Anesthesia E-ssential, February 29, 2012

Anesthesia E-ssential

 

Anesthesia E-ssential

February 29, 2012

 

Vital Signs

Your Input Needed: Supplemental Liability Insurance for Employed CRNAs

 


 

The Pulse

Inside the Association

Hot Topics

Federal Government Affairs and PAC

AANA Foundation and Research

Jobs

 

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.

 


 

Vital Signs

 
Your Input Needed: Supplemental Liability Insurance for Employed CRNAs
While AANA Insurance Services works primarily with self-employed CRNAs, "We are hearing more frequently from CRNAs who are employed by physicians and hospitals," said John Fetcho, CPCU, ARM, in an article that will appear in the March issue of AANA NewsBulletin. "These CRNAs are seeking to secure their own professional liability insurance policies to supplement the coverage provided by their employer."
 
Fetcho said that while there seems to be a "definite need for a professional liability insurance policy to address the specific needs of CRNAs who are employees of groups, hospitals, and other entities, no such type of policy currently exists." To help develop a supplemental liability policy, AANA Insurance Services has put together a simple five-question survey that should take just a few minutes of your time to complete. To access the survey, visit https://www.zoomerang.com/Survey/WEB22EVX348QVT

 


 

Inside the Association

 

Hot Topics

February Marks 10-Year Anniversary of Landmark Decision Ensuring Nebraskans Access to Safe, Cost-Effective Anesthesia Care
Ten years ago this month Nebraska became the second state to opt out of the federal physician supervision requirement for Certified Registered Nurse Anesthetists (CRNAs). The landmark decision by then-Governor Mike Johanns, which was supported by both the Nebraska Association of Nurse Anesthetists (NANA) and the state Board of Medicine and Surgery (BOMS), ensured Nebraskans access to safe, cost-effective anesthesia care, particularly in rural and other medically underserved areas of the state. For further information, read the AANA Press Release.
 
The Lifebox Project: Help Support Safe Surgery Across the World!
Lifebox (www.lifebox.org) is a not-for-profit organization that grew out of a global initiative by the World Health Organization (WHO) to make surgery safer across the globe. Since nurse anesthesia is all about patient safety, the AANA has adopted the cause of this valuable organization and is asking nurse anesthetists in the United States to consider making a donation to support the work of Lifebox.
 
Specifically, the Lifebox mission is "to ensure that no patient dies because a pulse oximeter and basic safety checks were not used during surgery." This project is a straightforward first step: Ensuring that every operating room in the world has a simple, essential device that can save lives – a pulse oximeter. For every $250 in donations, the program provides a pulse oximeter, rechargeable batteries, universal finger probe, AC/DC adapter charger and cradle, protective case, educational materials and a copy of the WHO Surgical Safety Checklist to eligible clinicians/facilities in low income/low resource areas.
 
"The AANA decided, as part of our mission of supporting patient safety and being socially responsible, that we needed to support the LifeBox pulse oximeter," said AANA President Debra Malina, CRNA, DNSc, MBA. "This low- cost device, part of ‘safe surgery’ initiatives for low-income countries is a simple way to improve patient safety outcomes that all anesthesia providers can support. Further, it provides support in the very areas of the world where many AANA members generously volunteer their time and expertise in bringing anesthesia services to those in need. I encourage all CRNAs to join their colleagues in considering a donation to the LifeBox initiative."
 
To view a video of the Lifebox "Make It Zero" campaign, click this link: http://youtu.be/iKEJJGxZA3g. A complete description of the program and link to donate can be found at http://www.lifebox.org. Donations in any amount will be greatly appreciated!
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AANA Introduces New Affinity Program Partner: CRNA Financial Planning
CRNA Financial Planning has been guiding CRNAs and their families through the complexities of investing and financial planning for more than 15 years.
 
Our Financial Planning Process: Our financial plans are designed to anticipate and calculate retirement income needs and lay out a roadmap to keep you on track with your goals. We help clients navigate the financial minefields of life.
 
Our Investment Process: Our unique Advance & Protect* approach to investing enables us to tailor a portfolio directly to goals and dreams of the individual while helping to protect against market volatility. We employ research and a statistical trend following model in order to help proactively target growth and manage risk.
 
Committed to Education: CRNA Financial Planning’s President, Jeremy Stanley, also teaches student registered nurse anesthetists the fundamental principles of financial management in preparing for graduation at the nurse anesthesia programs at Duke, Raleigh, and Carolina's Medical Center.
 
*No strategy ensures a profit or protects against a loss. There is no guarantee that the investment objective will be met.
 
Securities & Financial Planning offered through LPL Financial,
A Registered Investment Advisor Member FINRA/SIPC
 

 
CRNA Compensation/Benefits Data Available through AANA
For the first time, data collected from the CRNA Compensation and Benefits Survey is available for sale through the AANA Print-on-Demand Marketplace. Members and nonmembers can purchase this comprehensive, 130-page report by clicking here.
The decision to offer the CRNA Compensation and Benefits Survey for sale as a nondues revenue source was made after weighing a number of considerations. The AANA collects the data included in the report to gain a better understanding of the members in order to serve, promote, and advocate for them in the best way possible. Because there is significant cost involved in collecting and analyzing the data, as well as preparing the report itself, charging for the report will offset some or all of the cost. Finally, it is important to make sure that any information about CRNA compensation and benefits that becomes public is accurate—however, over the last few years inaccurate or incomplete salary data pertaining to CRNAs has appeared in the media, mostly supplied by locums agencies.
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Medication Safety DVD Available on APSF Website
On Jan. 26, 2010, the Anesthesia Patient Safety Foundation (APSF) held a national consensus conference of 100 stakeholders from many different backgrounds to develop new strategies for "predictable prompt improvement" of medication safety in the operating room and as a result of this national summit, APSF has produced an educational video to promote medication safety in the operating room. Medication Safety in the Operating Room: Time for a New Paradigm is now available for viewing on the APSF website, and a complimentary copy may be obtained by completing the request form. Click on http://apsf.org/resources_video2.php
 
AANA Facebook page and follow "aanawebupdates" on Twitter
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Federal Government Affairs and PAC

March 1 Medicare Cuts Averted for More Cuts January 1, 2013
Following over 5,000 CRNAdvocacy messages from AANA members to Capitol Hill, Congress approved legislation (H.R. 3630) averting 26.2 percent Medicare Part B payment CRNA and physician payment cuts that would have hit March 1. Had Congress not acted, each AANA member would have faced an average $365 weekly negative impact to reimbursements affecting their pay. The AANA and CRNAs had urged Congress to enact the longest possible relief package.
 
The measure provides relief from the cuts until Jan. 1, 2013, when cuts in excess of 30 percent will hit, and driving Congress to take up additional relief legislation in a year-end "lame duck" session following the Nov. 6 elections.
 
Packaged with legislation extending payroll tax relief and extending and reforming unemployment insurance programs, the $18 billion cost of ten months’ relief from Medicare cuts was offset in part by reducing Medicare reimbursements to hospitals for Medicare patients who fail to pay their copays and coinsurance ($6.9 billion over 10 years), reducing certain payments to large teaching hospitals ($4.7 billion over 10 years), and reducing a public health and prevention fund by a third ($5 billion over 10 years).
 
See how members of the House voted, the Senate voted, and the conference report to H.R. 3630 itself. Read the AANA’s letter to Congress (requires AANA member login and password).
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AANA to NY Times Editorial: Reject 17% Cuts to Anesthesia Care
A Medicare Payment Advisory Commission (MedPAC) proposal to cut Medicare anesthesia and specialty care 17 percent over three years should be rejected by Congress and replaced by initiatives to make more efficient use of CRNAs and other APRNs, AANA President Debra Malina, CRNA, MBA, DNSc, wrote in response to a Feb. 22 editorial in the New York Times.
 
"Instead of MedPAC’s proposal, peer-reviewed evidence urges Congress and Medicare to drive access to quality care and cost savings with APRNs," wrote Malina Feb. 22. "A peer-reviewed study in Health Affairs (2010) found no measurable difference in quality of care between CRNAs and other anesthesia providers or by anesthesia delivery model. A Lewin Group study published in Nursing Economic$ (2010) found that CRNAs acting as the sole anesthesia provider are 25% more cost effective than the next least costly model. Finally, the Institute of Medicine report "The Future of Nursing: Leading Change, Advancing Health" found that greater use of advanced practice registered nurses such as CRNAs correlated with high quality healthcare delivery, patient access to and satisfaction with their care, and overall system cost-effectiveness. Its first recommendation was to change policy so that nurses could practice to their full scope."
 
Read Pres. Malina’s letter and the Times editorial "A Real Doc Fix"
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Senate Pain Hearing Reviews IOM Report
The impact of pain in the United States—116 million Americans suffering from chronic intractable pain, at an economic and healthcare cost approaching two-thirds of a trillion dollars per year—deserves more attention, which the Institute of Medicine (IOM) report "Relieving Pain" is helping to draw, a Senate committee hearing found Feb. 14.
 
Chaired by Sen. Tom Harkin (D-IA), the Senate Health, Education, Labor and Pensions Committee hearing took testimony from the National Institutes of Health, the co-chairs of the 2011 IOM report panel, and from representatives of organizations of patients suffering from chronic pain. The AANA brought and distributed a written statement to the hearing.
 
One critical finding was reported by the witness from the National Institutes of Health. The NIH Pain Consortium of federal agencies and advisory bodies has posted a funding opportunity for establishing Centers for Excellence in Pain Education. Proposals are due March 5.
 
See a recorded webcast of the hearing and read witnesses’ prepared testimony,. See the IOM brief; and the is at AANA’s June 2011 statement on the IOM report release.
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Pass Drug Shortage Notification Bills, AANA Urges Congress
Directing pharmaceutical manufacturers to publicly notify the Food and Drug Administration of conditions that would lead to drug shortages would help alleviate the problem of drug shortages themselves, the AANA wrote sponsors of legislation on the topic Feb. 16.
 
"The Preserving Access to Life-Saving Medications Act of 2011 would reduce anesthesia drug shortages by requiring pharmaceutical manufacturers to provide early notification to the FDA of conditions that risk stable supplies of critical medications," wrote AANA President Debra Malina, CRNA, MBA, DNSc, to House and Senate sponsors of the bills (S 296 / HR 2245)." The House measure was introduced by Reps. Diane DeGette (D-CO) and Tom Rooney (R-FL); the Senate legislation is sponsored by Sens. Amy Klobuchar (D-MN) and Bob Casey (D-PA).
 
Congress appears to be waking up to the need for and benefits of such legislation, motivated by periodic threats of delayed and canceled surgeries and of outages of crucial cancer treatment medications. Inside Health Policy reported Feb. 17 that House Energy and Commerce Committee majority Republicans are circulating their own version of a new drug shortage advance notification measure, which is under review at AANA FGA.
 
Read the letter AANA sent to Senate bill sponsors. A similar letter was sent to sponsors of the House measure.
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President Obama Issues 2013 Budget: What’s In It for CRNAs?
President Obama released his FY2013 budget today, proposing relief from huge Medicare payment cuts plus $251 million for Title 8 Nursing Workforce Development programs, a $20 million increase over what Congress provided in FY 2012.
 
Within the Title 8 program boost, the $20 million increase is allocated to Advanced Education Nursing, which received $64 million from Congress in FY 2012 and receives $84 million in the President’s proposed budget. Part of Title 8 Advanced Education Nursing is where CRNAs access federal dollars to develop and expand educational programs and provide SRNAs with traineeships stipends to help offset their education.
 
The President’s budget is not law; Congress must pass appropriation bills to fund the federal government for FY 2013, which begins Oct. 1, 2012. Along with coalitions of nursing, advance practice nursing and other healthcare professional groups, AANA works to press Congress to reverse the huge Medicare payment cuts and to provide an adequate amount for Title 8 and Advanced Nursing Education programs.
 
For information on Title 8 Nursing Workforce Development Programs in the President’s budget, go to page 18 of the Budget in Brief. See the whole budget proposal.
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Congress’ Budget Gurus Issue Sober News about Healthcare
The government budget experts advising Congress say the 10-year cost of fixing the chronic Medicare Part B payment cuts is $316 billion—up from $290 billion just last November—and that total federal healthcare benefits spending will more than double within a decade. The Jan. 31 report by the Congressional Budget Office (CBO) increases the degree of difficulty for a permanent fix to the "sustainable growth rate" funding formula cuts impacting CRNA practice, and boosts the premium for high-quality healthcare delivery models that are also cost-effective.
 
The CBO’s "Budget and Economic Outlook" says total Medicare and Medicaid spending will grow at 8 percent a year between now and 2022, doubling from $847 billion now to $1.8 trillion in a decade, driven by growth of the population of aging persons in the U.S. and higher treatment costs. At that rate, Medicare and Medicaid alone would amount to 7.3 percent of the total economic output of the United States by 2022.
 
Read the CBO report and a summary of the report
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HHS Issues More Essential Health Benefits Guidance
The U.S. Department of Health and Human Services (HHS) Feb. 17 issued additional guidance and "frequently asked questions" (FAQs) regarding "essential health benefits," a critical health reform implementation term governing the development and marketing of health plans in states, and important to CRNAs.
 
Under the agency’s intended approach, states would have the flexibility to select an existing health plan to set the "benchmark" for the items and services included in its essential health benefits package. The AANA sent comments to HHS on this bulletin requesting that the proposed essential health benefits rule should include anesthesia services among the ten categories of essential services in the Patient Protection and Affordable Care Act (ACA) as anesthesia and analgesia care given by CRNAs fits into many of the essential health benefits requirements in the ACA.
 
The FAQs and AANA’s comments (requires AANA login and password) are available.
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HHS Delaying Implementation of ICD-10 Compliance
The U.S. Department of Health and Human Services is delaying implementation of transitions and compliance to a new clinical diagnosis code set called ICD-10 past its original Oct. 1, 2013, "go" date, the agency said in a statement Feb. 17. Learn more. A Medicare agency FAQ on ICD-10 for healthcare providers like CRNAs is here (though it does not reflect the agency’s Feb. 17 delay announcement).
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AANA Urges AMA Panel to Delay Decision Making on GI Sedation and to Not Credit GI Docs with Sedation They Don’t Perform
An American Medical Association panel considering changes to the relative value of gastrointestinal procedures is wise to consider alternatives to the current flawed system that allows some double-payment of sedation, but should delay decisionmaking on the issue until the AANA and CRNAs had the opportunity to review proposals further, AANA Pres. Debra Malina, CRNA, MBA, DNSc, wrote Jan. 27. The AANA had been excluded by the AMA’s physician-centric process.
 
In commenting to the AMA Coding Procedural Terminology (AMA CPT) Editorial Panel meeting early February, AANA Pres. Malina stated, "The use of a separate anesthesia service in GI procedures yields the benefit of more rapid patient recovery from the procedure, greater patient satisfaction, reduced recovery room time, and a larger number of procedures that may be provided to patients in a given facility with a given number of GI operating practitioners."
 
Read the AANA’s letter (requires AANA member login and password).
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Book Your Mid-Year and Business of Anesthesia Meetings
Now’s the time to book your seat at the AANA Business of Anesthesia conference Apr. 14, and the AANA Mid-Year Assembly Apr. 15-17, both in your Nation’s Capital!
 
The AANA’s first-ever Washington-based Business of Anesthesia conference provides AANA members practical, fundamental education on developing an anesthesia practice, and looking into the economic and policy crystal ball shaping CRNA reimbursement.
 
AANA’s Mid-Year Assembly is the association’s premier conference for federal policy issues education and advocacy. Learn the issues shaping CRNA practice and how to effectively advocate for them on Capitol Hill on Sunday, participate in AANA professional association business Monday featuring leaders running for national office in the organization, and then hear from leaders from Congress and the Administration before bringing CRNA issues directly to your members of the House and Senate Tuesday afternoon and Wednesday. If you can learn how to bring your issues to members of Congress in the U.S. Capitol during Mid-Year Assembly, what’s to keep you from bringing CRNA issues to other healthcare leaders in your state, community, hospital or healthcare facility?
 
The AANA Mid-Year Assembly will also host "An Affair of State" Sunday night, in the penthouse suite of the historic Hay Adams Hotel to benefit the CRNA-PAC. In addition, on Monday afternoon, members of the AANA will join in the interment ceremony for Ira Gunn, CRNA, MLN, FAAN, at Arlington National Cemetery. Attendees will gather at the Arlington Cemetery administration building at 12:30, and the ceremony begins at 1. Long recognized for her passion for the anesthesia profession in the regulatory and legislative arenas, the AANA established the Ira P. Gunn Award for Outstanding Professional Advocacy in 2000.
 
Learn more and register at www.aana.com; click on "Meetings" up top.
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Answer the Call to Care to be Counted
To continue strengthening CRNAs’ voice in Washington during this major election year, the CRNA-PAC has kicked off its Care to be Counted 2012 campaign with the release of a new video that underscores the importance of every AANA members’ contribution.
 
If you’ve contributed within the past couple of years, you may get a call from the CRNA-PAC asking you to support the Care to be Counted campaign once again. If you have any questions about the call, please contact AANA FGA at info@aanadc.com. To contribute to the CRNA-PAC, click www.caretobecounted.org and enter your AANA member login and password.
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Wanted: CRNAs Involved in Presidential Campaigns
Are you involved at the local or state level in the GOP Presidential contest, or in support of the reelection of the Obama-Biden ticket? Let us know; we’d be delighted to hear your story, and to encourage other AANA members to participate. Send your information to info@aanadc.com.
 
 
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 US Citizen.
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AANA Foundation and Research

Application Now Available for Janice Drake CRNA Humanitarian Award

Deadline: May 1, 2012
The AANA Foundation’s Janice Drake CRNA Humanitarian Award provides monetary assistance to CRNAs who wish to volunteer and provide anesthesia, education, and training in needy areas of the United States or overseas in developing countries. The purpose of the endowment is to increase CRNA volunteerism in the United States and in countries that are in need of anesthesia training, education and/or research expertise. This application is currently available online at www.aanafoundation.com. If you have any questions, contact the AANA Foundation at (847) 655-1170, or foundation@aana.com.
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The AANA Foundation Promotes Research…The Nurses’ Health Study (NHS) Needs 100,000 Nurses
Harvard researchers are recruiting 100,000 female nurses and nursing students for Nurses’ Health Study 3 (NHS3). In the past 35 years, more than 230,000 NHS participants have changed what we know about women’s health. NHS3 is the next generation! Female RNs, LPNs, or nursing students, 20 to 46 years old in the United States or Canada, can contribute to groundbreaking research on lifestyle, environment, nurses’ work life, and women’s health. Visit www.NHS3.org to complete a 30-minute online survey about lifestyle and health and to join the next generation of the world's largest, longest-running study of women's health. If you know other eligible nurses, click on the "Email-a-Nurse" link at http://nhs3.org/index.php/tell-others to send them a message sharing this opportunity.
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Healthcare Headlines

 
Taking the Pulse of Pulse Oximetry in Africa
Although the theory has not yet been clearly proven, there is strong consensus in the medical community that pulse oximeters—which monitor oxygenation of hemoglobin in sedated patients—are a critical component of anesthesia safety. Supporters point out that anesthesia-related mortality rates are exponentially higher in developing nations, where pulse oximetry use is constricted by its high price, than in the developed world, where use of the technology is commonplace. Hoping to address cost restraints in Africa and elsewhere, the World Health Organization in 2008 introduced the Global Pulse Oximetry Project. The goal of the initiative is to develop an inexpensive pulse oximeter for use in the developing world; and, now, researchers from the University of British Columbia (UBC) believe they may have found a solution. The team has found a way to convert mobile phones into pulse oximeters. "There is really no other technology that has become so ubiquitous," notes UBC researcher, anesthesiologist Mark Ansermino. "They're easily adaptable. Cell phones are amazingly powerful computing devices so we just had to find a way to get the software [for pulse oximetry] on to them." The UBC researchers are conducting a pilot project at Mulago Hospital in Uganda, where only 20 to 40 percent of hospitals use the technology. They are using smartphones for the experiment but ultimately hope to equip lower-cost mobile phones. If successful, collaborator Arthur Kwizera—an anesthesiologist at Mulago Hospital—says the impact of project will be significant. "What is the cheapest [electronic] thing in Africa?" he asks. "It's a mobile phone. Right now phones are being sold for $15 and if you buy a $3 patient probe ... you can actually have a pulse oximeter on your phone for $20, a tenth of what a $250 pulse oximeter costs."

From "Taking the Pulse of Pulse Oximetry in Africa"
Canadian Medical Association Journal (02/15/2012) Edwards, Jocelyn
 
Intravenous Ibuprofen: A Key Addition to Perioperative Pain Management
An article in the journal Pain Management discusses the use of intravenous ibuprofen for postoperative pain. An increasing number of anesthesia professionals use Caldolor (ibuprofen) Injection at induction of anesthesia as a preemptive measure against pain and inflammation in surgical procedures. Study author Peter Kroll, an anesthesia provider, notes that three adult surgical clinical trials found that patients who received injectable ibuprofen versus placebo experienced less pain, less need for opioid analgesics, and faster recovery from surgery. Kroll was the lead investigator in one trial which confirmed that 800 mg of intravenous ibuprofen given every six hours is safe and effective for the treatment of postoperative pain after abdominal hysterectomy. He notes that reduced opioid use could reduce related side effects such as nausea, vomiting, cognitive impairment, and respiratory depression. In the future, ibuprofen may be used with regional anesthesia, such as nerve blocks, to further reduce or even eliminate opioid use.

From "Intravenous Ibuprofen: A Key Addition to Perioperative Pain Management"
News-Medical.Net (02/23/12)
 
Evidence Points to Better Approach for Back Injections
Researchers in Chicago have demonstrated a correlation between needle position for low-back steroid injections and level of patient pain. In a study of 44 patients at Advocate Illinois Masonic Medical Center, half were randomly selected to receive lumbar epidural steroid injections via the parasagittal interlaminar (PIL) approach. The other half were injected using the midline interlaminar (MIL) approach. The two groups shared similar demographics and like levels of self-reported pain; and all had a medical background of unilateral lumbosacral radiculopathic pain along with herniated, bulging, or degenerated disks. Both groups experienced markedly lower pain during movement and at rest one, seven, and 28 days after their procedures; but the reduction was more significant for the PIL patients. Additionally, the PIL approach generated greater improvement in self-reported pain scores. The Advocate team, led by anesthesiology department chair Dr. Kenneth Candido, has since recruited 56 more patients into the study and is analyzing the data out to six months for all 100 subjects. "This will help us to define whether both approaches are similar or whether one is superior to the other," said Dr. David Provenzano of the Institute for Pain Diagnostics and care at Ohio Valley General Hospital in Pittsburgh.

From "Evidence Points to Better Approach for Back Injections"
Anesthesiology News (02/15/12) Frei, Rosemary
 
'Unacceptable' Pain Levels Common After Knee Arthroplasty
A study presented at a recent global conference on pain found that a "disproportionately large number" of knee arthroplasty patients who take part in postoperative pain studies are not given enough analgesia and suffer "unacceptable" pain levels. Researchers from the University of Copenhagen in Denmark analyzed more than 12,000 patients who participated in pain studies, as many as 3,000 of whom were found to have experienced extreme levels of pain. Most of the under-medicated patients were in control groups and given placebos that included systemic opioids—either by themselves or with other systemic analgesics, such as nonsteroidal anti-inflammatory drugs (NSAIDs), gabapentinoids, acetaminophen, and other less-powerful nonopioid analgesics, said Dr. Kenneth Jensen, the study's lead author. "We find this result problematic because current ethical standards dictate that we should not render patients in control groups less [optimally managed] than patients in intervention groups," he said. The report went on to declare, "According to the Helsinki II declaration, no patients participating in clinical studies should receive inferior treatment for painful conditions because of randomization to treatment arms with placebo or regimens providing less analgesia than the best available standard." The authors concluded that the use of systemic opioids as a control group is "questionable" by current scientific and ethical standards. The research team used the same data to study pain levels in patients who were given adjuvant NSAIDs, gabapentin/pregabalin, acetaminophen, or any combination thereof and found that these treatments only slightly reduced pain in patients who experienced severe post-operative pain at rest. The finding "supports our view that nerve blocks are pivotal for adequate pain management, systemic opioids are a troublesome but necessary default analgesic, and other systemic drugs are largely expendable in this clinical setting," noted Jensen. "Some of these results were really an eye opener for us."

From "'Unacceptable' Pain Levels Common After Knee Arthroplasty"
Medscape (02/14/12) Johnson, Kate
 
Grandad Laughs With the Surgeon During Operation
Surgeons at Lancashire Teaching Hospitals in the United Kingdom recently used a pioneering technique that allowed them to operate while their patient was wide awake. The shoulder surgery performed typically is conducted while the patient is under general anesthesia, but Edwin Robinson's narrowing of the airways put him at high risk for normal procedure. Instead, doctors gave him the option of the new technique, which allows patients who otherwise would not be able to tolerate general anesthesia to be treated using a nerve block. The approach, executed with the help of a small camera linked up to a monitor to guide the surgeon, is less invasive than conventional surgery and is intended specifically for operations on people who have difficulty moving their arms. "I was a bit nervous about having the operation while awake, but it was fine," said Robinson, a 65-year-old grandfather. "I didn't feel a thing and I was even laughing and joking with the surgeon while it was going on." Dr. Lawrence Azavedo, consultant anesthesiologist, noted: "Using a nerve block provides many benefits, not least the hugely improved recovery time and reduced hospital stay." It also reduces the actual amount of time required to complete the procedure.

From "Grandad Laughs With the Surgeon During Operation"
Lancashire Evening Post (UK) (02/25/12)
 
Illinois Funds Study to Test the Effectiveness of Stellate Ganglion Blocks for Veterans With PTSD
Stellate ganglion blocks can relieve symptoms of post-traumatic stress disorder (PTSD) in 75 percent of patients, according to a study published in Military Magazine. These blocks involve a local anesthetic injected into a bundle of the autonomic nerve fibers of the neck and have been used for chronic pain for 50 years. The study of PTSD treatment with stellate ganglion blocks only involved eight patients, but the results indicate that the procedure may be used in this application. Based on the study's positive findings, Illinois Gov. Pat Quinn awarded an $82,000 grant to investigate the effects on Illinois veterans. Beginning in late February, the research will measure the levels of the protein nerve growth factor and cortisol in patients before and after they receive the block.

From "Illinois Funds Study to Test the Effectiveness of Stellate Ganglion Blocks for Veterans With PTSD"
Becker's Orthopedic & Spine Review (02/12) Callard, Abby
 
Hospital for Joint Diseases First in Metro NY With Needle-Less System
A pilot program at the Center for Children at NYU Langone Hospital for Joint Diseases is demonstrating the benefits of a needle-free anesthesia system. Using a small canister of pressurized carbon dioxide in place of a needle, the J-tip syringe delivers fast-acting lidocaine into the skin. The targeted area is desensitized in less than one minute, allowing clinicians to draw blood and perform other venous procedures quickly instead of waiting 30 to 60 minutes for a topical mixture of local anesthetics to take effect and prepare an injection site for needle insertion. "Needle procedures are particularly frightening for children, so it's important to embrace techniques that safely and effectively reduce pain or enhance their experience in the hospital," explains Dr. Norman Otsuka of the Center for Children. "Children with chronic pediatric conditions often require multiple venipunctures over the course of their treatment, so eliminating any initial trauma will decrease anxiety at subsequent visits—making the process less stressful for the child and their family." While the J-tip currently is being used at the facility only to draw blood from pediatric patients prior to an operation, clinicians there expect the system eventually to be used for all orthopaedic services to children and possibly even other pediatric services. They also believe it ultimately will be applied to adult patients undergoing surgery as well as to infusion therapy, which entails IV lines and multiple needle sticks.

From "Hospital for Joint Diseases First in Metro NY With Needle-Less System"
Newswise (02/23/12)
 
Low Doses of Esmolol and Phenylephrine Act as Diuretics During Intravenous Anesthesia
The expulsion of infused crystalloid fluid from the kidneys tends to slow markedly in patients after receiving anesthesia and during the ensuing surgery; but animal studies suggest that renal fluid clearance might be normalized if the adrenergic balance is altered. To test the theory, researchers measured the distribution and elimination of infused fluid in three sets of females having laparoscopic gynecological surgery. A control group received conventional anesthetics, along with 20 ml/kg of lactated Ringer's over 30 minutes. In addition to that, subjects in the second group received an infusion of the beta1-receptor blocker esmolol or an infusion of phenylephrine, an alpha1-adrenergic agonist, over the course of three hours. Based on volume kinetic analysis that looked at hemoglobin levels in the blood and how much urine was passed at certain intervals, the researchers concluded that the introduction of esmolol or phenylephrine stimulated renal fluid clearance that had been slowed by anesthesia induction. Urinary excretion was doubled with the esmolol and nearly tripled with the phenylephrine.

From "Low Doses of Esmolol and Phenylephrine Act as Diuretics During Intravenous Anesthesia"
7thSpace (01/30/12)
 
Dexmedetomidine Is Easy, Effective for Pediatric Sedation During MRI
Researchers reported their positive experiences at an outpatient MRI center using dexmedetomidine to sedate pediatric patients. Some 279 pediatric patients received intravenous dexmedetomidine as a bolus of 3 µg/kg administered over a 10-minute period by an anesthesiologist. If the patient did not reach a Ramsay sedation score of 4, considered to be an adequate sedation depth to tolerate diagnostic imaging exams, a second or third dose was administered. On average, patients requiring only one dose were sedated in about seven minutes; for those requiring two or three doses of the drug, the time to sedation was 13 minutes. The authors note that 13 patients also required pentobarbital. The majority of patients met discharge requirements within 21 minutes, although one spent more than two hours in the recovery room. None of the patients experienced adverse respiratory events. One-third experienced blood pressure deviations from baseline by more than 20 percent, and 5 percent had heart rate deviations; but no treatment was required, and these conditions returned to normal within 10 minutes.

From "Pediatric Sedation in a Community Hospital-Based Outpatient MRI Center"
American Journal of Roentgenology (02/12) Vol. 198, No. 2, P. 448 Mason, Keira P.; Fontaine, Paulette J.; Robinson, Fay; et al.
 
Lethal Injection Drugs Harder and Harder to Find
Pentobarbital, a barbiturate used for prisoner executions in some states, is on the verge of becoming unavailable after the drug's one FDA-approved manufacturer opted not to sell it to states that use it for lethal injections. Pentobarbital was widely adopted in 2011 as a replacement for sodium thiopental after a different U.S. manufacturer decided to stop producing that drug, which previously was the standard for lethal injections. Both drugs, which are fatal in high doses, have been used in some states as the sole injection administered to death-row inmates; while other states administer the drug, which puts an inmate to sleep and dulls pain, as the first in a cocktail of three drugs. Because pentobarbital is known mostly as a drug used to put pets to sleep, prisoner advocates have complained that it might be ineffective and illegal to use on humans—a controversy that continues even as numerous inmates have been put to death with the chemical. Oklahoma, Florida, Ohio, and Texas all use pentobarbital in executions, while California is relying on a stockpile of sodium thiopental that it purchased from the United Kingdom and that expires in 2014. European nations have since banned manufacturers from selling sodium thiopental to U.S. states that want to use it for lethal injections. In the meantime, California has postponed state executions of prisoners as three lawsuits challenging the legality of the state's lethal injection process wind their ways through federal and state courts.

From "Lethal Injection Drugs Harder and Harder to Find"
KALW Public Radio (CA) (02/22/12) Palta, Rina
 
Combination Cosmetic Surgeries, General Anesthesia Drive AEs
A new study that reviewed adverse event (AE) reporting in Florida and Alabama indicates that the use of general anesthesia, liposuction under general anesthesia, and a combination of surgical procedures can all significantly raise the risk for AEs in office-based surgery. At least two-thirds of deaths and three-quarters of hospital transfers were associated with cosmetic surgery performed using general anesthesia, researchers write in the February issue of Dermatologic Surgery. Dr. C. William Hanke, from the Laser and Skin Surgery Center of Indiana, wrote in a companion commentary about three patient-safety practices: keeping the patient awake; reconsidering whether liposuction should be done in conjunction with abdominoplasty under general anesthesia; and advocating prospective, mandatory, verifiable AE reporting using data from physician offices, ambulatory surgical centers, and hospitals to help prevent problems. Although liposuction is among the most common cosmetic surgical procedures, no deaths occurred in the setting of local anesthesia. However, under general anesthesia, liposuction accounted for 32 percent of cosmetic procedure-related deaths. A total of 309 AEs were reported from office-based surgeries in the 10-year period studied in Florida, and 52 were reported in the six-year period studied in Alabama.

From "Combination Cosmetic Surgeries, General Anesthesia Drive AEs"
Medscape (02/09/12) Newman, Laura
 
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