 15, 2013

Anesthesia E-ssential

February 15, 2013 

Vital Signs

Updated Standards for Nurse Anesthesia Practice Released
As part of its ongoing work, the AANA Practice Committee reviewed the Scope and Standards for Nurse Anesthesia Practice. Due to the robust nature of this document, priority was given to the Standards for Nurse Anesthesia Practice. A quantitative literature analysis was used to ensure that the standards reflect current standards of anesthesia practice and to add clarity to the document. The original composition of the document included 11 standards with corresponding interpretive language. The standards revisions enhance the clarity of the standards without substantially changing their meaning. The end result is a more streamlined and updated set of standards, with minimal interpretive language. The Standards for Nurse Anesthesia Practice were approved by the Board of Directors in January 2013. Three other practice documents were also updated as a result of the standards revisions: These three documents will be reviewed in their entirety and revised based on the Practice Committee’s evidence-based process document review schedule. All CRNAs, student nurse anesthetists, and other healthcare professionals are strongly encouraged to familiarize themselves with the updated standards and incorporate them into their practice. CRNAs have a long history of providing high-quality, safe, and effective anesthesia care for their patients, and these standards will continue to reinforce those principles. The updated Standards for Nurse Anesthesia Practice are available on the public side of the AANA’s website at http://www.aana.com/resources2/professionalpractice/Pages/Professional-Practice-Manual.aspx. Individual documents or the entire Professional Practice Manual for the Certified Registered Nurse Anesthetist are available for download from the AANA website or purchase in a bound format through the AANA Marketplace. AANA members receive a discounted rate on these materials. Any questions regarding these standards can be directed to the AANA’s Professional Practice Division at practice@aana.com or (847) 655-8870.
 
 

 

The Pulse

 
  • AANA Issues Media Alert: Response Warranted to Fox News Attack
  • ANA Seeks Input on Code of Ethics Revision
  • AANA Staff Hears First-Hand CRNA Stories
  • Emotional Impact of Perioperative Catastrophes
  • Researcher seeks information on Helen Lamb
  • Read the New State Update
  • Regional Action Coalition Information on AANA Website
  • State Health Insurance Exchanges Webpage Offers Information on Affordable Care Act Implementation
 
Professional Practice
  • Noteworthy New Documents from the Joint Commission 
  • Fixing Medicare Cuts Half as Costly as Previously Thought, Affecting Congressional Outlook
  • Big Budget Issues Soon to Affect CRNAs, Unless Congress Acts
  • CRNA-PAC Kicks Off 2013 Care to be Counted Development Program
  • HHS Issues Final Rule on Physician Payment Disclosures
  • Medicare Proposes Regulatory Relief for Hospitals and Other Facilities
  • AANA Supports Confirmation of Marilyn Tavenner, RN, to Head CMS
  • Name Your State Reimbursement Director
  • Harkin will not run for Senate in 2014
  • 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
AANA Issues Media Alert: Response Warranted to Fox News Attack
On Monday, Feb. 11, former New York Lieutenant Governor Betsy McCaughey disparaged nurse anesthetists during her appearance on the Fox News program “Your World with Neil Cavuto.” AANA members are urged to respond and help correct the misinformation presented on the program. See the Media Alert on the AANA website (member login and password required) to view a clip, read the AANA response to the program, and arm yourself with information.
 
ANA Seeks Input on Code of Ethics Revision
The American Nurses Association (ANA) Center for Ethics and Human Rights is seeking your input on whether the Code of Ethics for Nurses with Interpretative Statements (the Code) should be revised. The Code was last revised in 2001. Access the survey here. The deadline for submitting comments is March 15, 2013. The survey takes approximately 30 minutes to complete, and it must be completed in one sitting.
 

AANA Staff Hears First-Hand CRNA Stories
During National Nurse Anesthetists Week 2013, a panel featuring AANA staff CRNAs Lorraine Jordan, CRNA, PhD, FAAN, Executive Director, AANA Foundation, Senior Director, Research; Christine Zambricki, CRNA, DNAP, FAAN, Senior Director, Federal Affairs Strategies; Francis Gerbasi, CRNA, PhD, Executive Director, Council on Accreditation of Nurse Anesthesia Educational Programs; Wanda Wilson, CRNA, PhD, Executive Director, AANA; Lynn Reede, CRNA, MBA, Senior Director, Professional Practice; and John Preston, CRNA, DNSc, Senior Director, Education and Professional Development; provided insight to staff on why they became nurse anesthetists. Read more about this event, and see how CRNAs and student registered nurse anesthetists across the country celebrated National Nurse Anesthetists Week on the Promotional Ideas, Events webpage. Be sure to send your own stories, ideas, and photos to chodson@aana.com.

Emotional Impact of Perioperative Catastrophes
Most anesthesia providers will experience a perioperative death of a patient or a major perioperative catastrophe in the course of their career. It’s important to be aware of the supportive resources that are available, see How to Cope With an Adverse Event. The Jan Stewart Speaker at Annual Meeting in Las Vegas this August is Maria Van Pelt, CRNA, MS, MSN, who’ll report on her recent study of CRNAs in the aftermath of tragedies. Van Pelt advocates for post-event procedures to lessen the potential negative impact to both emotional well-being and patient safety.

Researcher seeks information on Helen Lamb
Evan Koch, CRNA, MSN, is seeking information on Helen Lamb: “In support of my own research interest, I would like to hear your personal recollections of pioneer nurse anesthetist educator Helen Lamb. If you knew Lamb as a clinician, teacher, AANA official or otherwise, please contact me at (208) 818 9786 or Evan_Koch2000@yahoo.com."
 
 

  
 
Read the New State Update
The latest edition of the State Update has been published at: http://www.aana.com/myaana/Advocacy/stategovtaffairs/Pages/State-Update.aspx. The State Update, published four times per year, provides a snapshot of state-level legislative and regulatory issues, as well as policy developments that could potentially affect CRNAs for all 50 states. It’s an excellent resource for CRNAs who want to track nationwide trends on key issues like pain management and anesthesiologist assistants.
 
Regional Action Coalition Information on AANA Website
The Robert Wood Johnson Foundation (RWJF) has undertaken The Future of Nursing: Campaign for Action, an initiative designed to ensure that the healthcare workforce can deliver high-quality, patient-centered care to every American. A key component of this campaign is the creation of Regional Action Coalitions (RACs), whose goals, according to RWJF, are “focused on fostering interprofessional collaboration, the ability of all healthcare professionals to practice to the full extent of their education and training, strengthened nurse education and training and the increased participation of nurses as leaders.” The AANA, as part of its goal to help support CRNAs involved in RACs, has created an RAC resource page (available at: http://www.aana.com/myaana/Advocacy/stategovtaffairs/Pages/Regional-Action-Coalitions.aspx). CRNAs who want to learn more about RACs are encouraged to visit this page.
 
State Health Insurance Exchanges Webpage Offers Information on Affordable Care Act Implementation
The creation of State Health Insurance Exchanges under the federal Affordable Care Act (ACA) is ramping up. The latest figures show that 18 states (and the District of Columbia) are planning to create state-based exchanges, and at least seven other states intend to be involved in federal-state partnership exchanges (all other states will default to federally facilitated exchanges). Exchanges must have an effective initial date of coverage of Jan. 1, 2014, so these states have very little time remaining to get their systems up and running. The AANA State Health Insurance Exchanges webpage has links to information about how states are dealing with implementing the ACA. These links can help keep you informed about where your state currently is in the creation process.
 
 

 
 
Noteworthy New Documents from The Joint Commission
AANA members are encouraged to review several new resource documents and respond to an open comment survey:
 
 

 
 
 
Fixing Medicare Cuts Half as Costly as Previously Thought, Affecting Congressional Outlook
One barrier to permanently fixing the annual cycle of huge threatened Medicare Part B payment cuts for CRNA and physician services may have come down a few notches.  Because Medicare spending growth has slowed, the 10-year price tag for permanently alleviating the Medicare “sustainable growth rate” (SGR) funding formula problem has fallen, from $300 billion to $138 billion, according to a new report from the Congressional Budget Office (CBO).
 
As recently as January, Medicare Part B cuts to CRNA and physician payment totaling 27 percent were averted by last-minute congressional action, but only for one year.  Come January 2014, Medicare cuts approaching 30 percent will hit unless Congress takes action to address the problem for the short- or long-term.  The lower pricetag has helped motivate members of House healthcare committees to take the opportunity to develop long-term SGR fix legislation, draft summaries of which began circulating the week of Feb. 4.  The House Energy and Commerce Committee scheduled a hearing for Feb. 14 on SGR reform.
 
The CBO says the recent slowdown in Medicare payment growth probably won’t last, however. The wave of retiring baby boomers means that by 2023, in just 10 years, 40 percent more Americans will be eligible for Medicare benefits than are using the program today.
 
For further information, read the CBO long-term budget outlook,  a Feb. 8 framework of an SGR reform bill, and the official backgrounder for the Feb. 14 hearing.
 
Big Budget Issues Soon to Affect CRNAs, Unless Congress Acts
Automatic budget cuts from federal “sequestration” – an automatic spending reduction process so severe it was thought that Congress would do anything to avert it – appear more and more likely to strike on a March 1 deadline, as Congress and the White House stake out disparate recommendations for action.
 
For CRNAs, the greatest direct impact of budget sequestration would be an estimated 2 percent reduction in Medicare payments across the board, and cuts of approximately 9 percent to Title 8 nurse workforce development programs and to National Institutes of Health/National Institute of Nursing Research initiatives, according to the White House Office of Management and Budget. 
 
President Obama on Feb. 5 issued a recommendation that Congress temporarily forestall the impact of budget sequestration one more time, as it did Jan. 1.  The response from Capitol Hill was chilly, with House Speaker John Boehner (R-OH) expressing concern that the President’s budget proposal for FY2014 is late.
 
Kaiser Health News has summarized coverage of the health program impacts of the sequester at http://www.kaiserhealthnews.org/Daily-Reports/2013/February/11/health-programs-and-fiscal-fights.aspx
 
CRNA-PAC Kicks Off 2013 Care to be Counted Development Program
Following a record-setting 2011-2012 election cycle, the CRNA-PAC launched its 2013 Care to be Counted development campaign this month with an email to all AANA members and a refreshed Care to be Counted PAC and Grassroots website.
The campaign’s next step features the PAC’s annual telemarketing campaign, which began Feb. 12 and lasts until the end of April.  Calls will focus on upcoming cuts to CRNA reimbursement in Medicare as well as threats to CRNA scope of practice and AANA members will be asked to make a suggested contribution of a dollar a day ($365) or more to CRNA-PAC.
Check out the new Care to be Counted site at www.caretobecounted.org (requires AANA member login and password).
 
 
HHS Issues Final Rule on Physician Payment Disclosures
The Medicare agency Feb. 1 issued a final rule outlining how payments or other transfers of value from drug, device and supply companies to physicians and teaching hospitals must be publicly disclosed. The rule does not expressly apply to CRNAs and other advanced practice registered nurses, applying only to “physicians” as defined in the rule. 
 
The final rule will make information publicly available about payments or other transfers of value from certain manufacturers of drugs, devices, biologicals and medical supplies covered by Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), defined as applicable manufacturers, to physicians and teaching hospitals, which are defined as covered recipients.  According to the final rule, applicable manufacturers must report annually to the Secretary of Health and Human Services all payments or transfers of value (including gifts, consulting fees, research activities, speaking fees, meals, and travel) from applicable manufacturers to covered recipients.
 
In addition to reporting on payments, applicable manufacturers and group purchasing organizations (GPOs) must report ownership and investment interests held by physicians or their immediate family members in such entities.  All applicable manufacturers, GPOs, covered recipients, and physician owners and investors have at least 45 days to review, dispute and correct their reported information before posting it on a publicly available website.   Violators of the reporting requirements will be subject to civil monetary penalties, capped annually at $150,000 for failure to report, and $1 million for knowing failure to report.
 
CMS added that the HHS Office of Inspector General (OIG) and CMS reserve the right to audit, evaluate, or inspect applicable manufacturers and applicable GPOs for their compliance with the reporting requirements. In order to facilitate these inspections, applicable manufacturers and applicable GPOs must maintain all records and documents for at least five years from the date the payment or other transfer of value, or ownership or investment interest is published publicly on the website.
 
 

 
Medicare Proposes Regulatory Relief for Hospitals and Other Facilities
The Medicare agency Feb. 4 released a proposed rule outlining its second package of regulatory relief and reforms for hospitals, this time including critical access hospitals (CAH) and ambulatory surgery centers (ASCs), with several items of interest to CRNAs.  The proposed rule, published in the Federal Register Feb. 7, is open for public comment through early April, and the AANA is evaluating the proposal for comment on behalf of the nurse anesthesia profession.
 
Of interest to CRNAs, the proposed rule:
  • Eliminates the requirement that a physician must be onsite at a critical access hospital at least once in every two-week period, and proposes that an MD/DO would be present for sufficient periods of time to provide medical direction, consultation, and supervision for services provided in the CAH and is available through direct radio or telephone communication for consultation, assistance with medical emergencies, or patient referral.
  • Corrects a reference typo from the opt-out final rule regarding ambulatory surgical services and makes no further changes to that section.  The current rule references the opt-out process at 42 CFR §416.42(b)(2)(d).  While the current rule clearly authorizes the opt-out process, subparagraph “(d)” does not exist in the Code of Federal Regulations.  The opt-out process actually is described at 42 CFR §416.42(b)(2)(c).
  • Does not repeal physician supervision of nurse anesthetists, but it does welcome suggestions for additional reform candidates from the entire body of CoPs.
  • Makes revisions to the hospital conditions of participation (CoPs) for outpatient services so that the regulations would codify interpretive guideline changes that CMS made in November 2011 regarding the ordering of outpatient services.  One change included CRNAs and other practitioners among the list of practitioners that may be granted privileges to order respiratory care services.
  • Amends the medical staff CoP so that medical staffs are allowed to also include doctors of dental surgery or of dental medicine, doctors of podiatric medicines, doctors of optometry, and chiropractors.  It also retains the language allowing for other non-physician practitioners, such as APRNs.
  • Requires that each hospital must have its own organized and distinct medical staff distinct.
 
AANA Supports Confirmation of Marilyn Tavenner, RN, to Head CMS
The AANA has recommended that the U.S. Senate confirm Marilyn Tavenner, RN, to head the Medicare agency.  Now serving as Acting Administrator to the Centers for Medicare & Medicaid Services, Tavenner was renominated to the full Administrator post Feb. 7.
 
The AANA’s recommendation was quoted at length by CQ HealthBeat Feb. 7:  “’On behalf of the 45,000 members of the American Association of Nurse Anesthetists, I write to urge the Senate to schedule hearings and votes to confirm the President’s nominee for Administrator of the Centers for Medicare & Medicaid Services (CMS), Ms. Marilyn Tavenner,’ Janice Izlar, president of the association, wrote in a letter dated Thursday to Majority Leader Harry Reid, Minority Leader Mitch McConnell, (Finance Committee chairman) Max Baucus and Finance ranking member Orrin G. Hatch. ‘As critical as CMS is to the life and health of every American and to the fiscal state of the country, the nation’s interest is best served by the agency being led by an Administrator who carries the full responsibility and authority of the position.’” Tavenner is the first registered nurse to head the Medicare agency.
 
Name Your State Reimbursement Director
Has your state association of nurse anesthetists named its State Reimbursement Director (SRD) yet?  Now’s the time, and the breadcrumb trail for what to do and why to do it is available to state association leaders right now.
 
In September, your AANA Board of Directors approved the development of an SRD program, with the goal of representation from all 50 state associations of nurse anesthetists 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. 
 
To appoint that person in your state, state presidents should email the name and contact information of their SRD to: info@aanadc.com with the words “State Reimbursement Director” in the SUBJECT line.  To request more information about the SRD program, any AANA member may contact us at that same email address and SUBJECT line.
 
For further information, See the SRD official solicitation including a job description, the powerpoint presentation with audio from the first SRD webinar held on Jan. 31, and more CRNA reimbursement essentials (requires AANA member login and password).
 
Harkin will not run for Senate in 2014
Sen. Tom Harkin (D-IA), past winner of the AANA National Health Leadership Award, announced he is not running for reelection in 2014.  The seat will likely be a vigorous contest among the two parties’ nominees. Rep. Bruce Braley (D-IA) has already announced his intention to seek the Democratic nomination.  The GOP contest is taking shape, with early focus on Rep. Steve King (R-IA).
 
The following is an FEC required legal notification for CRNA-PAC5
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.
 
 

 
 
 

 
 
 
Spinal Anesthesia Shows Lower Post-TKA Complications, Operating Times
Patients given spinal anesthesia for a total knee arthroplasty (TKA) experienced shorter procedure times and fewer postoperative complications, according to research published in the Journal of Bone Joint Surgery, American Volume. Led by John Callaghan, MD, investigators pulled more than 14,000 TKA cases from the American College of Surgeons National Surgical Quality Improvement Database for review. The target outcome was morbidity of TKA patients in the 30 days following their surgeries. The results showed that short-term complications occurred at a rate of 15.28 percent in patients who received general anesthesia, while those who were administered spinal anesthesia experienced such problems only 11.63 percent of the time. The study showed that patients in the spinal anesthesia group also spent less time in surgery—96 minutes versus 100 minutes for those in the general anesthesia group—and were discharged from the hospital sooner—in 3.45 days compared to 3.77 days.
 
From "Spinal Anesthesia Shows Lower Post-TKA Complications, Operating Times"
Healio (02/11/2013) Pugely, A. 
 

Adductor Canal Block Versus Femoral Nerve Block and Quadriceps Strength
Continuous femoral nerve block (FNB) is often used to manage pain following knee surgery but tends to weaken the quadricep muscles, making the patient vulnerable to a fall. Adductor canal block (ACB) may provide similar analgesia but with less motor weakness—a concept that was tested in a double-blind, randomized study at the Copenhagen University Hospital. A small group of healthy male volunteers received either ACB or FNB with ropivacaine in one leg and a placebo in the other on each of two days. Their level of strength in the two muscle groups was then measured, using maximum voluntary isometric contraction (MVIC) for the quads and adductors as well as standardized ambulation tests. With a 25 percent reduction from baseline in the quads MVIC considered statistically significant, investigators had anticipated a change of 18 percent. However, the results indicated a weakening of just 8 percent with the ACB, as compared to the placebo. FNB, by comparison, weakened the quads by 49 percent. With the findings demonstrating a reduced risk of weakness and falling in ACB patients, the researchers say future studies are now needed to compare the analgesic effect of ACB against FNB.
 
From "Adductor Canal Block Versus Femoral Nerve Block and Quadriceps Strength"
Anesthesiology (02/13) Vol. 118, No. 2, P. 409 Jaeger, Pia; Henningsen, Maria H.; Hilsted, Karen Lisa; et al.
 

Bispectral Index Dynamics During Propofol Hypnosis Is Similar in Red-Haired and Dark-Haired Subjects
While earlier research has demonstrated that subjects with red hair need a greater dose of desflurane to achieve immobility, whether the same is true when propofol is used was unknown. The intravenous anesthetic was administered to 29 healthy red- and dark-haired volunteers, and Bispectral Index (BIS) was used to gauge the effect of the drug on them. Although investigators had anticipated that the redheads would require at least 50 percent more propofol concentration than the dark-haired group, the results indicated that red hair does not influence the pharmacokinetics or pharmacodynamics of the drug.
 
From "Bispectral Index Dynamics During Propofol Hypnosis Is Similar in Red-Haired and Dark-Haired Subjects"
Anesthesia & Analgesia (02/13) Vol. 116, No. 2, P. 319 Doufas, Anthony G.; Komatsu, Ryu; Lauber, Rolf; et al.
 

Sympathetic Nervous System Implicated in Acupuncture Analgesia
A randomized study reported in Acupuncture in Medicine indicates that acupuncture seems to activate the sympathetic nervous system (SNS) in people who are in pain. Researchers recruited 36 healthy adults who completed an exercise protocol designed to created delayed-onset muscle pain in the nondominant forearm. Forty-eight hours after completing the protocol, the participants returned and were randomly assigned to one of three groups: no treatment, one 15-minute session of acupuncture with penetrating needles, or a single session of non-penetrating sham acupuncture. Three gauges of SNS activation—skin conductance, skin temperature, and perfusion—were monitored before, during, and after treatment. In the group that received acupuncture, skin conductance increased significantly within five minutes of starting acupuncture and returned to baseline levels by 10 minutes after the end of acupuncture, while both ipsilateral and contralateral distal skin temperature decreased 5 minutes after starting treatment and throughout the recovery phase. By contrast, neither of these measures of SNS activation changed for the other groups. The research team concluded that the SNS is activated in response to acupuncture and presents an increase that is mediated systemically instead of locally. "Further study into the response of the SNS to acupuncture is required to enhance understanding of acupuncture analgesia," the investigators concluded.
 
From "Sympathetic Nervous System Implicated in Acupuncture Analgesia"
News-Medical (02/06/13) Lyford, Joanna 
 
Immunomodulatory Effects of Total Intravenous & Balanced Inhalation Anesthesia in Patients With Bladder Cancer Undergoing Elective Radical Cystectomy 
Although surgery and anesthesia are known to trigger immunosuppression, it remains largely unknown whether various anesthetic approaches have different immunosuppressive effects on cancer patients. Researchers designed a study to examine the influence of total intravenous anesthesia with target-controlled infusion (TIVA-TCI) and balanced inhalation anesthesia (BAL) on the perioperative levels of inflammatory cytokines and regulatory T cells (Tregs) in patients with bladder cancer who were undergoing radical cystectomy. A total of 28 consecutive patients fitting the intended study parameters were prospectively randomized into two groups to receive TIVA-TCI or BAL. Preliminary results showed that during the perioperative period, all cancer patients displayed a marked and significant increase in interleukin -6. The TIVA-TCI patients also showed a higher increase in interferon-gamma, while the BAL patients displayed Tregs that were reduced by approximately 30 percent. The conclusion is that TIVA-TCI and BAL both can be used in major surgery in patients with bladder cancer without risking a more negative outcome.
 
From "Immunomodulatory Effects of Total Intravenous & Balanced Inhalation Anesthesia in Patients With Bladder Cancer Undergoing Elective Radical Cystectomy"
7thSpace (02/03/13); et al.
 
Registry Sheds Light on Poor Outcomes of Nerve Blocks
The practice of regional anesthesia has made great strides over the years but is still associated with some adverse outcomes, which must be recognized and addressed in order for patient safety to see improvement. The complications range from epidural abscesses, spinal hematoma, and meningitis to neurologic damage—although these problems are few and far between. Based on one national database including outcomes from more than a million spinal blocks and about 450,000 epidural blocks, the rate of complications is one per 20,000 to 30,000 blocks. Speaking at the American Society of Regional Anesthesia and Pain Medicine's spring meeting last year, Michael Barrington, MD, noted that determining whether anesthetic or surgical factors triggered a complication can be tricky. An anesthesia provider at St. Vincent's Hospital in Melbourne, Australia, Barrington's own research suggests that patients with comorbidities are most likely to experience negative events after a nerve block. "So perhaps we should pay more attention to those patients with increased risk factors and think about changing the way we administer anesthetic to them," he suggested. Barrington's campaign to launch a collaborative standardized registry has pooled a large volume of data, according to Jeff Gadsden, MD, director of regional anesthesia at New York City's St. Luke's-Roosevelt Hospital. He believes the information ultimately will produce a greater understanding of poor outcomes tied to regional anesthesia and also drive changes at the practice level. "For example, will a reduction in the concentration of local anesthetics for 'at-risk' patients prevent injury?" he wonders. "This is an exciting topic for regional [anesthesia provider] and large, global registries such as these will be invaluable in aiding our understanding of these potentially catastrophic complications."
 
From "Registry Sheds Light on Poor Outcomes of Nerve Blocks"
Anesthesiology News (02/01/13) Vol. 39, No. 2 Vlessides, Michael 
 

February Anesthesiology Studies Address the Relief of Pain in Patients After Breast Cancer Surgery and in Labor
Pain relief for women is the focus of a pair of studies published in the February issue of Anesthesiology, one of which looks at the correlation between the type of analgesia provided after breast cancer surgery and the development of chronic pain. The other analyzes the association between the topical drug capsaicin and pain during childbirth. For the first study, French researchers explored the effectiveness of local anesthetic wound infiltration after breast surgery on chronic pain. The findings revealed that the technique was able to lower the incidence of acute pain in patients by half in the first 48 hours after surgery but failed to decrease the incidence of chronic pain at three months. The results are contrary to other research that has suggested a link between the severity of acute postoperative pain and the risk of developing chronic postsurgical pain. In the second study, the role that topical application of capsaicin to the uterine cervix plays in the reduction of labor pain and the expedition of delivery in mice was examined, as was the impact of capsaicin on labor pain behaviors and labor progress. The American and Lebanese investigators concluded that, in the absence of analgesia there was a statistically significant increase in pain behaviors during labor compared to after delivery, which is consistent with that idea of labor in mice being painful. It was also found that when applied days before delivery, capsaicin reduced these labor pain behaviors. "Capsaicin may emerge as a new, minimally invasive, natural adjunct to the medical induction of labor, one of the most commonly performed obstetrical procedures worldwide," speculated study author Fadi Mirza, MD. "In addition, there is a potential global role of capsaicin, particularly in regions with limited access to analgesia and labor-induction agents."
 
From "February Anesthesiology Studies Address the Relief of Pain in Patients After Breast Cancer Surgery and in Labor"
Newswise (01/23/13)
 

Intubation Success With Ketamine Comparable to Etomidate
While etomidate currently is the standard choice of sedative in emergency rooms, ketamine is being looked at more often for rapid-sequence intubation. Etomidate takes effect quickly, lasts only for a short period, and has minimal impact on the cardiopulmonary system, but some evidence also suggests that it can lead to adrenal suppression—which, in turn, can increase mortality in septic patients. "Ketamine would be a good alternative," believes Asad Patanwala, PharmD, of the University of Arizona's Department of Pharmacy Practice and Science. Patanwala led a team in evaluating more than 1,500 rapid-sequence intubations and reported the findings at the Society of Critical Care Medicine 42nd Critical Care Congress. Intubation was achieved on the first attempt 75 percent of the time when etomidate was used but 83 percent of the time with ketamine. However, upon adjustment for variables such as gender, trauma status, and more, type of sedative was not predictive of first-attempt intubation success. Moreover, it has been reported that some patients intubated with ketamine experienced rapid cardiovascular compromise. "Some compelling scenarios that might lean a clinician toward the selection of ketamine for rapid-sequence intubation could include sepsis or, if you don't have intravenous access or have that out-of-control patient, ketamine can be given intramuscularly," noted co-investigator Courtney McKinney, MD, of the Intermountain Medical Center in Murray, Utah. "... If you're faced with an etomidate shortage, you can also feel confident in reaching for ketamine."
 
From "Intubation Success With Ketamine Comparable to Etomidate"
Medscape (01/28/13) Melville, Nancy A. 
 
Deep Sedation Used in 8.7 Percent of Routine Colonoscopies
According to an article published in Gastroenterology, use of anesthesia assistance for routine colonoscopy varies markedly by region across the United States and is not associated neither with lower complication rates nor higher polyp detection rates. Overall, deep sedation is applied in 8.7 percent of colonoscopies. Researchers identified the factors predicting the use of anesthesia assistance as African-American ethnicity, female sex, a nonscreening indication for the procedure, and non-hospital site of service. The patient's median income and presence of comorbidities also increased the use of anesthesia assistance. It was also found that physician attributes mattered, as general and colorectal surgeons and endoscopists with fewer years in their practice were significantly associated with increased use of anesthesia assistance. According to the researchers,"Use of anesthesia assistance didn't alter the rate of detection of colonic polyps or the rate of complications such as GI bleeding, perforation, and hospital/ED visits within 30 days."
 
From "Deep Sedation Used in 8.7 Percent of Routine Colonoscopies"
Outpatient Surgery (01/30/13) Wasek, Stephanie
 
 

Hospitals Report Reductions in Some Types of Health Care-Associated Infections
A new report from the Centers for Disease Control and Prevention (CDC) shows that hospitals are making strides in the battle against some types of healthcare-associated infections. The study—which used 2011 data from the National Healthcare Safety Network—found a 41 percent reduction in central line-associated bloodstream infections since 2008, an increase from the 32 percent decline reported in 2010, with progress seen in intensive care units (ICUs), wards, and neonatal ICUs in all reporting facilities. In addition, there was a 17 percent reduction in surgical site infections since 2008, up from a 7 percent decline in 2010; however, the increase was not seen for all procedure types. Health officials also saw a 7 percent decline in catheter-associated urinary tract infections since 2009, the same percentage recorded in 2010. Of particular concern are catheter-associated urinary tract infections in ICU patients, as they are more likely to require antibiotics—which can help treat bacterial infections but can also put patients at risk for complications, such as severe diarrhea caused by Clostridium difficile. CDC Director Tom Frieden, MD, called the reductions in some of the healthcare-associated infections "encouraging" but said the "report also suggests that hospitals need to increase their efforts to track these infections and implement control strategies that we know work."
 
From "Hospitals Report Reductions in Some Types of Health Care-Associated Infections"
CDC News Release (02/12/13)
 
 

FDA Convenes Hearing on Pain-Pill Labels
The U.S. Food and Drug Administration (FDA) held a two-day public hearing on opioid painkillers as the agency considers a petition by a group of 35 doctors and pain specialists to modify the painkillers' labels. The petition recommends the inclusion of the upper daily dose on the label and to reduce the duration of opioid treatment to 90 days. Doctors also indicate the drugs should be indicated for "severe," and not just "moderate," pain. Relatives of overdose victims also support the changes, though some pain patients say the changes could limit their access to the drugs. The Centers for Disease Control and Prevention reported more than 16,000 opioid overdose deaths in 2010, higher than the number of deaths from heroin, cocaine, and other illegal drugs combined. IMS Health reports the generic version of Vicodin is the most widely prescribed drug in the United States, and while doctors say opioids are effective in treating acute pain, there is little evidence to suggest they are effective and safe for long-term use.
 
From "FDA Convenes Hearing on Pain-Pill Labels"
Wall Street Journal (02/08/13) P. B6 Catan, Thomas
 
 

Teva to Resume Propofol Production
Teva Pharmaceutical Industries reportedly is resuming production of propofol, which is in short supply, and plans to have product ready for distribution by the end of February. The manufacturer stopped making propofol in 2010 in the wake of legal troubles following a hepatitis C outbreak in Las Vegas caused by unsafe practices at several endoscopy centers, including the reuse of syringes to access vials of propofol and the reuse of vials on subsequent patients. It is reported that Teva paid more than $250 million to settle 80-plus lawsuits, which had accused the company of trying to increase propofol-related profits by discontinuing the sale of 10mL vials in favor of larger vials that prompted physicians to reuse the drug several times.
 
From "Teva to Resume Propofol Production"
Outpatient Surgery (01/29/13) Cook, Daniel 
 
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