Anesthesia E-ssential, July 15, 2013

Anesthesia E-ssential

July 15, 2013


Vital Signs

The AANA Goes to Vegas!
Take a trip back to “Yesterday” during The Fab Four's performance at the AANA Annual Meeting's opening ceremonies. With uncanny, note-to-note live renditions of Beatles songs, the Fab Four will make you think you are watching the real thing. Watch the video on this page and see and hear for yourself. Don’t miss the premier Beatles tribute band during the Annual Meeting opening ceremonies on Saturday, Aug. 10, 2013.
The entertainment during the Annual Meeting never stops and includes “Saturday Night Live’s” Kenan Thompson hosting the AANA Foundation’s Fundraiser; a “Rat Pack Retro Reception” held by the CRNA-PAC; and military-veteran-turned-actor and motivational speaker J.R. Martinez presenting the keynote address.
And let’s not forget the education—this meeting offers CRNAs the opportunity to obtain 20+ CE credits from a variety of outstanding educational sessions and hands-on workshops. What better way to meet more than half of the two-year recertification requirements? Best of all, attendees will receive four free CE credits online at AANALearn. Don’t miss this entertaining, informative, and career-enhancing event!


The Pulse

  • Joint Commission Updates on Clinical Alarm Safety
  • Recent Medical Device Recalls
  • Don't Miss Out on these Popular AANA Workshops
  • AANALearn® - Continuing Education Credits Always Available!
  • Las Vegas Annual Meeting 2013 Walk/Run Registration
  • Research Discussion Forum Available Now
  • AANA Foundation Presents... Vegas - The Stars Come Out At Night
  • Anesthesia Pioneers Meeting Invitation
  • AANA Executive Director Serves on Democratic Governors Association Conference Panel
  • Medicare Proposes Eliminating Requirement that Bariatric Surgery Take Place Only in Certified Facilities; Certifying Body Proposing to Require Anesthesia be Provided or Supervised by Anesthesiologists
  • Medicare Rural Pass-Through Program Will Pay for CRNA Services within their State Scope of Practice, Clarifying Policy over Coverage of Chronic Pain Management Services
  • Medicare Proposes 2014 CRNA, Physician, Hospital Outpatient and ASC Payment Rules; AANA Reviewing
  • House Panel Offers New SGR Fix Bill that Addresses Some AANA Concerns
  • AANA Urges Medicare to Require National Accreditation Organization Standards that Exceed Medicare Requirements to be Based on Evidence, Not on Protecting Guilds
  • AANA and Alliance for Injection Safety Request that HHS Viral Hepatitis Action Plan Include Safe Injection Practices
  • Medicaid Alternative Benefit Plan Final Rule Leaves Coverages up to the States
  • How Does Employer Mandate Delay Affect CRNAs?
  • Plan to Join the CRNA-PAC’s Retro Rat Pack in Las Vegas at the AANA Annual Meeting
  • Amendments

Healthcare Headlines

Healthcare Headlines is for informational purposes, and its content should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

Inside the Association
Joint Commission Updates on Clinical Alarm Safety
The Joint Commission has approved a new National Patient Safety Goal (NPSG) focusing on clinical alarm safety (NPSG.06.01.01) for 2014 for hospitals and critical access hospitals. The new goal will be implemented in two phases. Phase one will begin Jan. 1, 2014, when hospitals will be required to establish alarm safety as an organizational priority and identify the most important alarms to manage based on their own internal situations. Phase two will begin Jan. 1, 2016, when hospitals will be expected to develop and implement specific components of policies and procedures and to educate staff in the organization about alarm system management. 
The Joint Commission has also released a sentinel event alert on medical device alarm safety in hospitals. Access the alert and listen to the supplemental podcast here
Recent Medical Device Recalls
Class I recalls of numerous medical devices, which may affect anesthesia practice, have been recently issued. These recalls include:
  • Medtronic, Inc. – Sutureless Connector Intrathecal Catheter products due to catheter occlusion
  • Medtronic, Inc. – SynchroMed II and SynchroMed EL Implantable Drug Infusion Pumps due to feed through failure
  • Medtronic, Inc. – SynchroMed II and SynchroMed EL Implantable Drug Infusion Pumps due to failure of priming bolus
  • Medtronic Xomed, Inc. – NIM Trivantage EMG Endotracheal Tube due to “cuff leak” or “cuff deflation”
  • Respironics California, Inc. – V60 Ventilators due to software issue
  • Symbios Medical Products – GOPump and GOBlock Kits due to excessively high flow rates
  • Verathon, Inc. -  Class I recall of the GlideScope Video Laryngoscope GVL and AVL Reusable Blades due to the potential risk of breakage and premature failure of the blade tip.
Don’t Miss Out on These Popular Fall AANA Workshops
  • There is still room in the Sept. 28-29, 2013, AANA Upper and Lower Extremity Block Workshop. This fast-filling workshop being held in Park Ridge, Ill., will include discussion on anatomy, pharmacology, and techniques. Between the lectures, attendees can put into practice what they’ve learned in the “hands-on” sessions. Click here to register!
  • Register now for the Oct. 23, 2013, AANA Essentials of Obstetric Analgesia/Anesthesia Workshop, which will be held in the AANA Foundation Learning Center in Park Ridge, Ill. This workshop addresses clinical applications of obstetric analgesia/anesthesia. Lecture format will cover normal and abnormal physiology of pregnancy, pharmacology, and techniques, plus case presentations will enhance lecture material. Hurry, space is limited.
    Click here to register for the OB Workshop!
  • On Oct. 24-26, 2013, the AANA will be offering the popular Spinal and Epidural Workshop in Park Ridge, Ill. This program includes discussion on the pertinent anatomic knowledge necessary for performing spinal and epidural anesthesia, comparisons of the differences and similarities between spinal and epidural anesthesia, and review of the clinical use of various local anesthetic and adjunct drugs for spinal anesthesia. This workshop fills quickly so register today!
  • Exciting revisions have been made to the AANA Advanced Pain Management Workshops to better serve members and to respond to requests by past attendees. AANA’s fall lineup of workshops will focus on various aspects of importance to the pain practitioner. Each workshop can be registered for separately, but the biggest impact comes from taking them all together as a training plan. Workshop options:
    • AANA Jack Neary Advanced Pain Management I Workshop – Oct. 12-13, 2013
    • AANA Jack Neary Advanced Pain Management II Workshop – Oct. 14-15, 2013
    • Neuroanatomy Prosection Workshop – Oct. 16, 2013
Sign in as a member at to register now.
AANALearn® - Continuing Education Credits Always Available
Do you need a few more CE credits for recertification this year? The deadline is quickly approaching. There’s no better time than now to review your transcript and make sure you have adequate CE credits, especially if you plan to recertify by July 31. There are more than 50 courses to select from and two courses currently on sale for members. 
All courses are prior approved by the AANA and the credits will automatically transfer to the AANA transcript*. AANA members have an existing account with AANALearn® which is easily accessed from the AANA website using the AANA login username and password. Browse the AANALearn® catalogs now at
* CE credit transfer is only for AANA members or nonmembers with record-keeping contracts.
Las Vegas Annual Meeting 2013 Walk/Run Registration
Follow this link to our video invitation to the eighth annual Fun 5K Walk/Run on Monday, Aug. 12, 2013. Walk/run sign-up is separate from meeting registration—to take your spot among your colleagues register here. Onsite registration is available, if not sold out, with limited shirts while supplies last. 

Research Discussion Forum Available Now
The AANA Research Department and the AANA Foundation promote and facilitate the knowledge and utilization of research in anesthesia and support professional development. In an effort to engage members in research, the AANA Research Department has created the AANA Research Discussion Forum. The purpose of the AANA Research Discussion Forum is to provide a platform for individuals interested in research to delve more deeply into research-related topics and methodology as they apply to the art and science of anesthesia, health policy, health service, and evidenced-based practice. This forum will be monitored by research content moderators. You will need a username and password to access the contents of the Research Discussion Forum.
AANA Foundation Presents… Vegas – The Stars Come Out At Night
Preview and vote for your favorite CRNA/SRNA Vegas Stars today:
Register: Click here to be directed to the AANA 2013 Annual Meeting Web page and register. Once on the registration form, be sure to complete section 5 – Ticketed Events and register for the Monday Evening – AANA Foundation Fundraiser.
All votes are tax-deductible and a portion of your registration fee is tax-deductible. Thank you in advance for your support of nurse anesthesia education and research.

AANA Executive Director Serves on Democratic Governors Association Conference Panel
Wanda Wilson, CRNA, PhD, AANA Executive Director/Chief Executive Officer​, second from left, served as a panelist during the Democratic
Governors Association Regional Policy Conference.
On June 12, 2013, Dr. Wanda Wilson, CRNA, PhD, AANA executive director/chief executive officer, helped lead a discussion on healthcare when she served as a panelist during the Democratic Governors Association Regional Policy Conference in Chicago. The panel, which was comprised of several governors and healthcare industry leaders, focused on the issues pertaining to implementation of the Affordable Care Act, healthcare delivery models, and access to care. Wilson’s remarks about the importance of advanced practice nurses and other healthcare practitioners practicing to the full extent of their training and education in order to meet the growing demand for quality healthcare services were welcomed and supported by all panelists. During the discussion, Wilson emphasized the important role CRNAs play in improving access to quality anesthesia and related services through the country. After the panel discussion, Wilson and Anna Polyak, RN, JD, Senior Director of State Government Affairs, had scheduled meetings with Gov. Pat Quinn of Illinois and Gov. Steve Bullock of Montana. During these meetings, Wilson and Polyak were able to emphasize issues specific to CRNAs in each state.
Since joining the Democratic Governors Association (DGA) and Republican Governors Association (RGA) earlier this year, the AANA staff and AANA members attended several DGA and RGA events and had numerous opportunities to educate governors about the value of CRNA services and advocate for specific legislative and regulatory issues in the states.

Medicare Proposes Eliminating Requirement that Bariatric Surgery Take Place Only in Certified Facilities; Certifying Body Proposing to Require Anesthesia be Provided or Supervised by Anesthesiologists
Medicare proposed June 27 to eliminate its requirement that covered bariatric surgery services be provided in accredited bariatric surgery “centers of excellence,” where certification guidelines were becoming more problematic for CRNAs. The agency’s recommendation, subject to a 30-day public comment period ending July 26, is consistent with a comment on this issue that the AANA submitted to the Centers for Medicare & Medicaid Services (CMS) last February. 
Currently, CMS recognizes bariatric surgery centers that have been certified by either the American College of Surgeons (ACS) or the American Society for Metabolic and Bariatric Surgery (ASMBS), and covers bariatric surgical procedures only to the extent that they are provided in such recognized facilities. Increasing CRNA problems with bariatric center guidelines were raised in the AANA letter to CMS signed by President Janice Izlar, CRNA, DNAP:  “As the ACS and ASMBS bariatric accreditation programs have merged, the new program has proposed an accreditation requirement for all hospital and outpatient bariatric programs that an anesthesiologist provide anesthesia services or supervise anesthesia services when CRNAs deliver anesthesia care. The AANA strongly opposes these anesthesiologist requirements as they have no valid scientific basis, and numerous studies dismiss the need for such requirements.” Where hospitals house certified bariatric surgery centers, such requirements for anesthesiologist services discourage optimal use of CRNAs. The AANA has also asked the ACS and ASMBS to eliminate the proposed anesthesiologist requirements.
The AANA will develop and submit a comment to CMS on this issue and encourages effected state associations of nurse anesthetists to consider doing likewise. Following the comment period, Medicare will evaluate the comments and release a binding final decision.
Medicare Rural Pass-Through Program Will Pay for CRNA Services within their State Scope of Practice, Clarifying Policy over Coverage of Chronic Pain Management Services
Medicare released a transmittal to contractors June 27 clarifying that its reasonable cost-based rural pass-through program for the services of a CRNA will cover all medically necessary Medicare services within a CRNA’s state scope of practice. The notification clarifies an important issue for CRNAs in qualifying rural and critical access hospitals (CAHs): that Medicare Part A covers all services that a CRNA is legally authorized to perform in a state, including medically necessary chronic pain management services for Medicare patients.
The Centers for Medicare & Medicaid Services (CMS) has issued Transmittal 2719 stating that “effective January 1, 2013, qualifying rural hospitals and CAHs [critical access hospitals] are eligible to receive CRNA pass-through payments for services that the CRNA is legally authorized to perform in the state which the services are furnished.” This means that CMS will now reimburse as part of the pass-through program CRNA services that are normally paid under the general fee schedule, such as pain management, line insertions, and intubations. To maintain eligibility for the pass-through program, CAHs must still demonstrate that they do not exceed 800 procedures in a year.
The transmittal states it has an implementation date of Sept. 9, 2013. According to CMS, “claims with dates of service on or after January 1, 2013, that are brought to the attention of the contractor will be reprocessed and can be paid back to January 1.” Claims will be reprocessed starting on Sept. 9, which the CMS notice terms the “implementation date.”
For further information, read the CMS Transmittal, and the CMS Medicare Learning Network MLN Matters article on this issue.
Medicare Proposes 2014 CRNA, Physician, Hospital Outpatient and ASC Payment Rules; AANA Reviewing
On July 8, the Medicare agency proposed its 2014 CRNA and physician fee schedules (PFS) and its hospital outpatient prospective payment system (HOPPS) and ASC payment system proposed rules. Once again, huge Medicare payment reductions are projected for Jan. 1, 2014, that would have a significant impact on CRNA and physician payments unless Congress acts to reverse or repeal the flawed Part B “sustainable growth rate” (SGR) formula.
Each proposed rule is several hundred pages long and is being reviewed by AANA for potential impacts on CRNAs and for regulatory comment by AANA before a Sept. 6, 2013, deadline. The proposals are posted in “preview” now on links that will expire when the rules appear in the Federal Register July 19.
Read a summary of the PFS proposed rule preview here and a summary of the hospital and ASC proposed rule preview  here. Both summaries link to the previews of the proposed rules.
House Panel Offers New SGR Fix Bill that Addresses Some AANA Concerns
House Energy and Commerce Committee Republicans issued a second draft bill June 28 intending to repeal the Medicare sustainable growth rate (SGR) funding formula and reform Medicare payment. The draft’s “advanced legislative framework” appears to favorably address one key CRNA issue: different types of healthcare professionals performing the same service appear to be held to the same standards and same quality measures for the purpose of calculating incentive payments.
AANA’s July 9 comment to the proposal focused on the safety, access, and cost-efficiency provided by CRNA services, and expressed support for “treating fee schedule providers the same with respect to development and use of quality measures for incentive payments, whether the provider is a CRNA or other advanced practice registered nurse (APRN), a physician, or other provider type.”
The bill continues to leave open significant issues, such as the size of incentive payments and the offsetting revenue source intended to pay for it. The SGR fix alone costs approximately $134 billion over 10 years.
In addition to the Energy and Commerce draft bill to repeal SGR, work continued in both the House and Senate to explore other potential Medicare and delivery system reforms. On June 26, the Senate Finance Committee held a hearing titled “Health Care Quality: The Path Forward,” and the House Energy and Commerce Health Subcommittee held a hearing titled “A 21st Century Medicare: Bipartisan Proposals to Redesign the Program’s Outdated Benefit Structure,” to examine possible next steps for reform.
Read the statement accompanying the “advanced legislative framework”  here. The statement includes links to the draft legislation and to questions that lawmakers are posing to the public. Read the AANA’s comment to the draft here (requires AANA member login and password), the Senate Finance Committee record here, and the House Energy and Commerce Health Subcommittee record here.
AANA Urges Medicare to Require National Accreditation Organization Standards that Exceed Medicare Requirements to be Based on Evidence, Not on Protecting Guilds
The AANA recommends that the Centers for Medicare & Medicaid Services (CMS) ensure that national accreditation organization (AO) survey and certification requirements that go beyond the Medicare Conditions of Participation be based on evidence and that they do not protect guilds and increase costs without improving quality.
The July 5 letter signed by President Janice Izlar, CRNA, DNAP, stated, “To the extent that the agency extends regulatory authority beyond its current authority to review and approve AOs’ standards for alignment with Medicare standards, CMS should also require that AO requirements exceeding Medicare standards are themselves based in peer-reviewed evidence, and are not protecting guilds that would increase costs without improving quality …. In its process for extending AOs’ deemed authority, CMS must not permit an AO to impose additional restrictions that are not evidence-based and create barriers to the full utilization of CRNAs; such barriers would reduce access to care and increase costs of anesthesia services without improving quality.”
Read the comment letter here and the proposed rule here (both require AANA member login and password).

AANA and Alliance for Injection Safety Request that HHS Viral Hepatitis Action Plan Include Safe Injection Practices
The Department of Health and Human Services (HHS) should address healthcare transmission of viral hepatitis through unsafe injection practices in its renewal of the Viral Hepatitis Action Plan, said the AANA and the Alliance for Injection Safety (AIS) in a July 2 letter.
In response to the request for information on HHS’s action plan, the AANA and AIS stated, “In the last decade, more than 160,000 patients in the United States were notified of potential exposure to hepatitis B, hepatitis C, and HIV due to unsafe medical injection practices. Given the continued frequency of patient notifications and confirmed outbreaks, members of the AIS believe now is the time for swift federal coordination to help eliminate the threat of healthcare transmission of viral hepatitis…. Based on this mounting evidence and the continued frequency of patient notifications and confirmed outbreaks, the AIS urges HHS to continue stressing the importance of eliminating the healthcare transmission of viral hepatitis, with a special emphasis on unsafe medical injection practices, in the renewed Viral Hepatitis Action Plan.”
Read the comment letter here (requires AANA member login and password) and the HHS Request for Information
here. Learn about the AANA-backed One and Only Campaign for injection safety at
Medicaid Alternative Benefit Plan Final Rule Leaves Coverages up to the States
The final Medicaid Alternative Benefit Plan rule issued July 5 by the Centers for Medicare & Medicaid Services (CMS) states that “coverage of particular services will depend upon the coverage option selected by the state and the Essential Health Benefits (EHB) that are determined based on the state-selected base benchmark plan.” For CRNAs, this rule means Medicaid coverage of anesthesia and pain management services may hinge on how private plans in the state cover those services. It also highlights the important work of AANA state reimbursement specialists (SRS) in each state, building relationships with key Medicaid and private health plan officials and educating them further about the value and importance of CRNA care.
Section 1302 of the Affordable Care Act provides for the establishment of an EHB package that includes coverage of EHBs. The law directs that EHB cover at least the following 10 general categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. Anesthesia services fall into many of these categories.
In its comment letter to CMS’ proposed rule on this subject last spring, the AANA requested that anesthesia and pain management services be included in the 10 EHB categories, and that Medicaid alternative benefit plans include CRNAs and other non-physician providers who bill for Medicare Part B. The AANA also requested the agency require Medicaid alternative benefit plans to comply with state and federal non-discrimination provisions. The final rule states that the agency “will require that all providers are operating within their scope of their licensure or certification when providing services to Medicaid beneficiaries.”
For further information, view the final rule in preview final rule in preview. The final will appear in the Federal Register later in July. Read the AANA’s comments on the proposed rule here (requires AANA member login and password).

How Does Employer Mandate Delay Affect CRNAs?
On July 3, the Obama Administration announced a one-year delay of the Affordable Care Act’s (ACA) Employer Shared Responsibility provision, also known as the “employer mandate.” The requirement for all employers with more than 50 employees to provide health insurance coverage or pay a penalty will now begin in 2015, not 2014 as originally scheduled. The change appears unlikely to affect CRNA practice and reimbursement, as government budget experts estimated that the original provision would not significantly affect enrollment in health coverage overall.
According to the official U.S. Treasury Department notice, the enforcement of the mandate’s reporting requirements and fines will be delayed until 2015 because the regulations for the mandate have not all been released, noting that employers expressed concern that they would not have time to adapt to them. This issue will be the subject of a hearing on Capitol Hill in the House Ways and Means Subcommittee on Health July 10.
For further information, read the official Treasury Department Notice, an FAQ on this issue, and the July 10 hearing notice.
Plan to Join the CRNA-PAC’s Retro Rat Pack in Las Vegas at the AANA Annual Meeting
While you’re at the AANA Annual Meeting in Las Vegas, embark on a one-of-a-kind experience with the CRNA-PAC at the Cleveland Clinic Lou Ruvo Center for Brain Health on Saturday, Aug.10, from 6:30 to 8:30 p.m.
Starting from our convention hotel, guests will be transported a short drive off the Vegas strip and back to a different decade as the CRNA-PAC celebrates with a “RETRO RAT PACK” reception and silent auction. Designed by world-renowned architect Frank Gehry, the Lou Ruvo Center is an iconic architectural landmark that includes a Wolfgang Puck-inspired kitchen, 199 unique windows, and a surrounding stainless steel trellis canopy, creating a truly magical experience.
With a venue mantra of “Keep Memory Alive,” the evening will surely be one to remember for years to come. Get your tickets today when you register for the AANA Annual Meeting. Tickets can also be purchased and/or picked up on site at the PAC booth located near meeting registration. Please visit for additional information. Proceeds to benefit the AANA’s CRNA-PAC, the only PAC in the United States devoted 100 percent to keeping the voice of nurse anesthesia strong in Washington, D.C.
  • Some CRNAs and student nurse anesthetists are among those seeing interest rates double on some of their student loans because Congress did not address a federal student aid program issue by a July 1 statutory deadline. Holders of federally subsidized Stafford student loans are seeing their interest rates double from 3.4 to 6.8 percent. While the President’s budget proposed extending lower rates and the U.S. House approved legislation late this spring setting subsidized Stafford loan interest according to a market rate, the Senate did not adopt the House bill and did not come to an agreement on how to address the situation, setting July 10 as a date when the chamber was scheduled to take votes on alternative solutions. Lawmakers on both sides of the aisle say the issue will be resolved later this summer, likely retroactively. Learn more about the issue in context from this PBS NewsHour coverage and get more information from the US Department of Education or from your educational institution’s financial aid office.
  • This November, the AANA Fall Leadership Academy will offer the first dedicated track for State Reimbursement Specialist (SRS) development. Every participant will leave this “reimbursement boot-camp” educated and energized, prepared to coordinate the efforts of reimbursement advocacy in their states. We are asking state presidents who have not already done so to please contribute to the community of CRNAs advancing state reimbursement goals by submitting the name and contact information for your state SRS today. You can do this as well as get additional information by writing to with the subject line “SRS.”
About This Document
The AANA Federal Government Affairs Hotline is published for the nurse anesthetist members of AANA Mondays when Congress is in session by the AANA Office of Federal Government Affairs, Washington DC, (202) 484-8400,, Frank Purcell, Senior Director. © 2013 American Association of Nurse Anesthetists. The following is an FEC required legal notification for CRNA-PAC: Gifts to political action committees are not tax deductible. Contributions to CRNA-PAC are for political purposes. All contributions to CRNA-PAC are voluntary. You may refuse to contribute without reprisal. The guidelines are merely suggestions. You are free to contribute more or less than the guidelines suggest and the association will not favor or disadvantage you by reason of the amount contributed or the decision not to contribute. Federal law requires CRNA-PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. Each contributor must be a US Citizen.


Study Questions Current Hypothermia Quality Measure
New research is casting doubt on the efficacy of guidelines meant to prevent hypothermia in surgical patients. The existing hypothermia quality measure from the Centers for Medicare & Medicaid Services dictates that patients in surgery and under general anesthesia for longer than an hour must either receive normothermia maintenance or be covered with a forced-air warming blanket. However, a retrospective review of medical records for 316 thoracic surgery patients at Mount Sinai in New York City indicated that 7.2 percent of patients developed postoperative hypothermia despite being covered with a warming blanket during the perioperative period. The death rate within 30 days of surgery was significantly higher among that subset of patients, at 8.7 percent, than among the larger patient population, at just 0.7 percent. While the findings raised at least one call for a revision of the hypothermia quality measure, lead researcher and associate anesthesiology professor David Bronheim, MD, said Mount Sinai's rate of hypothermia should be compared against other facilities. He added that, going forwad, his team will investigate whether hypothermia is inherently a risk factor for morbidity and mortality or whether it reflects an underlying condition that puts patients at risk. "If we find that hypothermia is indeed a direct risk factor for mortality, we would have to study whether other warming techniques might improve outcomes," Bronheim said.
From "Study Questions Current Hypothermia Quality Measure"
Anesthesiology News (07/01/13) Vol. 38, No. 7 Wild, David

Plant-Made Drug Reverses Breathing Paralysis
The neuromuscular blocking agent succinylcholine often is administered along with a sedative during surgical anesthesia, and it also is commonly used for rapid sequence intubation and other airway trauma procedures. Failure to quickly remove the drug from the patient's system and restore normal breathing, however, can cause fatal outcomes. Researchers reporting in the journal PLOS ONE believe they may have found a solution to the problem in plant-based butyrylcholinesterase (BChE), a recombinant human enzyme that is known to rapidly reverse paralysis of the airways—known as apnea—caused by succinylcholine. A deficiency of BChE in the serum, whether due to genetic factors or because of acquired conditions such as cirrhosis or malnutrition, can lead to dangerously prolonged succinylcholine-induced apnea. The enzyme can be found in blood products; but using BChE from stabilized serum, fresh frozen plasma, or purified enzyme not only is costly but bears the risk of blood-borne pathogens and other complications associated with transfusion. "Plants expressing recombinant human BChE may provide the answer for this limitation," according to Arizona State University researcher Tsafrir Mor. The ASU study involved modifying transgenic tobacco plants to synthesize BChE in their leaves. Animal trials demonstrated the ability of plant-derived BChE to reverse post-succinylcholine apnea.
From "Plant-Made Drug Reverses Breathing Paralysis"
Bioscience Technology (07/08/13)

Online Camera Hookup Links Hospitals to War-Zone Clinicians
University of Nebraska Medical Center (UNMC) researchers have demonstrated how a newly developed camera can connect with existing technology to assist clinicians working in war zones. They set up a connection between UNMC's Center for Advanced Technology and Telemedicine, the Spanish Army Hospital in Madrid, and a NATO base in Afghanistan using the new C-CAM camera along with a device that reproduces images in a format that can be transmitted via computer and a USB computer port to allow online video sharing. The configuration allowed study participants in all locations to receive quality, real-time images of an oral intubation on a difficult airway manikin. While the demonstration was executed using a video stylet produced by the global firm Karl Storz, any conferencing software—including FaceTime, Adobe Connect, or Skype—can be used. That represents a huge advancement, considering that this kind of video collaboration previously has required costly T-1 hookups and permanent audio-visual setups. Now, battlefield clinicians can get advice and support with intubations and other complex situations with just a basic Internet connection, helping them to provide better in the most extreme circumstances. It also can be used to coach deployed medical personnel on new techniques, say the study co-authors, an anesthesiology professor and instructor at UNMC. "It's quicker, cheaper, and gives better accessibility," according to the UNMC instructor, Thomas Nicholas, MD. "Not just with anesthesia but with combat trauma care."
From "Online Camera Hookup Links Hospitals to War-Zone Clinicians"
Anesthesiology News (07/01/13) Vol. 38, No. 7 Hanawald, Jennifer

Opioid-Antidepressant Combinations Prominent in Drug Overdose Deaths
Most U.S. deaths caused by prescription drug overdose involve opioid analgesics and are accidental, based on the Centers for Disease Control and Prevention's (CDC's) analysis of 2010 data. CDC researchers calculated that of 22,134 such fatal overdoses that year, opioid analgesics played a role in 75.2 percent of the cases. High rates of overdose deaths occurred when opioids were paired with benzodiazepines, antiepileptic and antiparkison drugs, antipsychotics and neuroepileptics, and barbiturates; but the findings also show that almost 30 percent of incidents tied to opioid analgesics involved no other pharmaceuticals at all. The analysis results are published in the Journal of the American Medical Association.
From "Opioid-Antidepressant Combinations Prominent in Drug Overdose Deaths"
Pain Medicine News (06/01/2013) Vol. 11 Frei, Rosemary
Study Raises Concerns Over Anaesthetic's Possible Link to Cancer Recurrence
Laboratory trials appear to support the theory that anesthesia drugs may affect whether cancer returns following surgery, with regional and local anesthetics resulting in fewer recurrences. Researchers in London discovered that isoflurane, a widely used general anesthetic, caused human cancer cells to grow and migrate more quickly—conditions that are linked to malignant tumors. "This study looked at cells in the lab, so we don't know whether the same effects are present in the body," acknowledged lead researcher Dr. Daqing Ma of Imperial College. "But we do know that the choice of anaesthetic can affect clinical outcomes, and we think this needs to be investigated further." Aside from the possible implications for using isoflurane in cancer surgery, the lab results also could influence medical experimentation using live mice, which typically are given an anesthetic—often isoflurane—that researchers now suspect may affect the test results and possibly even mask the effects of potentially effective treatments.
From "Study Raises Concerns Over Anaesthetic's Possible Link to Cancer Recurrence"
domain-B (06/29/13)
Local Infiltration Analgesia Plus Adductor Canal Block Iimproves Ambulation After TKA
Researchers have discovered that, compared to continuous femoral nerve block alone, the use of local infiltration analgesia in tandem with an adductor canal block resulted in better patient ambulation the first day after total knee arthroplasty. According to the study published in Regional Anesthesia and Pain Medicine, the use of local infiltration both with and without adductor canal block produced better pain scores at rest and reduced opioid consumption during the first 24 hours following surgery. In the study abstract, the investigators wrote: "Local infiltration analgesia was associated with improved early analgesia and ambulation. The addition of adductor canal nerve block was associated with further improvements in early ambulation and a higher incidence of home discharge."
From "Local Infiltration Analgesia Plus Adductor Canal Block Iimproves Ambulation After TKA"
Healio (06/26/2013) Perlas, Anahi

Antibiotic Shows Analgesic Action Following Surgery
A study published in The Journal of Pain found that administering a single dose of the antibiotic ceftriaxone for antimicrobial prophylaxis prior to surgery improved patient pain thresholds following the procedure. Earlier animal research suggested that drugs with a mode of action that enhances glutamate clearance may be effective in the treatment of chronic pain, showing that repeated does of the antibiotic ceftriaxone lead to reduced neuropathic and visceral pain in lab subjects. The most recent study, out of Rome's University Sapienza, is the first to investigate the analgesic activity of ceftriaxone in humans. The randomized study of 45 patients undergoing surgery for carpal tunnel syndrome or ulner nerve compression disease showed no change in mechanical pain thresholds six to seven hours postoperatively for patients treated with saline and cefazolin; however, patients who received a single, preoperative dose of ceftriaxone experienced significantly higher pain thresholds. The study authors concluded that ceftriaxone should be the drug of choice for surgical prophylaxis in instances where pain does not rapidly resolve, or where strong pain is expected to occur following the surgery.
From "Antibiotic Shows Analgesic Action Following Surgery"
Science Daily (06/25/2013)

Ipsilateral Pressure Parasthesias During Interlaminar Lumbar Epidural Steroid Injections Related to Pain Relief
Interlaminar lumbar epidural steroid injections (LESI) are shown to offer temporary relief for low back and unilateral radicular pain, but predicting patient response to the technique previously had been somewhat of a mystery. A study conducted by researchers in Chicago, however, has found that ipsilateral pressure paresthesias occurring during LESI correlates with pain relief, which can then be used as a prognostic indicator when using a parasagittal approach to the epidural space. Nebojsa Nick Knezevic, MD, PhD, director of anesthesiology research at Advocate Illinois Masonic Medical Center, explained that the study tested the theory that pressure paresthesia occurring in the same distribution of the radicular pain could provide information on how effective the LESI would be for the patient in question. The 100 adult patients enrolled in the study were prospectively assigned to receive LESI via either the midline interlaminar or parasagittal approach, both under fluoroscopic guidance. Patients confirmed whether or not they experienced a pressure paresthesia; said whether it was in the distribution of "usual and customary pain;" and graded it, both ipsilaterally and contralaterally. The researchers found that both LESI approaches achieved clinical and statistically significant reduction in unilateral lumbosacral radiculopathic pain compared with the basal level, both at rest and during movement. Knezevic said the preliminary findings "actually confirm our hypothesis that a pressure paresthesia occurring during the injection—if it's concordant in the same distribution as the pain—could be a prognostic factor. So potentially it could be utilized to optimize our therapeutic success in patients who get these injections for radiculopathic pain."
From "Ipsilateral Pressure Parasthesias During Interlaminar Lumbar Epidural Steroid Injections Related to Pain Relief"
Pain Medicine News (06/01/2013) Vol. 11 Vlessides, Michael
Socioeconomic Status Plays Major Role in Opioid Pain Control
According to a University of Rochester Medical Center study published in the Journal of General Internal Medicine, emergency rooms nationwide are less likely to prescribe opioid pain medications to patients who are black, Hispanic, poor, or who have little education than they are to more affluent patients. Though ethnic and racial disparities have been well-documented in the scientific literature, the URMC researchers believe their effort is the first to investigate whether the prescription of opioid pain medications is influenced by aspects of socioeconomic status. The team analyzed a cross-section of data from the National Hospital Ambulatory Care Survey of people 18 and older, from the years 2006 to 2009, using zip codes to identify socioeconomic status. The results confirmed that blacks and Latinos were less likely to receive opioids for like levels of pain, as were those living in impoverished neighborhoods. There also were discrepancies found among the levels of poverty, with the most needy also being less likely to be treated with opioids than those who were less poor. Regional discrepancies were also discovered, as opioids are prescribed less frequently in the Northeast than in the South and West. Co-authors Michael Joynt, MD, and Meghan Train, DO, said the reasons why the disparities occur should be investigated further and commented that having uniform standards and more medical education would help to promote unbiased prescribing.
From "Socioeconomic Status Plays Major Role in Opioid Pain Control"
University of Rochester Medical Center (06/26/13)

Nasal Spray Shows Promise for Dental Anesthesia
According to trial results published in the Journal of Dental Research, an experimental nasal spray developed by St. Renatus is as effective for maxillary dental anesthesia as an injection of lidocaine. The spray, under the moniker Kovacaine Mist, combines tetracaine with the decongestant oxymetazoline hydrochloride. Phase 2 studies were conducted on 45 healthy adults, 30 of whom were randomly assigned to receive the nasal spray as well as a sham injection and 15 of whom were given a placebo nasal spray and a real lidocaine injection. Pain was evaluated by using a probe to apply pressure at four sites in the mouth. Based on the results—and the results of Phase 3 trials that have since been performed—lead researcher Sebastian Ciancio, DDS, sees no disadvantage to using the Kovacaine Mist instead of an infiltration. "Even if it bothers you to have something sprayed in your nose," he says, "I think it would bother you less than having an injection." Ciancio believes the new anesthesia approach can revolutionize the dental experience, particularly for people who avoid the dentist because an aversion to needles.
From "Nasal Spray Shows Promise for Dental Anesthesia"
Medscape (06/24/13) Harrison, Laird

Hospitals Seek High-Tech Help for Hand Hygiene
Poor hand sanitation causes infection in hospitals, but hospitals still have difficulty forcing workers to sanitize as often as is necessary. To combat this, some hospitals have begun to use a sensor-badge that flashes green when hands are clean, flashes red when they need cleaning, and records whether hands were cleaned at each opportunity. Success rates are reported at 97 percent and 99 percent. Other hospitals use video monitoring, a wireless network that tracks when hand sanitizing stations have been used, and wall-mounted stations that sense clean hands and notify workers if their hands need cleaning. The badge system has caused a reported 66 percent reduction of hospital infections at Miami Children's Hospital.
From "Hospitals Seek High-Tech Help for Hand Hygiene"
USA Today (06/28/13) Salter, Jim

Sedation Eases Dental Procedures for Panicky Patients
Studies suggest that conscious sedation in dentistry is becoming more popular across the United States. This method—ranging from mild to deep sedation—eases visits for patients as well as dentists and, in some cases, helps people whose anxiety has prevented them from seeking dental care in the past. However, sedation also increases costs; prolongs appointment times; and comes with its own medical risks, including respiratory problems, brain damage, and even death. Mild sedation is most common and uses nitrous oxide, called "laughing gas." For those with more serious anxiety, dentists can provide a pill, generally Valium-based, in conjunction with nitrous oxide. Deep sedation is used for those with debilitating anxiety, for which a dentist might suggest combinations of drugs or even IV sedation. The American Dental Association has issued training guidelines for dentists who use sedation, urging state dental boards to put controls in place so that only qualified dentists are allowed to practice sedation and anesthesia.
From "Sedation Eases Dental Procedures for Panicky Patients"
Spokesman-Review (06/18/13) Rogers, Adrian
Abstract News © Copyright 2013 Information Inc.