Anesthesia E-ssential February 28, 2014

 
Anesthesia E-ssential

February 28, 2014

 

Vital Signs

AANA Election Slate Announced
The AANA Nominating Committee, after completing candidate deliberations at its February meeting, has announced the slate of candidates for the upcoming election of the AANA Board of Directors, Nominating, and Resolutions Committee members. Click here for the complete slate of candidates and further information about the upcoming elections. (Member login and password required.) The order of names on the ballot was determined through the use of a random number generator by the Nominating Committee. Those elected will begin their fiscal year 2015 terms of office at the conclusion of the 2014 AANA Nurse Anesthesia Annual Congress in Orlando, Fla.
 
 
Online Forum for Candidates for the AANA Board of Directors
The Online Forum for Candidates for the AANA Board of Directors will become available to members for question submission two weeks prior to the Mid-Year Assembly (March 24, 2014). This un-moderated forum will be located in the members-only section of the AANA website. All AANA members will be able to submit questions to the Forum during the voting cycle. The forum will be available for viewing until the voting cut-off date of May 20, 2014.
 

 

The Pulse

 
  • New Board-Approved Document Now Available: Considerations for Adding New Activities to Individual CRNA Scope of Practice
  • Etomide Injection 2mg/mL Recall
  • MBSAQIP Releases Accreditation Standards for Bariatric Surgery Centers
  • For Patient Safety Awareness Week, NPSF Urges Public to Navigate Your Health…Safely
  • AANALearn: Discounts on Patient Safety Courses in March
  • AANA Recognition Awards Nominations Due March 15
  • AANA Student Writing Contest Deadline is April 1
  • Anesthesia College Bowl Deadline is April 15
  • CRNAs Needed for College Bowl Challenge Team
 
  • Business of Anesthesia
  • NEW AANA Workshop: Foundations of Advanced Pain Management
  • AANA 2014 Nurse Anesthesia Annual Congress
  • AANA Essentials of Obstetric Analgesia/Anesthesia Workshop
 
  • AANA Foundation: Call for Board Members
 
  • California Ballot Initiative Seeks to Raise Limit on Medical Malpractice Non-Economic Damages
  • New Hampshire Tax Ruled Unconstitutional
 
  • AANA, APRN Groups Support Bipartisan Legislation to Repeal “Sustainable Growth Rate” Cuts, Reform Medicare Payment
  • Physician Groups Press 46 House Members to Express Concerns about Veterans Administration Recognizing CRNAs and Other APRNs to their Full Scope
  • Federal Trade Commission to Hold Workshop on Competition in Healthcare March 24-25, including Focus on Licensure of Healthcare Professionals
  • Register Now for 2014 AANA Mid-Year Assembly
  • Unveiling the New www.crna-pac.com
  • 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
New Board-Approved Document Now Available: Considerations for Adding New Activities to Individual CRNA Scope of Practice
CRNAs, state boards of nursing, legislators, regulatory agencies, healthcare payers, accreditors, facility administrators, and other interested parties often look to the AANA for guidance regarding nurse anesthesia scope of practice. At the Assembly of School Faculty, the Board of Directors approved the document titled, “Considerations for Adding New Activities to Individual CRNA Scope of Practice.” This document is intended to provide CRNAs and others with a tool to conduct an analysis to clarify whether a specific procedure or technique is related to anesthesia and within the individual CRNA’s scope of practice. This document can be downloaded from the Professional Practice Documents webpage.
 
 
Etomide Injection 2mg/mL Recall
Mylan Inc. has announced that its subsidiary Agila Specialties Private Limited is conducting a voluntary nationwide recall to the hospital/user level of 10 lots of Etomidate Injection 2 mg/mL – 10 mL and 20 mL. The product was recalled due to the potential for small black particles, identified as paper shipper labels, to be present in individual vials; the potential for missing lot number and/or expiry date on the outer carton, and the potential for illegible/missing lot number and expiry on individual vials. The affected lot numbers and more information can be found in the press release.
 
 
MBSAQIP Releases Accreditation Standards for Bariatric Surgery Centers
The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (the joint accreditation program of the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery) released new standards that are positive for CRNAs. The new anesthesia standard requires the facility to develop anesthesia protocols compliant with local and state laws. Read page 29 of the Resources for Optimal Care of the Metabolic and Bariatric Surgery Patient 2014.
 
 
For Patient Safety Awareness Week, NPSF Urges Public to Navigate Your Health… Safely
Navigate Your Health…Safely, the theme for Patient Safety Awareness Week, March 2-8, 2014, highlights the need for healthcare providers to ensure that patients and consumers are more engaged in the healthcare process, whether they are visiting the doctor for a routine exam or entering the hospital for surgery. Initiated by the National Patient Safety Foundation (NPSF) in 2002, Patient Safety Awareness Week is an annual education and awareness campaign for healthcare safety. For Patient Safety Awareness Week 2014, NPSF has teamed up with the Society to Improve Diagnosis in Medicine (SIDM) to develop and disseminate educational materials for clinicians, health systems, and patients and consumers specifically related to better understanding and prevention of diagnostic errors. For more information on Patient Safety Awareness Week and to view the educational materials, visit www.npsf.org.

 



 
Discounts on Patient Safety Courses in March
In support of Patient Safety Awareness Week, AANA’s Online Continuing Education resource, AANALearn, is featuring the following courses on some of the most common patient safety challenges at a 40 percent discount during the month of March:
  • Infection Control: It’s Everyone’s Business (1 CE credit)
  • What Can the CRNA do to Improve Medication Safety and Decrease Cost in the OR? (2 CE credits)
Click here for more information.
 
 
AANA Recognition Awards Nominations Due March 15
Nominations are being sought for the following awards, which will be presented during the AANA 2014 Nurse Anesthesia Annual Congress: the Agatha Hodgins Award for Outstanding Accomplishment, the Helen Lamb Outstanding Educator Award, the Alice Magaw Outstanding Clinical Practitioner Award, the Ira P. Gunn Award, the Clinical Instructor of the Year Award, the Didactic Instructor of the Year Award, and the Program Director of the Year Award. For information, visit the AANA website at www.aana.com/awards.
 
 
AANA Student Writing Contest Deadline is April 1
Each year, the AANA Education Department accepts Student Writing Contest papers between January 1 and April 1. Only students are eligible to enter the contest. For a complete set of contest rules, click here. All manuscripts and related documents must be submitted to the AANA Education Department at education@aana.com by April 1. 
 
 
Anesthesia College Bowl Deadline is April 15
Each school is encouraged to submit one student to be selected at random for participation in the 25th Annual Anesthesia College Bowl, which will be held during the 2014 Nurse Anesthesia Annual Congress. Applications can be obtained from your program director, through the AANA Education Department at education@aana.com or here on the AANA website.
 
 
CRNAs Needed for College Bowl Challenge Team
Deadline: April 15
The Annual Anesthesia College Bowl at the AANA Annual Meeting will once again be the site of a stirring contest between the 2014 Student Champion Team and a CRNA Challenge Team. Don’t be afraid to show off your brainpower and volunteer to be on the CRNA Challenge Team! Contact the Education Department for an application at education@aana.com.
 
 

 

Meetings and Workshops

 
Business of Anesthesia
Save the Date: The AANA Business of Anesthesia Workshop addresses critical business issues facing CRNAs and will be held July 12 in Chicago, Ill. Whether you are employed or have your own business, this workshop has the necessary information to help you navigate the changing business environment in healthcare. Watch for registration information coming soon.
 
 
NEW AANA Workshop: Foundations of Advanced Pain Management
AANA’s newest workshop, Foundations of Advanced Pain Management, will be held June 6-9, 2014, at the Regional Medical Center, Manchester, Iowa. Interventional pain management is an area of practice that demands critical assessment and knowledge to provide proper and precise treatment interventions to maximize positive patient outcomes. Foundations of Advanced Pain Management offers CRNAs practical, didactic, and hands-on content to support their practice is advanced pain management. Register now.
 
 
AANA 2014 Nurse Anesthesia Annual Congress
The AANA 2014 Nurse Anesthesia Annual Congress will be held Sept. 13-16 in Orlando, Fla. Registration opens March 3. Look for the preliminary program in the March NewsBulletin.
 
 
AANA Essentials of Obstetric Analgesia/Anesthesia Workshop
The AANA Essentials of Obstetric Analgesia/Anesthesia Workshop will be held April 30, 2014 in Park Ridge, Ill. Pain management remains a concern for women during labor. The relationship between the patient and the CRNA anesthesia provider is critical in the experience. AANA’s Essentials of Obstetric Analgesia/Anesthesia Workshop will address normal and abnormal physiology of pregnancy as well as pharmacology and current techniques in this specialty. Register now.
 
 

  
 
AANA Foundation: Call for Board Members
Application Deadline: April 1, 2014
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. The ideal candidate enjoys fundraising and possesses expertise in research. The criteria are as follows:
  • 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:
    • Cover letter describing why you wish to be an AANA Foundation Board member
    • CV
    • Completed Nomination Application for AANA Foundation Board of Trustees
    • Completed 2014 Nominee Profile Form
To apply, click here to access the application and nominee profile form, and forward completed forms via email to foundation@aana.com. Include “Board Trustee Application” in the subject line of your mail. If you have any questions, please contact the Foundation at (847) 655-1170 or foundation@aana.com.
 
 

 
 
 
California Ballot Initiative Seeks to Raise Limit on Medical Malpractice Non-Economic Damages
Since 1975, California has had a $250,000 limit on medical malpractice non-economic damages (also known as "pain and suffering"). A ballot initiative has been proposed that would raise the limit to account for inflation since then - meaning the cap would go up to approximately $1.1 million (conversely, adjusting for inflation, the 1975 cap of $250,000 is worth less than $58,000 in 2014 dollars). The initiative would also automatically adjust the cap in the future to account for inflation. Healthcare providers and insurance companies say the limits have kept healthcare costs down, and changing the law may put many small clinics out of business. According to the Los Angeles Times, supporters of the initiative have raised $1.7 million so far, while groups opposed to changing the cap have raised more than $33 million. 
 
 
New Hampshire Tax Ruled Unconstitutional
A New Hampshire Medicaid Enhancement Tax on hospitals has been ruled unconstitutional by a state superior court judge. The law taxes hospitals on patient service revenues, but when the same services are provided by non-hospitals (for example, at an ASC or in-office), they are not taxed. The court stated that the law created an “unconstitutional classification of taxpayers” and that hospitals cannot be treated different than other businesses for tax purposes. It is likely that the state will appeal this decision to the New Hampshire Supreme Court.
 
 

 
 
 
AANA, APRN Groups Support Bipartisan Legislation to Repeal “Sustainable Growth Rate” Cuts, Reform Medicare Payment
As part of a coalition of 10 APRN organizations, the AANA expressed support for bipartisan legislation pending in Congress (H.R. 4015 / S. 2000) repealing Medicare “sustainable growth rate” (SGR) cuts and reforming Medicare payment, through a letter sent to Congress Feb. 25.
 
“In the interest of the patients for whom we provide care, we strongly support Congress moving to enact this needed legislation, and for it to recognize APRNs the same as physicians in the development and implementation of quality measures for payment incentives,” the letter stated.
 
AANA and APRN groups have been working for months on Capitol Hill to enact legislation repealing the SGR cuts that threaten CRNA and physician Medicare payment with 24 percent reductions April 1. The coalition has also been working to ensure that Medicare payment reforms, such as linking payment to quality measures and quality improvements, treat APRNs the same as physicians. Most of the legislation meets that standard, the letter said, but some improvements can still be made.
 
The APRN-backed legislation omits one important matter that a final bill must include: funding to pay its $140-150 billion cost. Until its funding is settled, Congress continues work on this issue—and AANA will continue working to protect and advance the interests of the patients for whom CRNAs provide care.
 
 
Physician Groups Press 46 House Members to Express Concerns about Veterans Administration Recognizing CRNAs and Other APRNs to their Full Scope
A campaign by the American Society of Anesthesiologists (ASA) and other medical societies pressed some 46 members of the U.S. House of Representatives to write the Veterans Health Administration (VHA) expressing concern about the agency’s plan to recognize CRNAs and other APRNs as full practice providers.
 
“Because this proposal represents a significant change from the current care delivery procedures within VHA, it must be closely examined to ensure that there are no unintended consequences which could have a detrimental impact on our veterans’ health care services,” said the letter circulated by Reps. Michael Grimm (R-NY) and Ann Kirkpatrick (D-AZ) to Secretary of Veterans Affairs Eric Shinseki.
 
However, the letter included numerous misstatements, chief among them that recognizing CRNAs and other APRNs as full-practice providers would “override the current and longstanding Anesthesia Service Handbook” governing anesthesia services in the VHA. It does not. Previous versions of the “Grimm-Kirkpatrick” letter circulating on Capitol Hill attacked the safety of APRN services outright. Following the objections of more than 10,000 CRNA and APRN messages to Capitol Hill, the final letter reduced but did not eliminate such material.
 
The AANA continues working in Washington to promote VHA recognition of CRNA and APRN services to their full scope, having secured support from dozens of members of Congress, the AARP, and more than 50 nursing organizations. AANA members attending Mid-Year Assembly, April 5-9, 2014, in Washington, will have the opportunity to learn more about the issue and then to educate members of Congress about it directly on Capitol Hill.
 
Read the Grimm-Kirkpatrick letter here and what ASA President Jane Fitch, MD, told her society’s members about it at https://www.asahq.org/For-Members/Advocacy/Washington-Alerts/A-Message-from-ASA-President-Jane-Fitch-regarding-the-VA-APRN-Independent-Practice-Initiative.aspx.
 
 
Federal Trade Commission to Hold Workshop on Competition in Healthcare March 24-25, including Focus on Licensure of Healthcare Professionals
Competition in healthcare is the topic of a new workshop being hosted by the Federal Trade Commission March 24-25 in Washington, and several of the areas of review have deep interest for CRNAs.
 
Published by the FTC Feb. 14 and in the Federal Register Feb. 25, the workshop will focus on professional regulation of healthcare providers, innovations in healthcare delivery, advancements in healthcare technology, measuring and assessing quality of healthcare, and price transparency of healthcare services. As providers of high-quality anesthesia and pain management services who nonetheless find their practice challenged and constrained by medical community competitors, the AANA and CRNAs will be following these proceedings closely and offering expert public comments representing the profession.
 
 
Register Now for 2014 AANA Mid-Year Assembly
To make your voice and the voice of CRNAs strong in Washington, register now for AANA Mid-Year Assembly, April 5-9, 2014, in Arlington, Va.
 
 
Unveiling the New www.crna-pac.com
The CRNA-PAC has promised a new look, new openness to members, and new services as part of a top-to-bottom renovation of its development campaign in 2014. On March 3, the first phase of this renovation for members comes into view with the unveiling of the CRNA-PAC’s new website, at www.crna-pac.com.
 
“Our new site provides members the information they’ve been looking for on issues we’re advancing on Capitol Hill, and recognizes AANA members for their own individual investment in our profession through support of CRNA-PAC and engagement in our advocacy programs,” said CRNA-PAC Committee Chair Paul Beninga, CRNA, MS.
 
While the new www.crna-pac.com site works for AANA members day and night, and requires members to enter their regular AANA member website login and password to access it, the CRNA-PAC is preparing to unveil the next phases of its 2014 campaign in mid-March. Email outreach and educational information will encourage AANA members to renew their membership in CRNA-PAC, and phone calls to motivate past donors begin closer to April 1.
 
“Our PAC is by far the largest PAC in nursing and one of the largest among all healthcare professional organizations,” said Beninga, “but the ASA-PAC is twice our size, and the share of our membership giving to CRNA-PAC is down to 8 percent—one out of 12. If more members support the CRNA-PAC, we will have the stronger voice on Capitol Hill that we need in a time of fiscal constraint, turmoil in the healthcare industry, and intensifying opposition to our full scope of practice from the medical community.”
 
 
The following is an FEC required legal notification for CRNA-PAC: Gifts to political action committees are not tax deductible. Contributions to CRNA-PAC are for political purposes. All contributions to CRNA-PAC are voluntary. You may refuse to contribute without reprisal. The guidelines are merely suggestions. You are free to contribute more or less than the guidelines suggest and the association will not favor or disadvantage you by reason of the amount contributed or the decision not to contribute. Federal law requires CRNA-PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. Each contributor must be a US Citizen.
 
 

 
 
 

 
 
 
Acetaminophen Use During Pregnancy, Behavioral Problems, and Hyperkinetic Disorders
Children whose mothers used acetaminophen during pregnancy may have a higher risk of developing hyperkinetic disorders (HKDs) and attention-deficit/hyperactivity disorder (ADHD)-like behavior. Past data suggests that the pain medication acetaminophen is a hormone disrupter that could influence fetal brain development. In a new study, researchers looked at 64,322 children and mothers who were enrolled in the Danish National Birth Cohort during 1996-2002. More than half of all mothers reported some use of acetaminophen during pregnancy. Children whose mothers used acetaminophen during pregnancy were at higher risk for receiving a hospital diagnosis of HKD, using ADHD medications, or having ADHD-like behaviors at age seven years. There were stronger associations observed when acetaminophen was used in more than one trimester.
 
From "Acetaminophen Use During Pregnancy, Behavioral Problems, and Hyperkinetic Disorders"
JAMA Pediatrics (02/24/2014) Liew, Zeyan; Ritz, Beate; Rebordosa, Cristina; et al.
 
 
 
Many Seniors Get Painkillers From Multiple Doctors
After combing a database of 1.8 million Medicare Part D patients who filled at least one opioid prescription in 2010, researchers at Harvard Medical School determined that more than 40 percent of them received narcotics from more than one healthcare provider. About 23 percent had prescriptions from two doctors, nearly 10 percent from three providers, and almost 8 percent filled orders from four or more doctors. According to the findings, patients given prescription narcotics from multiple providers were much more likely to be admitted to the hospital for complications from the drugs—including respiratory depression, drowsiness, and injuries from falling. "Our findings not only highlight the dramatic prevalence of multiple provider opioid prescribing among elderly and disabled people but, more importantly, show the adverse health outcomes associated with this fragmented prescribing," said study author Anupam Jena, a physician at Massachusetts General Hospital. He emphasized the importance of physicians warning patients about the dangers of receiving opioids from more than one provider.
 
From "Many Seniors Get Painkillers From Multiple Doctors"
American News Report (02/20/14) Anson, Pat
 
 
 
CT Study Shows Anesthetic Spread Similar for Low, High Pressure Injections
Building on earlier research showing a correlation between high-pressure anesthesia injections and nerve damage, an international team of investigators used computed tomography (CT) to examine the effect of injection pressure on the spread of injectate. The study involved nine volunteers, each of whom received a low-pressure injection of less than 15 psi in the right interscalene space and a higher-pressure injection of greater than 20 psi in the left. While the spread of injectate was similar in both applications, high-pressure injections triggered more patient discomfort and, in at least one case, led to significant epidural spread. "With our imaging approach, we demonstrated that low-pressure injections are more comfortable for patients and may have less risk for spread into the epidural space, possibly resulting in high neuroaxial block," said lead researcher Philippe Gautier, MD, of Brussels. He conceded uncertainty over whether the results would be duplicated for a larger range of pressures. It also is unclear, according to Jeff Gadsden, MD, director of regional anesthesia at New York City's St. Luke's-Roosevelt Hospital Center, "if this phenomenon would translate to other block sites ... where surrounding connective tissue and muscle planes are different." He was not involved in the research.
 
From "CT Study Shows Anesthetic Spread Similar for Low, High Pressure Injections"
Anesthesiology News (02/01/01) Vol. 40, No. 2 Dunleavy, Brian P.
 
 
 
Study: Regional Anesthesia Does Not Increase Chance of Falling
A study published in the March issue of Anesthesiology found that the chances of suffering a fall following knee replacement surgery are no greater when patients receive epidurals or peripheral nerve blocks than when they do not. While popular opinion has held that regional anesthesia for this procedure may cause motor weakness that increases the likelihood of a fall in the first days following surgery, the new research refutes this belief. It even suggests that patients can experience better pain control and faster rehabilitation with fewer complications if they receive neuraxial anesthesia and blocks instead of general anesthesia. Lead author Stavros Memtsoudis, MD, PhD—professor of anesthesiology at the Hospital for Special Surgery in New York City—said, "We found that not only do these types of anesthesia not increase the risk of falls, but also spinal or epidural anesthesia may even decrease the risk compared to general anesthesia." The findings, based on just shy of 200,000 patient records, "suggest that fear of in-hospital falls is not a reason to avoid regional anesthesia for orthopedic surgery," Memtsoudis concluded.
 
From "Study: Regional Anesthesia Does Not Increase Chance of Falling"
Outpatient Surgery (02/19/14) O'Connor, Dan
 
 
 
Dose of Oxytocin Is Associated With Higher Epidural Drug Consumption
New findings suggest that labor is more painful for women who receive higher doses of oxytocin to induce or augment labor. Obstetric anesthesiologist Andrew Geller, MD, led the study, which discovered that women who received higher doses of the drug during childbirth required more epidural analgesic than those who did not. In a retrospective review of 216 charts from first-time laboring women who received oxytocin for labor augmentation in 2008, the team compared administration of oxytocin before delivery as calculated by area under the curve (AUC) with epidural drug consumption calculated in the same manner. The researchers compared oxytocin AUC in quartiles of exposure with the hourly epidural rate and found that increasing quartile oxytocin AUC was associated with increasing total epidural use in the augmented patients. Additionally, Geller noted that the rate of cesarean delivery nearly doubled between oxytocin exposure quartile 1 and quartile 4, although the interquartile rates were not statistically significant. Geller said that he and his colleagues want to compare epidural use and pain management requirements of women who do not receive oxytocin before delivery with the epidural use and pain management requirements of those who did have augmented delivery.
 
From "Dose of Oxytocin Is Associated With Higher Epidural Drug Consumption"
Pain Medicine News (02/19/2014)
 
 
 
Sedation Before Nerve Block Increases Risks, Not Pain Relief
New findings suggests that sedating patients before administering a nerve block that is needed to diagnose or treat chronic pain significantly boosts the odds of a false-positive result, increasing the chances that the patient will undergo unnecessary surgery. Moreover, said lead research Steven Cohen, MD, "Sedation doesn't help, but it does add expense and risk." Research suggests that this method "should be used very sparingly," he added. Along with investigators from several other U.S. medical centers, Cohen—an anesthesiology professor at Johns Hopkins University—recruited 73 patients with back or limb pain who were scheduled to receive multiple nerve blocks. Half were given the first block with sedation and the second without, while the other patient group received the first block without sedation and the second with. All patients were asked to rate their satisfaction in six-hour pain diaries and were seen a month later to gauge their pain and function. The results showed that while sedated, patients reported less pain immediately after the nerve block injection; on every other metric, the results were the same, indicating that the costly treatment had "very little benefit."
 
From "Sedation Before Nerve Block Increases Risks, Not Pain Relief"
HealthCanal.com (02/16/14)
 
 
 
Ice Packs Shrink Post-Op Pain, Narcotic Use
While earlier studies have demonstrated the benefit of cryotherapy in alleviating pain following gynecologic, hernia, and orthopedic operations, new findings suggest that applying ice packs can be helpful after abdominal surgery as well. The research involved 55 abdominal surgery patients who had midline incisions. Patients in the control group, 28 in all, were given only morphine after their procedures; the remaining 27 study participants were given ice packs—not to be applied for longer than 30 minutes per hour—for a minimum of 24 hours. Patients in the cryotherapy group not only reported significantly lower postoperative pain scores on the first and third days after surgery, they also required less narcotic medication the day after their procedures. In addition, said study co-author Viraj Master, MD, PhD, there were no adverse events associated with the cryotherapy regimen; and the ice packs are economical. "I don't think this is some kind of 'miracle' remedy," Master emphasized, "but it's one more component in the armamentarium that healthcare providers can use to treat pain."
 
From "Ice Packs Shrink Post-Op Pain, Narcotic Use"
Anesthesiology News (02/01/14) Vol. 40, No. 2 Guarino, Ben
 
 
 
No Added Benefit in Pain Relief Seen With Axillary Nerve Block After Elbow Surgery
Based on research published in the Journal of Shoulder and Elbow Surgery, axillary nerve blocks do not offer improved control over postoperative pain in patients following arthroscopic elbow surgery. Thirty-six patients who had the procedure under general anesthesia were randomly assigned to receive either axillary nerve block (Ax group) or portal site injections of a local anesthetic (Lo group). The researchers assessed patient satisfaction, amount of oral analgesics, and pain scores at 12 hours, 24 hours, and 48 hours after the surgery. There was no time point after the surgery where the researchers observed any intergroup differences between the Ax and Lo groups, and the study results indicated that both groups had a mean overall patient satisfaction score of 91. Takuro Wada, MD, and colleagues wrote, "Postoperative pain levels after arthroscopic elbow surgery could be well managed with oral analgesics and local anesthetic. An axillary nerve block was not found to provide any postoperative pain control benefits."
 
From "No Added Benefit in Pain Relief Seen With Axillary Nerve Block After Elbow Surgery"
Healio (02/14/2014) Wada, T.
 
 
 
Harnessing the Herpes Virus to Precisely Target Pain
Anesthesiology researchers at the University of Miami are manipulating the herpes simplex virus (HSV)—tapping into its predilection for neurons—in an effort to rewrite pain signals at the source. Using HSV's sizable genome, which accommodates a relative large "payload" of genetic instructions, anti-nociceptive neuromodulating molecules are delivered directly to the dorsal root ganglia to treat chronic pain. Because the virus remains latent after it enters the neurons of sensory ganglia, the gene transfer can take place without the risk of an immune system reaction. Invented by David Fink, MD, of the University of Michigan; Joseph Glorioso, PhD, of the University of Pittsburgh; and their colleagues at Periphagen Holdings, the approach has had success in animal models and early trials of cancer patients. Roy Levitt, MD, one of the Miami researchers, speculated that applications of the approach for clinical medicine could be endless. In terms of anesthesiology, for instance, he said, "I can envision an approach where we might treat a patient preoperatively with a nerve block and 'activate' the dormant pain treatment just before the surgery to treat acute pain, and possibly post-op to treat and/or avoid chronic pain development in susceptible individuals."
 
From "Harnessing the Herpes Virus to Precisely Target Pain"
Infectious Diseases Special Edition (02/01/14) Vol. 1 McNamara, Damian
 
 
 
Virginia May Use New Execution Drug
Correctional authorities in Virginia have given the go-ahead for a change to the state's lethal injection process. Midazolam, which calms and makes patients drowsy before surgery, has been approved as an alternate first drug in the three-drug protocol. It will serve as a replacement for pentobarbital or thiopental sodium, both of which are in short supply due to manufacturer qualms about their use in executions. The switch is unlikely to quell the controversy, however, as the use of midazolam in Ohio and Florida has spawned concerns and claims over cruel and unusual punishment. Corrections departments in Louisiana and Kentucky also are considering a move to midazolam, but states across the country continue to face roadblocks in obtaining the drugs needed to carry out capital punishment sentences. European suppliers and at least one major American manufacturer have refused to sell their products for use in lethal injections.
 
From "Va. May Use New Execution Drug"
Washington Post (02/22/14) P. B1 Weiner, Rachel
 
 
 
Pediatric Hospital Physicians Form 3D Printing 'Think Tank'
A group of pediatric specialists at Children's Hospital of Philadelphia (CHOP) have formed a 3D printing "think tank" that is working to determine how 3D printing can be used to create medical devices customized specifically for the complex needs of children. Pediatrics tends to be overlooked by medical-device companies, as children represent a relatively small market, and there may be complications with adapting adult medical devices for children. The 3D printing think tank hopes to develop applications for the technology across different pediatric specialties including cardiology; anesthesiology; ear, nose and throat; and orthopedics. As 3D printing becomes more mature, customized devices could be developed more quickly. The Society for Technology in Anesthesia's annual contest this year focused on 3D printing applications, seeking ways to use the technology to develop a Williams intubating airway that could be adjusted based on measurements from a CT or MRI scan. Many pediatric hospitals have a need for specialized devices for children with variations in the shapes of their airways.
 
From "Pediatric Hospital Physicians Form 3D Printing 'Think Tank'"
MedCity News (02/21/14) Baum, Stephanie
 
 
   
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