Anesthesia E-ssential, January 30, 2012

Anesthesia E-ssential
 

Anesthesia E-ssential

January 30, 2012
 
 

Vital Signs

The Pulse

Inside the Association
Hot Topics
State Government Affairs
Federal Government Affairs and PAC
PR, Publications and eCommunications
AANA Foundation and Research
News from COA
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.

New Air Force Policy Recognizes Full Scope of Nurse Anesthetist Practice
AANA Commends USAF for Ensuring Access to Safe, Cost-Effective Anesthesia Care for Men and Women Serving Our Country and Their Dependents
 
A new U.S. Air Force (USAF) policy governing anesthesia delivery in USAF facilities worldwide recognizes the full scope of Certified Registered Nurse Anesthetists (CRNAs) practice, thereby ensuring military personnel and their dependents access to the safest, most cost-effective anesthesia care. The policy promotes patient safety by approving anesthesia delivery models common to other American military service branches with which the Air Force often operates jointly, and that are also widely used in civilian healthcare. For further information, read the AANA press release.
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Inside the Association

Hot Topics
 
VANA President Cathy Harrison Honored at Legislative Reception
Capt. Cathy Harrison, CRNA, NC, USN, was honored on Jan. 25 at the Virginia Association of Nurse Anesthetists’ (VANA) legislative breakfast as the first and only CRNA in the Navy Reserves to serve as the commanding officer of an operational health support unit. Harrison, who is president of VANA, is a decorated Navy Officer with the United States Navy (Reserve Component), educator, and entrepreneur. She was recognized for her outstanding meritorious service to the United States and her commitment and leadership in furthering the delivery of quality healthcare in Virginia. For further information, read the VANA press release.
 
Memorial Service for Ira Gunn to be held at Arlington National Cemetery
A memorial service for Ira Gunn, CRNA, MLN, FAAN, who passed away on Oct. 25, 2011, will be held at Arlington National Cemetery on April 16, 2012. Her ashes will be buried with full military honors. Further details will be posted on the AANA website and in the March issue of the AANA NewsBulletin.
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National Nurse Anesthetists Week in the News
All across the nation, CRNAs and student nurse anesthetists proudly showcased their profession during the 13th annual National Nurse Anesthetists Week, observed Jan. 23-28, 2012. Visit the special AANA webpage for links to news coverage.
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Somnia Anesthesia Launches CRNA of the Year Contest
To commemorate National Nurse Anesthetists Week (January 22-28), Somnia Anesthesia has announced its first annual CRNA of the Year contest. Somnia, a national anesthesia practice management company, will be accepting nominations of CRNAs from throughout the country from Jan. 22 through Feb. 10. Visit www.somniainc.com/CRNA2012 for further information. CRNAs may be nominated by a colleague, patient, or other healthcare professional. The winner, who will be selected by a panel of senior-level healthcare clinicians and administrators, will be announced on Feb. 14. He or she will receive iPad2.
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Wisconsin Association of Nurse Anesthetists (WIANA) Marks 75th Year Anniversary
Along with being the 14th state to opt out of the federal requirement for medical supervision for Medicare reimbursement, WIANA has many professional, regulatory and legislative wins to celebrate at its gala event on March 24, 2012.
 
At the educational portion of this celebration, past AANA President Patrick Downey, CRNA will describe the history of WIANA’s accomplishments—specifically winning prescriptive authority, being included in Wisconsin’s unique Injured Patient and Family Compensation Fund, weathering a medical malpractice insurance crisis, and being at the national helm when DRGs were implemented.
 
Two AANA past presidents were practicing in then “small state” Wisconsin when they served AANA’s highest elected position. At least two more were educated here at St. Francis Hospital Program of Nurse Anesthesia, La Crosse: AANA former Executive Director John Garde, CRNA, MS, FAAN, and Rodney Lester, CRNA, PhD, MSN. The gala will feature dinner with keynote speech by “Jan” Mannino, CRNA, JD, live entertainment by The Laryngospasms and dancing to follow. If you have anesthesia “roots” within Wisconsin or would just want to “be a Badger” for one night of festivities, consult the website at www.wiana.com.
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New This Year! The Business of Anesthesia Workshop
Mark your calendar! Plan to attend the Business of Anesthesia Workshop, to be held on April 14, 2012, prior to the Mid-Year Assembly in Washington, D.C. at the Renaissance Washington, D.C. Downtown hotel.
 
This meeting provides attendees with an opportunity to learn what the hospital administrator expects of them, along with the nuts and bolts of billing, coding, and reimbursement options. Sessions will explore the financial impact of various practice models on nurse anesthesia economies, a primer on compliance and RAC audits, contract negotiation and legal issues related to the Business of Nurse Anesthesia, and how the information learned at this workshop can be used to lobby legislators. For program information on the Business of Anesthesia Workshop visit the AANA website at www.aana.com or see Professional Growth in the NewsBulletin.
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New AANALearn® Pharmacology Course Available Online
In response to members’ requests for more pharmacology topics with continuing education (CE) credit, a new pharmacology course has been added to the AANALearn® catalog. “Inotropes and Vasopressors - New Uses in Clinical Anesthesia?” has been approved for one CE credit and is available now at special reduced pricing until the end of February.
 
As always, the online continuing education courses in AANALearn® are available for members 24/7 and the CE credits are automatically and quickly transferred into your CE transcript. AANA members always receive a 30 percent discount off the regular price of courses. If you are seeking a few or many CE credits for 2012 recertification, AANALearn® can provide what you need.
 
Check us out now at www.aanalearn.com to browse the catalogs.
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State Government Affairs

New Jersey Office Surgery Legislation Vetoed
New Jersey Assembly Bill 4099/Senate Bill 2780 has been vetoed by Governor Christie, effectively killing the legislation. This bill would have required surgical practices (defined to mean a facility that has no more than one operating room and has one or more post- anesthesia care units) to be licensed as ambulatory care facilities.
 
The legislation was introduced in response to a recent report questioning the safety of unlicensed surgical practices. A spokesperson from the New Jersey Association of Ambulatory Surgery Centers has stated a belief that that legislation was vetoed because the New Jersey Department of Health and Senior Services did not feel prepared (in terms of staff and funding) to take on the additional workload of inspecting and licensing these practices. It is believed that similar legislation will be reintroduced in the future.
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Federal Government Affairs and PAC

Medicare 2012 Anesthesia Conversion Factors Up 2 Percent from 2011
Anesthesia services provided to Medicare patients the first two months of 2012 will be reimbursed at an average $21.41 per unit, up about 2 percent the 2011 figure of $21.05 per unit, according to figures provided to the AANA by the Medicare agency in January.
 
Medicare Part B pays for anesthesia services by the formula (base units plus time units) times (dollar value anesthesia conversion factor). However, actual Medicare reimbursement figures and changes vary by locality, based on agency surveys of labor costs, practice expense costs, and real estate costs. The new anesthesia conversion factors are in effect for Medicare Part B services delivered between Jan. 1 and Feb. 29, 2012. On March 1, 2012, Part B payments for anesthesia services will be cut 26.2 percent unless Congress enacts relief legislation.
 
See the new Medicare anesthesia conversion factors (requires AANA member login and password).
 
Newly Posted Medicare Hospital Anesthesia Interpretive Guidelines Same as the Old Ones from Early 2011
The Medicare agency has posted new Medicare hospital conditions of participation interpretive guidelines (AANA login and password required) for anesthesia services. Analysis by the AANA’s Washington, D.C. office indicates that they are the same as the version Centers for Medicare & Medicaid Services (CMS) issued early in 2011, except with a new implementation and effective date of Dec. 2, 2011.
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Where Did Those Surgical Checklists Come From?
CRNAs reporting new surgical safety checklists to complete can point to a new Medicare final rule that links checklist adherence to quality measures, reduced medical errors, and increased patient safety—a rule that AANA supported in public comments (AANA login and password required).
 
According to the Medicare hospital outpatient final rule preamble, “This proposed structural measure assesses whether a hospital outpatient department utilizes a Safe Surgery checklist that assesses whether effective communication and safe practices are performed during three distinct perioperative periods: (1) The period prior to the administration of anesthesia; (2) the period prior to skin incision; and (3) the period of closure of incision and prior to the patient leaving the operating room. The use of such checklists has been credited with dramatic decreases in preventable harm, complications and post-surgical mortality. In November 2010, the New England Journal of Medicine (NEJM) published a study concluding that surgical complications were reduced by one-third, and mortality by nearly half, when a safe surgery checklist was used.”
 
The final rule also says that the use of the Safe Surgery Checklist is endorsed by the Council for Surgical and Perioperative Safety to which the AANA belongs. Though CMS does not require use of a particular checklist, the one circulated by the World Health Organization (WHO) is common and cited by CMS as an example.
 
 
House, Senate Name Conference Committee to Address Medicare Cuts Issue by March 1 Deadline
The House and Senate have named a bipartisan conference committee to develop a consensus version of legislation reversing 26.2 percent Medicare cuts to anesthesia and physician services and financing the needed relief before the reductions hit March 1.
 
Members of the conference committee are Sens. Max Baucus (D-MT), Jack Reed (D-RI), Ben Cardin (D-MD), Bob Casey (D-PA), John Barrasso MD (R-WY), Jon Kyl (R-AZ), and Mike Crapo (R-ID); plus Reps. Kevin Brady (R-TX), Dave Camp (R-MI), Fred Upton (R-MI), Renee Ellmers RN (R-NC), Tom Price MD (R-GA), Nan Hayworth MD (R-NY), Tom Reed (R-NY), Greg Walden (R-OR), Allyson Schwartz (D-PA), Sandy Levin (D-MI), Xavier Becerra (D-CA), Chris Van Hollen (D-MD), and Henry Waxman (D-CA). They were slated to meet for the first time Jan. 24.
 
In addition to addressing the Medicare payment issue, the conference committee must also address the extension of payroll tax relief and of unemployment insurance benefits. Their greatest challenge will not be whether to support relief from Medicare cuts, but how to pay the cost of relief which tops $25 billion a year and $300 billion over 10 years. If the cuts do not get extended, the average CRNA providing 900 13-unit nonmedically directed anesthesia services annually, a third of which are for Medicare patients, would lose $19,000 a year or over $365 a day in Medicare reimbursement alone.
 
Stay tuned for CRNAdvocacy opportunities to weigh -in with your member of Congress to reverse these threatened Medicare cuts and restore stability to the Medicare program – which will be made available on www.caretobecounted.org.
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New England Journal Focuses on Pain, Need for Providers
An editorial published in the Jan. 19 New England Journal of Medicine underscores the enormous social and economic costs of pain in the United States, and the lack of trained healthcare professionals to address it, concluding that a “comprehensive, population-level strategy for pain prevention, treatment, management and research” is needed, echoing the recommendations of a 2011 Institute of Medicine panel (IOM) that the authors co chaired.
 
The authors, Philip Pizzo, MD, from Stanford University, and Noreen Clark, PhD, from the University of Michigan, said, “More than 116 million Americans have pain that persists for weeks to years. The total financial costs of this epidemic are $560 billion to $630 billion per year…. The (IOM) report offers 16 recommendations…. Three recommendations address education as central to the necessary cultural transformation. Specifically, we recommend expanding and redesigning education programs to transform understanding of pain, improving education of clinicians, and increasing the number of health professionals with advanced expertise in pain care.”
 
The IOM panel report “Relieving Pain” was authorized by a Pain Care Act provision supported by AANA within the major national health reform law of 2010. The AANA provided comments to the panel, monitored its deliberations, and attended the release of its landmark final report.
 
 
Most Medicare Demonstration Projects Don’t Save Money – Except the One on Bundled Payments
Most Medicare demonstration projects do not save the Medicare program money, except for a demonstration project on bundling payment for certain cardiovascular procedures, according to a report issued Jan. 19 by the Congressional Budget Office (CBO).
 
Of 10 demonstration projects studied by the CBO, only one, a project bundling physician and facility payments for heart bypass operations, saved money (about 10 percent of total Medicare spending for these services). Both Medicare payment system innovations in general and bundled payment systems in particular are of interest to CRNAs because they portend substantial change to the way CRNA services are reimbursed. To the extent that payment innovations promote quality, access and cost effectiveness, demand for CRNA services may increase even in a competitive environment.
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HHS Releases 2012 Regulatory Priority List
The U.S. Department of Health and Human Services 2012 regulatory priority list includes several items of direct and indirect interest to CRNAs.
 
According to the Administration’s Office of Information and Regulatory Affairs, an item listed on HHS regulatory priority list may be subject to a proposed or final rulemaking within the next 12 months. The list includes a rule establishing health insurance exchanges in states, a rule to promote the viability of coverage through exchanges, and expansion of Medicaid coverage. It also includes expansion of value-based purchasing programs, promotion of meaningful use of health information technology, and a pending proposal providing regulatory relief and streamlining for hospitals and healthcare facilities to which AANA and APRN groups have already submitted public comments.
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MedPAC Urges 17 Percent Cuts to CRNA and Other Specialty Care
The Medicare Payment Advisory Commission (MedPAC) in Washington continues urging Congress to fix statutorily required Medicare Part B payment cuts in part on the backs of CRNAs and other specialty care providers.
 
Meeting in Washington Jan. 12-13, the MedPAC said its October 2011 letter to Congress stands, in which the advisory body urged replacing the 26.2 percent Medicare Part B payment cuts attributable to the flawed “sustainable growth rate” funding formula with 10 years of level payment for primary care and three years of 5.9 percent cuts each year for CRNA and specialty care. The AANA had warned MedPAC off of such a recommendation, saying a cumulative 17 percent cut to anesthesia payment was unjustified and would impair patient access to needed services. Moreover, at the recommendation of AANA and other organizations, over 90 members of the U.S. House from both parties wrote their bipartisan leaderships to urge Congress against adopting the MedPAC recommendation.
 
In addition, the MedPAC recommended that Congress authorize the Medicare agency to increase ambulatory surgery center (ASC) payments 0.5 percent in 2013, and to recommend the Secretary of Health and Human Services develop a Value-Based Purchasing (VBP) program for ASCs to take effect no later than 2016. The MedPAC also recommended that Medicare consider equalizing its system of outpatient hospital payments with office- based fee-for-service payments, and to undertake a study of whether such a policy would impact patient access to care.
 
See the MedPAC hearing materials with its transcript appearing soon, the MedPAC Oct. 2011 letter on SGR, the AANA’s letter to MedPAC Sept. 30, 2011, urging against CRNA and specialty payment cuts (requires AANA member login and password), and the Burgess-Green letter on the MedPAC recommendation.
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CRNA Pain Care: AANA Posts Primer on Medicare “Incident-to” Billing
Because two Medicare administrative contractors, Noridian and WPS Medicare, have published bulletins denying direct Medicare reimbursement for CRNA pain care services and said that instead such services be billed “incident-to” the services of a physician, the AANA has developed and posted for AANA members a primer on the subject.
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Book Your Mid-Year and Business of Anesthesia Meetings Now
Now’s the time to book your seat at the AANA Business of Anesthesia conference Apr. 14, and the AANA Mid-Year Assembly Apr. 15-18, 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.
 
The 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. The AANA Mid-Year Assembly will also host an Affair of State Sunday night, in the penthouse suite of the historic Hay Adams Hotel overlooking the White House, to benefit the CRNA-PAC. 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?
 
In addition, on Monday afternoon Apr. 16, 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, she had the Ira P. Gunn Award for Outstanding Professional Advocacy established and named in her honor by the AANA in 2000.
 
Learn more and register at www.aana.com; click on “Meetings” up top. Learn more about Ira Gunn.
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Will You 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 member’s contribution.
 
Already, the CRNA-PAC is halfway towards its two- year, $1.75 million fundraising goal, intended to help make the profession’s voice heard in a politically polarized U.S. Capitol that has many new faces – two- fifths of the House is new since 2007. And even though the CRNA-PAC in 2011 raised more money in a year than ever before – more than $750,000 – the American Society of Anesthesiologists ASAPAC raised an astounding $1.633 million in 2011 alone, more than twice what CRNA-PAC did.
 
“Our practice and our profession is under attack from huge Medicare cuts, and from organized efforts to characterize our services as solely the practice of medicine in a way that would eliminate CRNA care through payment cuts – a kind of economic credentialing,” said CRNA-PAC chair Steven Mund, CRNA, DNP. “With 2012 being an election year, we are asking all AANA members – CRNAs and students – to care to be counted by contributing to CRNA-PAC today.”
If 26.2 percent Medicare payment cuts take effect March 1 as threatened, the average CRNA providing 900 13-unit nonmedically directed cases, 30 percent to Medicare patients, could see a $19,000 cut in reimbursement over a year – just about $365 per week. “A dollar a day for the CRNA-PAC is a small investment to keep Washington from cutting Medicare CRNA reimbursements $365 every single week,” said Mund.
 
To contribute to the CRNA-PAC, click www.caretobecounted.org and enter your AANA member login and password.
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U.S. Justice Department Files Health Reform Brief with Supreme Court 
The U.S. Department of Justice has filed a brief urging the U.S. Supreme Court to find the Affordable Care Act to meet constitutional muster, saying that Congress acted within its authority to mandate persons purchase health coverage or pay a penalty. The high court is slated to host oral arguments on health reform March 26-28, 2012. for further information, read the Supreme Court’s files on the subject. 
 
Presidential Contenders’ Health Policy Links
With voters in Florida casting ballots for a GOP presidential nominee Tuesday, Jan. 31, how can CRNAs find where the major contenders stand on health policy issues? The contenders’ campaign websites provide helpful guidance.
 
Amendments
Congress is more unpopular than ever, reports a poll published by the Washington Post on Jan. 16.
 
Healthcare spending growth continues slowing way down, according to analysts at CMS reporting in January’s Health Affairs. Health spending in the U.S. grew 3.9 percent in 2010, 0.1 percentage points more than in 2009, totaling $2.6 trillion or $8,402 per person.
 
The next presidential primary election is Jan. 31, 2012, in Florida. 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.
 
Your comments and questions are welcome! Please email your AANA federal policy questions and comments 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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PR, Publications and eCommunications

 
New Website Page Offers "Promotional and Advocacy Resources for AANA Members"
This new page in the Professional Resources section (under AANA Business) on the member’s side of the ‎website page pulls together a variety of materials that members can use for promotional, advocacy, and ‎educational purposes. You'll find to up-to-date fact sheets, landmark research data, and strategy-building ‎tools, and new resources will be added to this page as they become available. Check it out (requires AANA login and password)‎.
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AANA Foundation and Research

Applications Now Available on the AANA Foundation Web Page
The AANA Foundation is excited to announce that we are once again offering scholarships, fellowships, grants, and “State of the Science” awards for 2012 thanks to the generosity of our supporters. Applications are now available on our website.
 
Here are upcoming deadline dates and opportunities:
March 1, 2012:
  • “State of the Science” Oral Poster Presentation
  • Dean Hayden Student Research Scholarship – available to nurse anesthesia students only
 
April 1, 2012:
  • Palmer Carrier, CRNA Doctoral Scholarship
  • Doctoral and Post Doctoral Fellowship
  • Lorraine D. Dankowski Doctoral Fellowship
  • Florida Association of Nurse Anesthetists Doctoral Fellowship
  • Kay Wagner Pennsylvania Association of Nurse Anesthetists Practice and Research Doctoral Fellowship
May 1, 2012:
  • “State of the Science” General Poster Presentation
  • Grant Proposals
 
Contact the AANA Foundation if you have any questions – call (847) 655-1170 or email foundation@aana.com.
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News from COA

Save the Date! COA Doctoral Workshop at AANA Annual Meeting
The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is offering “The Nuts and Bolts ‎of Developing a Professional Doctoral Degree Offering” on Friday, Aug. 3, 2012. This one-day workshop ‎provides information on the key activities to establish doctoral degree offerings consistent with the COA’s ‎Additional Criteria for Practice-Oriented Doctoral Degrees contained in the Standards for Accreditation, and ‎COA Policies and Procedures.
 
The content is valuable for programs establishing both entry level and CRNA post-master’s doctoral degrees. ‎Topics include a dean’s perspective, key considerations in getting started, developing a curriculum that ‎meets national standards for similar degrees, interpreting the COA’s additional criteria for doctoral degrees, ‎and tips for success in the submission and review of doctoral applications.
 
Who should attend:
  • Nurse anesthesia program administrators
  • Deans of academic units affiliated with nurse anesthesia
  • Nurse anesthesia faculty
The fee is $250 per person. Attendees can earn six CE credits. Registration opens March 1. Registration is ‎limited so register early to avoid getting closed out! For full program details and registration information ‎please visit the COA website at http://home.coa.us.com.‎
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Healthcare Headlines

 
New Study in Anesthesiology Supports Mixed Lipid Emulsion to Reverse Toxicity of Local Anesthetics
New research findings have implications for the use of lipid emulsion infusion in reversing toxicity that, although rare, can be caused by the use of anesthetics. The technique is believed to extract local anesthetic out of serum and absorb it into the lipid, thus preventing it from reaching the heart and other critical areas. However, while existing guidelines for this process dictate long-chain triglyceride emulsion, the new study suggests that a mixed lipid emulsion solution containing both medium- and long-chain trigylcerides is more effective. Results from the tests—carried out with actual human serum injected with bupivacaine, ropivacaine, and mepivacaine—were contrary to earlier findings that used buffer solutions instead of serum. Researchers additionally discovered that although anesthetic toxicity often presents when acid levels are high in the blood, the lipid emulsion infusion works the same whether the patient's blood is acidic or not; therefore, there is no need to wait for blood levels to return to normal levels before initiating treatment. The study is published in the February issue of Anesthesiology.
 
From "New Study in Anesthesiology Supports Mixed Lipid Emulsion to Reverse Toxicity of Local Anesthetics"
Newswise (01/25/12)
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Pediatric Analgesic Clinical Trial Designs, Measures, and Extrapolation: Report of an FDA Scientific Workshop
Analgesic trials pose a number of challenges in pediatrics, but the trials can be improved with the use of innovative study designs and outcome measures targeted specifically for children. The U.S. Food and Drug Administration sponsored a scientific workshop in which participants developed consensus on aspects of pediatric analgesic clinical trial design. While adult trials commonly utilize the standard parallel-placebo analgesic design, this has ethical and practical difficulties in pediatrics, as the subjects may experience pain for extended periods of time. Immediate-rescue designs that use opioid-sparing rather than pain scores have seen success in pediatric analgesic efficacy trials. The workshop participants recommended preferred outcome measures for each age group. Acute pain trials were considered feasible for children undergoing surgery. In addition, pharmacodynamic responses to opioids, local anesthetics, acetaminophen, and nonsteroidal anti-inflammatory drugs were found to be substantially mature by age two years. At present, there is no strong evidence for the efficacy of acetaminophen or nonsteroidal anti-inflammatory drugs in children under three months of age. Small sample designs for some chronic pain conditions and for studies of pain and irritability in palliative care should be considered in pediatric studies.
 
From "Pediatric Analgesic Clinical Trial Designs, Measures, and Extrapolation: Report of an FDA Scientific Workshop"
Pediatrics (01/12) Berde, Charles B.; Walco, Gary A.; Krane, Elliot J.; et al.
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Deep Sedation for Catheter Ablation of Atrial Fibrillation
Deep sedation for catheter ablation of atrial fibrillation is feasible and safe, researchers reported after conducting a prospective study of 650 consecutive patients. The study involved sedation initiated with an intravenous (IV) bolus of midazolam and analgesia with an IV fentanyl bolus. Sedation maintenance was achieved with continuous IV propofol, while heart rate, invasive arterial blood pressure, and oxygenation were continuously monitored. Administration of sedation and analgesia medication were performed by a nurse under an electrophysiologist. The mean initial dose of midazolam bolus was 2.4 mg, while the propofol bolus was 32 mg, with additional boluses given as needed. Researchers found no major sedation-related complications, and none of the patients needed endotracheal intubation. The researchers noted that the study achieved the goal of keeping the patients in deep sedation while maintaining spontaneous ventilation and cardiovascular hemodynamic stability. Deep sedation can reduce patient stress during during a relatively long procedure compared to conscious sedation. In addition, it facilitates motionless lying of the patient on the operating table. The findings are reported in the Journal of Cardiovascular Electrophysiology.
 
From "Deep Sedation for Catheter Ablation of Atrial Fibrillation"
Medscape (01/09/12) Vol. 22, No. 12, P. 139 Kottkamp, Hans; Hindricks, Gerhard; Eitel, Charlotte; et al.
 
Anesthesia May Leave Patients Conscious—And Finally Show Consciousness in the Brain
Discovering how anesthetics affect the brain holds great promise for a better understanding of awareness itself; however, the operating theater/recovery room is not the best setting to conduct this kind of research. So, rather than study patients undergoing surgery, Valdas Noreika from Finland's University of Turku led a group of researchers in an investigation using healthy student volunteers. To gauge how the drugs can render subjects behaviorally unresponsive but still subjectively conscious, a bispectral index was used to record simple electrical brain responses in 40 subjects who had been anesthetized with propofol, sevoflurane, xenon, or dexmedetomidine. Consciousness was checked by conducting standard medical protocols, by asking subjects to open their eyes at different points during the session in order to record when they stopped and started responding, and by asking them to recount their memories of the session afterwards to see if they may have had conscious experiences even when they appeared to be "under." Despite being unresponsive—and, thus, according to current medical definition, unconscious—the volunteers reported conscious experiences in 60 percent of the sessions, such as seeing or hearing the researchers, having simple thoughts, or having dream-like hallucinations. By contrast, anesthesia awareness occurs at a rate of only about 1 in 1,000 cases during surgery—which involves the use of multiple drugs at once and at much higher doses. Still, the new research is an important development in understanding how consciousness is tied to brain function; and the Finnish team believes that gradually ramping up the level of anesthetic in studies could help determine precisely which neural changes affect the disappearance of subjective experiences.
 
From "Anesthesia May Leave Patients Conscious—And Finally Show Consciousness in the Brain"
Discover (01/04/12) Bell, Vaughan
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In Rating Pain, Women Are the More Sensitive Sex
Recently published in The Journal of Pain, research from Stanford University suggests that women appear to suffer from pain more than men who have the same ailment. When analyzing the electronic medical records of 11,000 patients the researchers found that women reported experiencing higher levels of pain with joint and inflammatory conditions, back problems, diabetes, ankle injuries, hypertension and sinus infections. The pain levels reported by women were about 20 percent higher than those reported by male patients, although the data does not offer any information as to why. Some suggest that socialization has an impact, as men are encouraged to be more stoic about pain and often underreport what they are experiencing. Previous studies indicate that gender does play a role, noting that men and women respond differently to anesthesia and pain drugs; and the differences in pain response can fade for some conditions when a woman reaches menopause. The Stanford researchers emphasize that more study of pain is needed so that treatment can eventually be designed to suit each patient's response to pain.
 
From "In Rating Pain, Women Are the More Sensitive Sex"
New York Times (NY) (01/24/12) P. D5 Parker-Pope, Tara
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Contact Lenses Release Anesthesia to Your Eyeballs
Scientists lead by the University of Florida's Anuj Chauhan created a contact lens that is capable of delivering a continuous supply of anesthetic to the eyes of patients who have a photorefractive keratectomy (PRK). Patients undergoing this type of eye surgery experience a longer period of pain than LASIK patients, requiring administration of medication via eye drops multiple times a day. They also must wear a "bandage contact lens" to help the outer surface of the eye heal. The team discovered that by loading the bandage lens with anesthetics and vitamin E, three common anesthetics drugs could be administered on a continuous time release for anywhere from two hours to a day or longer. The team published their report in Langmuir, the journal of the American Chemical Society.
 
From "Contact Lenses Release Anesthesia to Your Eyeballs"
SmartPlanet (01/22/12) Fang, Janet
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Best Practice Measures May Not Curb Central-Line Infections
Best practices designed to curtail central line-associated bloodstream infections (CLABSI) do not appear to have much impact on patients in intensive care, based on a study presented at a meeting of the American Association for the Surgery of Trauma. Researchers from the University of Maryland Medical Center's shock trauma center in Baltimore conducted a retrospective analysis of CLABSI rates for the sickest general-surgery patients in their ICU from April 1, 2008, to April 30, 2010. In 2009, about halfway into the study, new infection control best practices were adopted based on Centers for Disease Control and Prevention guidelines. Despite the new protocols—which included a checklist, proper catheter maintenance, patient/family education, antibiotic coating on catheters, and a program to identify and remove catheters that are no longer needed—the CLABSI rate was not improved in the second half of the study period. Lead researcher Matthew Lissauer, MD, said that being critically ill is a risk factor for infection, noting that in this population, "the catheters tend to be more difficult to insert, often requiring numerous sticks that remain in place longer." Other groups cited as being at high risk for CLABSI include males, patients admitted to the emergency surgery service, and those having an open abdomen as indicated by the Current Procedural Terminology code.
 
From "Best Practice Measures May Not Curb Central-Line Infections"
Anesthesiology News (01/01/12) Frangou, Christina
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Antimicrobial Scrubs Help Reduce Infection Risks
Healthcare workers who wear antimicrobial scrubs and practice good hand hygiene can reduce the risk of transmitting methicillin-resistant Staphylococcus aureus (MRSA), researchers report in Infection Control and Hospital Epidemiology. Over the course of four months, scientists at Virginia Commonwealth University studied 32 healthcare workers who wore either conventional scrubs or scrubs that contained a germ-killing compound. The healthcare workers also received hand-hygiene training sessions every four weeks. Researchers took unannounced weekly cultures of the workers' hands at the beginning and end of a shift as well as cultures from the abdominal and pants pockets of the scrubs. Studies show that the abdominal and pants pockets are two high-touch and high-bacterial colonization areas. The antimicrobial scrubs were associated with a four to seven average log reduction of MRSA burden but did not reduce MRSA levels on the workers' hands. Lead researcher Dr. Gonzalo Bearman says that healthcare workers should remember that surfaces and apparel in their work environments are not sterile and can be reservoirs of resistant bacteria.
 
From "Antimicrobial Scrubs Help Reduce Infection Risks"
Outpatient Surgery (01/24/12)
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OR Itself May Promote Bacteria Contamination
New research suggests that the surgical environment itself could pose significant infection risks to patients. In three separate investigations, researchers found that providers, the surgical environment, and the patients themselves were all major reservoirs for transmitting bacteria, not only the providers. This means that interventions targeting just providers may be ineffective. Instead, hospitals should target patient reservoirs, establish systems that encourage hand hygiene during surgery, and improve cleaning strategies for the surgical environment. The investigators presented their findings at the annual meeting of the American Society of Anesthesiologists. Study results showed that patients were the primary source of Staphylococcus aureus, while the hands of healthcare providers before surgery were most likely to transmit vancomycin-resistant Enterococcus. Provider hands before, during, and after surgery were a frequent reservoir for gram-negative bacterial pathogens. In one study, intravenous stopcocks became contaminated in 23 percent of surgeries. Researchers also found that basic alcohol wipes were better at decontaminating stopcocks than a new cleaning device, Site-Scrub.
 
From "OR Itself May Promote Bacteria Contamination"
Anesthesiology News (01/01/12) Vol. 38, No. 1 McCook, Alison
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8 Tips for Efficient IV Catheterization
There are eight ways nurses can improve their success rate for IV starts in patients, including the old adage that practice makes perfect. Nurses should perform the task over and over again in order to become proficient. Selecting the right IV site requires nurses to be educated on how to gauge patients' anatomies and aware of what medications and fluids the patients will receive during surgery so they can make an informed decision about IV site selection. Nurses must palpate the IV site properly and hold traction when advancing the catheter. Hospitals should invest in vein-finding technologies that use light or ultrasound to help nurses visualize veins beneath the skin. Moreover, nurses need to brush up periodically on the Centers for Disease Control and Prevention's recommendations pertaining to hand hygiene and site preparation for the insertion of peripheral intravenous catheters, which differ from the recommendations for central lines. Finally, all staff should be trained on needle and catheter devices, as well as how to educate patients about possible complications.
 
From "8 Tips for Efficient IV Catheterization"
Outpatient Surgery (01/01/12) Tsikitas, Irene
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