(requires AANA member login and password).
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.
Answer the Call to Care to be CountedTo 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 firstname.lastname@example.org
. To contribute to the CRNA-PAC, click www.caretobecounted.org
and enter your AANA member login and password. Return to Headlines
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 email@example.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. Return to Headlines
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 firstname.lastname@example.org
.Return to Headlines
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.Return to Headlines
Taking the Pulse of Pulse Oximetry in AfricaAlthough 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 ManagementAn 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"
Evidence Points to Better Approach for Back InjectionsResearchers 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 ArthroplastyA 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 OperationSurgeons 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 PTSDStellate 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 SystemA 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"
Low Doses of Esmolol and Phenylephrine Act as Diuretics During Intravenous AnesthesiaThe 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"
Dexmedetomidine Is Easy, Effective for Pediatric Sedation During MRIResearchers 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 FindPentobarbital, 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 AEsA 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