Anesthesia E-ssential, June 15, 2012

Anesthesia E-ssential

June 15, 2012

 

Vital Signs

HHS Office of Inspector General Opinion Finds Potential Anti-Kickback Violations in Anesthesia Arrangements with ASCs—

So, What Should CRNAs Working in ASCs Do Now?
Anesthesia services arrangements in ambulatory surgery centers (ASCs) come under close scrutiny in an advisory opinion posted June 1 by the U.S. Department of Health and Human Services Office of the Inspector General (HHS OIG). Foreshadowed by an article published in the May AANA NewsBulletin, HHS OIG Advisory Opinion Number 12-06 focuses on prohibited self-referral and kickback arrangements that should prompt CRNAs – especially those contracted to work with ASCs – to examine their own arrangements closely to ensure compliance, according to members of the AANA Anesthesia Payment Policy Coordinating and Specialist Panels. AANA members, read more about this critical opinion here (requires AANA member login and password).
 
 

 

The Pulse

 
  • New State Association Webpage Is Here
  • FDA, NIOSH and OSHA Joint Safety Communication
  • Joint Commission Report Describes New Influenza Vaccination Standard
  • Past President Jackie Rowles Elected IFNA First Vice President
  • Be Younger Next Year
  • AANALearn®: All the CE credits you need for Recertification!
  • Coalition to be Featured on Internet Radio Program
  • VA Launches Campaign to Raise Awareness and Understanding of Post-Traumatic Stress Disorder
  • NCSBN Launches Consumer Education Initiative About APRNs

 

  • Check out “State Update” Improvements on the AANA Website
  • New Resource Toolkits Available on the AANA Website
 
  • AANA Foundation Call for FY13 Committee Members
  • Register Now for AANA Foundation Events at the Annual Meeting
 
  • Election of COA Officers
  • COA Call for Comments Closing Friday, June 22
  • Standards Hearing to Be Held at Annual Meeting
 
  • Possible Delay in Medicare Rule that May Include Pain Issue
  • Supreme Court Soon to Decide Constitutionality of Health Reform Law
  • Negotiators Working on Drug Shortage Bill Agreement
  • AANA Presents at FDA Workshop on Chronic Non-Cancer Pain
  • Senate Panel OKs Level Funding for Title 8 Nurse Workforce Programs
  • FEC REQUIRED LEGAL DISCLAIMER FOR CRNA-PAC
  • To Help Fix SGR, AANA Urges Congress to Make More Use of CRNAs, APRNs
  • FEC REQUIRED LEGAL DISCLAIMER FOR CRNA-PAC
 
  • Visit the CRNA Career Center
 

Healthcare Headlines

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

 
 
Inside the Association
New State Association Webpage Is Here
The AANA is pleased to offer consultative and support services to state leaders. As a new addition to the services offered, a state association resources webpage has been developed (requires AANA member login and password).
 
The page includes:
  • Toolkits on state government affairs issues
  • Organizational health samples and templates
  • RFPs for Legal Counsel, Lobbyist
  • Governing Documents
  • PAC fundraising ideas
  • Sample association management contracts
  • And much more!
Staff resources are also available for consultation and support in any of the above listed areas, organizational health development, state government affairs initiatives, connecting state associations and more. Contact the AANA State Management Affairs division at (847) 655-1156, lrivera@aana.com or evolland@aana.com for more information.
 
FDA, NIOSH and OSHA Joint Safety Communication
The Food and Drug Administration (FDA), the Centers for Disease Control and Prevention’s (CDC) National Institute for Occupational Safety and Health (NIOSH), and the Occupational Safety and Health Administration (OSHA) strongly encourage healthcare professionals to use blunt-tip suture needles to reduce needlestick injuries and reduce the risk of subsequent bloodborne pathogen transmission to surgical personnel. Read the report here.

 
Joint Commission Report Describes New Influenza Vaccination Standard
On May 30, 2012, The Joint Commission issued a report describing the new influenza vaccination standard for licensed independent practitioners and staff that takes effect on July 1, 2012. This report provides a detailed rationale and evidence supporting this new standard, which applies to settings relevant to CRNA practice, including Joint Commission-accredited hospitals, critical access hospitals, ambulatory healthcare settings, and office-based surgery settings. (Specified elements of performance take effect on July 1, 2013 for the ambulatory care and office-based surgery programs.)

Past President Jackie Rowles Elected IFNA First Vice President
Congratulations to AANA Past President Jackie Rowles, CRNA, MBA, MA, FAAPM, who was elected first vice president of the International Federation of Nurse Anesthetists (IFNA) at the recent World Congress of Nurse Anesthetists held May 26-29 in Llubljana, Slovenia. Rowles had served as the United States country representative since June 2010, following the World Congress in The Hague, The Netherlands.
 
In her two-year officer's term, Rowles will be “the second in command” and serve on the Executive and the Congress Planning Committees.  As part of her duties, she will attend two meetings each year: the Congress Planning Committee, which is usually in held in November,  and the Executive Committee meeting, which meets in May or June of each year that the World Congress is not scheduled.
 
 
The IFNA is an international organization representing nurse anesthetists, serving the public and its members. The mission of the federation is dedicated to the precept that its members are committed to the advancement of educational standards and practices which will advance the art and science of anesthesiology and thereby support and enhance quality anesthesia care worldwide. The IFNA establishes and maintains effective cooperation with all institutions that have a professional interest in nurse anesthesia.

The IFNA Board of Directors is currently made up of 37 country representatives.  Board members must serve as a country representative for two years being eligible for election to an officer position. In addition to serving as a country representative Rowles also was elected in June 2010 to the IFNA Executive Committee, which consists of six elected at large positions.  Country representatives vote for the IFNA officers and the Executive Committee at large positions at each biennial IFNA World Congress.

Rowles reports that the IFNA officers, along with the Practice and Education Committees, will meet this June in Tunisia, host country for the 2014 IFNA World Congress.

Be Younger Next Year
AANA Health and Wellness recommends the Younger Next Year books by Chris Crowley and Dr. Henry S. Lodge for lifestyle changes to turn back your biological clock. Good news for anyone attending the Annual Meeting in San Francisco! Crowley is the eighth speaker in the Jan Stewart Memorial Wellness Lecture series. He’ll inspire and motivate attendees of all ages to enjoy life and be stronger, healthier, and more alert.

AANALearn®: All the CE credits you need for Recertification!
The recertification deadline is quickly approaching for 2012—if you need additional CE credits to meet the requirements, check out the courses in the AANALearn® catalogs. The 49 available courses are available round the clock and provide a total of 52 CE credits, with a variety of topics. With a 30 percent discount, prices for members range from $12-$35 for 1 CE credit and $70 for 2 CE credits. Once you complete a course in AANALearn® the credit will transfer to your transcript within one day—no other provider can offer this quick transfer of credits.
 
 
Coalition to be Featured on Internet Radio Program
The Coalition For Patients’ Rights (CPR) will be featured on the Internet radio station RN.FM on June 18. The interview will focus on scope of practice issues and the importance of multidisciplinary care. Lisa Summers of American Nurses Association and Janet Bezner of APTA will be representing the CPR. The show is scheduled to air live at 9 p.m. Eastern. Listen to the live show. A recording will be avaible for downloading from the RN.FM website next week.

VA Launches Campaign to Raise Awareness and Understanding of Post-Traumatic Stress Disorder
The Department of Veterans Affairs (VA) is raising awareness of post-traumatic stress disorder (PTSD) during the month of June by providing resources to individuals, families, and communities designed to help those who may be at risk. During the month of June, VA’s National Center for PTSD website will feature weekly topics including How I knew I had PTSD; My family suffered; How treatment helped me; and My advice: Don’t wait to increase awareness. The Web site contains extensive resources for the public and mental health professionals.
 
VA is the nation’s leading provider of care for PTSD, currently treating nearly 500,000 Veterans for the condition. VA provides effective PTSD treatment and conducts extensive research on PTSD, including prevention. VA has many entry points to care through the use of Veterans readjustment counseling centers, the Veterans Crisis Line, and integration of mental health services in the primary care setting. Since 2007, VA has seen a 35 percent increase in the number of Veterans receiving mental health services, and a 41 percent increase in mental health staff.

NCSBN Launches Consumer Education Initiative About APRNs
The National Council of State Boards of Nursing (NCSBN)has launched a new educational campaign that introduces consumers to the fact that boards of nursing in the U.S. license advanced practice registered nurses (APRNs) as part of their mission of protecting the public. The campaign is designed to explain that boards of nursing are working toward the goal of more APRN licensure uniformity across the country to continue to keep the public safe as healthcare reform advances. Forming the centerpiece of this new campaign is a 30-second television spot produced in conjunction with the CBS Community Partnership Program that will air on CBS affiliates in eleven major markets. The campaign will also include a 60-second radio commercial. Both the radio and TV ads mention CRNAs.
 
 

  
 
Check out “State Update” Improvements on the AANA Website
Visit www.aana.com to see the recent improvements to the “State Update,” which is published quarterly and provides a snapshot of state-level legislative and regulatory issues, as well as policy developments that could affect CRNAs in all 50 states.
Previously, State Updates would typically run around 100-130 pages, with a significant amount of the content being the same from issue to issue (for example, a trend alert on the NCSBN Interstate Compact for Nursing that appeared in every issue). The new State Updates will be around 40-60 pages, and will have a stronger focus on key current issues potentially affecting CRNAs in the states. Nonessential topic areas have been removed from the Update entirely, so that there can be a stronger focus on key areas like anesthesiologist assistants and pain management. In addition, the State Update pdf will now contain a bookmark function, allowing readers to navigate the document more easily.
 
New Resource Toolkits Available on the AANA Website
Visit the AANA website to access the new resource toolkits on the State Association Resources webpage. These toolkits help state associations deal with particular issues by providing resources including history, talking points, lessons learned and public relations, based in part on experiences from other states. So far, toolkits have been created for pain management, anesthesiologist assistants, state reimbursement advocacy, and supervision/opt-outs. State nurse anesthetist association leaders participated in webinars in March through May 2012 demonstrating these toolkits.
 
 

 
 
AANA Foundation Call for FY13 Committee Members
The mission of the AANA Foundation is to advance the science of anesthesia through education and research. You can play an active role in supporting these important aspects of the CRNA profession by participating on an AANA Foundation committee. The Foundation is currently looking for committee members to serve on the Research and Scholarship Committees for fiscal year 2013 which runs September 1, 2012 through August 31, 2013.
 
The AANA Foundation Research Committees are comprised of CRNAs who are interested in research.  Tasks include reviewing applications for research grants, fellowships and poster sessions.  The Board of Trustees makes funding decisions based on the recommendations of these committees.  Members of the Research Committees are also occasionally called upon to assist on research advisory panels.
 
The AANA Foundation Scholarship Committee is comprised of CRNAs. The task of this committee is to review student scholarship applications.  The Board of Trustees bases funding decisions on the recommendations made by this committee.
 
Many members of the AANA Foundation Board of Trustees, both past and current, have served on the Research and/or Scholarship Committees.  Please consider giving back to your profession by joining this effort by serving on one of these committees.   Interested?  Submit your CV and a brief bio including your interest in research or scholarship to ljordan@aana.coma. If you have questions, please contact the Foundation at (847) 655-1170.

 
Register Now for AANA Foundation Events at the Annual Meeting
If you’re planning to attend the Annual Meeting in San Francisco and are looking to have a great time, experience local flavor, and support a great cause, register today for the following events:
  • Saturday, Aug. 4, California Hornblower Dinner and Dance Cruise on San Francisco Bay
  • Tuesday, Aug. 7, 15th Annual Golf Tournament at San Francisco’s Presidio Golf Course – register by June 15, 2012 to receive the early bird registration fee of $215.

To register, use the AANA Annual Meeting Registration Form. Print the form and be sure to complete section 5 – Ticketed Social Events to register for the AANA Foundation Fundraiser and/or the AANA Foundation Golf Outing. Mail, fax or email the form to AANA, 222 S. Prospect Ave, Park Ridge, IL 60068.
 
Thank you in advance for your support. A portion of your registration fee for these events is tax-deductible and will support nurse anesthesia education and research.

 
 

 
 
Election of COA Officers
The Executive Committee officers are elected annually at the spring Council on Accreditation of Nurse Anesthesia Educational Programs (COA) meeting. A newly elected Executive Committee assumed office immediately following the May 2012 meeting. The committee includes Kathleen Cook, CRNA, MS, chair; Kay Sanders, CRNA, DNP, vice chair; and Mary Shirk Marienau, CRNA, PhD, secretary/treasurer.
 
COA Call for Comments Closing Friday, June 22
The call for written comments on the first draft of the Practice Doctorate Standards for Accreditation of Nurse Anesthesia Programs will close this Friday, June 22. To comment, or view a copy of the standards, visit the COA website at http://home.coa.us.com. Your feedback is critical in shaping the final draft of Practice Doctorate Standards. Please use the online tool to express your support for specific standards as well as your concerns.
 
Standards Hearing to Be Held at Annual Meeting
The COA will be holding its third hearing on the first draft of the Practice Doctorate Standards on Saturday, Aug. 4, 2012 at 5 p.m. at the AANA Annual Meeting, immediately following the AANA Business Meeting. Contact the COA at accreditation@coa.us.com with any questions about the draft Standards or the process for the major revision of the COA accreditation Standards.

Return to Headlines
 

 
 
 
Possible Delay in Medicare Rule that May Include Pain Issue
Ordinarily the Medicare physician fee schedule proposed rule that governs the next year’s Part B anesthesia and physician payments – and this year may carry a proposal regarding Medicare patient access to CRNA chronic pain care services – would appear in late June or early July for a 60 day comment period. But the month when the Supreme Court says it will rule on the constitutionality of the Affordable Care Act health reform law is not an ordinary time. Thus, the Medicare agency is quietly signaling that instead of being released late June or early July as usual, the CY 2013 physician fee schedule proposed rule is more likely to appear in mid-July, after the Supreme Court’s anticipated late June ruling and after the July 4 holiday.
 
Supreme Court Soon to Decide Constitutionality of Health Reform Law
The U.S. Supreme Court is slated to decide any day on the constitutionality of the Affordable Care Act health reform law, with significant impacts on CRNAs any way the high court goes.
 
If the court upholds the law, it will continue being implemented and will remain an election year issue. If the court strikes down the law, then provisions that have not already been implemented by the administration or states would not take effect. For CRNAs, this means that the provider nondiscrimination provision -- an AANA-backed provision prohibiting health plans from discriminating against qualified licensed providers solely on the basis of licensure and slated to take effect January 2014 – would be repealed, along with many other insurance-related provisions. Funding projects already under way, such asthe graduate nursing education demonstration project and Title 8 nurse workforce development programs appropriated by Congress, would likely be in limbo, their status uncertain. And if the court strikes part and leaves part of the law, the impact on CRNAs depends on what is struck and what is kept. As soon as the court rules, the AANA will review the ruling and the dissents and provide AANA members a CRNA-specific perspective useful in anesthesia practice. Read the Supreme Court’s docket of health reform case.
 
Negotiators Working on Drug Shortage Bill Agreement
Legislation intended to address anesthesia drug shortages, by requiring manufacturers to publish more advance notice of conditions that might lead to shortages, continues to progress on Capitol Hill as House-Senate negotiators iron out differences between Food and Drug Administration user fee bills passed by both chambers.
 
Meanwhile, the AANA joined a coalition letter urging negotiators to drop a Senate amendment offered by Sen. Joe Manchin (D-WV) which would list hydrocodone (Vicodin®) and all products containing it on Schedule II. Currently, hydrocodone itself is on Schedule II, but many products containing it are listed on Schedule III which permits the medication to be prescribed or administered by APRNs where allowed by their state scope of practice.
 
 
AANA Presents at FDA Workshop on Chronic Non-Cancer Pain
A May 30 Food and Drug Administration workshop on Assessment of Analgesic Treatment of Chronic Pain was the venue for a presentation by AANA member Mark Odden, CRNA, ARNP, BSN, MBA. Odden’s talk highlighted that both acute and chronic pain management services are within a CRNA’s professional scope of practice. The purpose of the workshop was to hear a discussion of the available data on the efficacy of analgesics in the treatment of chronic non-cancer pain (CNCP).
 
The AANA is planning to provide additional written comments to the FDA on the topic, due Aug. 1.
 
Senate Panel OKs Level Funding for Title 8 Nurse Workforce Programs
Title 8 nurse workforce development programs, including the Advanced Nursing Education programs that help fund CRNA school improvements and nurse anesthetist traineeships, got a boost on June 12, as a key Senate panel approved a bill providing level funding for them in FY 2013.
 
The action by the Senate Labor-HHS-Education Appropriations Subcommittee chaired by Sen. Tom Harkin (D-IA) was seen as a victory for Title 8 program advocates concerned that the program is vulnerable to budget pressures even though APRNs and other nurses help improve healthcare delivery and save the healthcare system money. Similar to current FY 2012 funding levels, the panel’s package provides $232 million for Title 8 including $64 million for advanced education nursing. Nurse anesthetist educational programs and nurse anesthetist traineeships are provided $3-4 million annually through Title 8. The AANA had joined with the nursing community to support Title 8 appropriations.
 
The next step for the bill (not yet numbered) is for the full Senate Appropriations Committee to act on it, which it is scheduled to do later this week. House action on FY 2013 Labor-HHS-Education appropriations is slated for later this summer. Read the summary of the Senate subcommittee’s work
 
To Help Fix SGR, AANA Urges Congress to Make More Use of CRNAs, APRNs
To help fix the Medicare sustainable growth rate (SGR) funding formula that threatens 32 percent Part B cuts to anesthesia and physician services this coming January, AANA recommends Congress promote the use of CRNAs and other APRNs and lower barriers to the use of their services as the Institute of Medicine has recommended. The AANA’s recommendations appear in a letter sent May 25 to the House Ways and Means Committee, whose Republican majority requested the AANA’s views in a late April letter.
 
In addition, the AANA advised lawmakers that “the scientific literature suggests reforming the Medicare anesthesia payment system that promises substantial savings to the healthcare system while ensuring quality. The Medicare anesthesia fee-for-service system should not be repealed or subject to across-the-board cuts, but should be reformed to combat the inefficiencies that it drives,” referring specifically to the recent article in the journal Anesthesiology underscoring common lapses in anesthesiologist supervision of CRNAs.
 
The AANA also urged lawmakers to ensure that CRNAs and APRNs are in positions of leadership and “fully recognized participants in reformed healthcare delivery systems.”
 
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.
 
 

 
 
 

 
 
 
FDA Focusing on Patients Catching Fire in Operating Rooms
At approximately 550 to 650 incidents each year, based on Food and Drug Administration (FDA) estimates, surgical fires are a relatively rare—but potentially devastating—occurrence. In addition to the severe, and sometimes even fatal, injuries that patients can suffer, fires in the operating room also traumatize hospital staff and ruin expensive machinery. Three elements must be present to spark a surgical blaze: an oxidizer such as nitrous oxide or oxygen, which tends to have a heavy presence in operating rooms; an ignition source, like a laser or cauterizing instrument; and a fuel, such as tracheal tubes or surgical drapes. While alcohol often is blamed for operating room fires, expert Mike Bruley of the ECRI Institute in Pennsylvania says it actually is the catalyst in only about 4 percent of them. In cases where it is the contributing factor, he says it is because the alcohol solution was not allowed to dry for at least three minutes—the amount of time recommended by manufacturers. To address the problem of surgical fires, the FDA this week is hosting a Webinar on the topic. It is part of the FDA's Safety Initiative, which launched a campaign in October to educate healthcare professionals on fires in the operating room.
 
From "FDA Focusing on Patients Catching Fire in Operating Rooms"
Kentucky Post (06/12/12) Swift, Aisling
 

Magnets May Help Prevent Rare Complication of Spinal Anesthesia
A simple technique that combines local anesthetic with magnetized "ferrofluids" could help prevent high spinal block, a rare complication of spinal anesthesia. Researchers described the technique in the June issue of Anesthesia & Analgesia. Additional research could turn the magnet technique into another way to prevent high spinal block, which occurs when anesthetics spread to the upper portions of the spinal cord. The complication only occurs at a rate of about 0.6 per 1,000 cases, but it can cause sharp drops in heart rate and blood pressure, with a risk of cardiac arrest and death. The researchers used fluid-filled plastic tubing to create a simple model of the spine, then prepared a local anesthetic solution with or without a water-based ferrofluid to magnetize it. Both fluids ran downward by gravity in this model, but when a magnet was placed outside the tubing, below the needle's level, it stopped the downward flow of the magnetized fluid. The researchers believe that a similar technique with magnetized local anesthetic solution and exterior magnets could help control how spinal anesthesia spreads during surgical procedures, which can add another safeguard against high spinal block. Future research must determine the safety of the magnetic fluid, the quality of anesthesia, and practical issues related to the use of a magnetic field in the operating room.
 
From "Magnets May Help Prevent Rare Complication of Spinal Anesthesia"
Science Daily (06/01/2012)
 

How Does Exercise Affect Nerve Pain?
The results of a study published in the June issue of Anesthesia & Analgesia support the use of exercise as a non-drug treatment for pain caused by nerve damage, which can be difficult to treat. The findings indicate that physical activity helps reduce the level of inflammation-promoting substances called cytokines. The investigators documented the effects of exercise on neuropathic pain by observing rats with sciatic nerve injury and having some of them perform progressive exercise over a few weeks. By monitoring observable pain behaviors, the research team then assessed the effects on pain severity, with the results pointing to significant reductions in neuropathic pain for the rats assigned to swimming or treadmill running. Exercise was found to reduce abnormal responses to temperature and pressure and to lower the expression of inflammation-promoting cytokines in sciatic nerve tissue. The expression of a protein called heat shock protein-27 increased with exercise, which may have been a contributing factor in the reduction seen in cytokine expression. The results of the study, led by Yu-Wen Chen, PhD, of China Medical University in Taiwan, support the benefits of exercise as a non-drug therapy for reducing neuropathic pain, with abnormal pain responses lowered by 30 percent to 50 percent. The study also adds new evidence suggesting that inflammation contributes to neuropathic pain development.
 
From "How Does Exercise Affect Nerve Pain?"
Medical Xpress (06/01/12)
 

Femoral Blocks a Boon for Hip, Knee Surgery
Femoral nerve blocks (FNBs) offer a clear benefit over anesthetic approaches to pain management following knee and hip replacement, according to three separate studies. The results indicate that femoral blocks more effectively curtail pain during early recovery, avoid the negative side effects of opioid use, reduce the need for post-operative joint manipulation, and move patients out of the post-anesthesia care unit (PACU) more quickly. One experiment, conducted at the Hospital for Joint Diseases in New York City, found that patients who received opioids after hip arthroscopy stayed in the PACU longer than those who received single-injection FNBs. "An hour decrease of PACU time is enormous, and provides a huge cost savings," notes Dr. Brian Ilfeld, an associate anesthesiology professor at the University of California, San Diego, who was not involved in the research. At Boston's New England Baptist Hospital, meanwhile, a retrospective study discovered that regional anesthesia such as continuous FNB improved patients' range of motion and curtailed the need for manipulation after total knee arthroplasty (TKA). "Because manipulation is expensive—if you avoid it, you easily more than make up the cost of the infusion," Ilfeld observed. Finally, investigators at the Hospital for Special Surgery in New York City compared results from 45 patients who received epidural anesthesia plus FNB following TKA against results from 45 TKA patients who were given periarticular injections plus oral opioids to manage perioperative pain. While reporting similar pain scores, the FNB patients experienced less pain on the first day following surgery and less pain in terms of quality of recovery. "It has become a trend for orthopedic surgeons to try high-dose local anesthetics," Ilfeld said. "But we don't have adequate data. This study sheds more light on what's optimal for patients after TKA for pain control." Findings from all three studies were presented at the 2012 annual meeting of the American Academy of Orthopaedic Surgeons.
 
From "Femoral Blocks a Boon for Hip, Knee Surgery"
Anesthesiology News (06/01/12) Vol. 38, No. 6 Hawkins-Simons, Dana
 
A Cross-Sectional Analysis of the Effect of Patient-Controlled Epidural Analgesia Versus Patient Controlled Analgesia on Postcesarean Pain
Patient-controlled epidural anesthesia (PCEA) provides greater pain control than patient-controlled analgesia after a cesarean section, researchers report. The study compared PCEA with PCA for postcesarean analgesia and sought to determine the impact of pain-relief perception on breastfeeding within the first 24 hours after birth. The study included 621 women with cesarean births in 2007; the infants were at least 34 weeks gestational age at birth. Women who received PCEA reported significantly less average pain and needed significantly less analgesic adjuvant medication doses compared to women on PCA. There were statistically significant negative correlations for average total pain score with the number of breastfeeding sessions. Women who experienced mild pain, had a term neonate, were breastfeeding within two hours, and no supplemental feedings were significantly more likely to breastfeed six or more times in the first 24 hours. The researchers note that the women who experienced greater pain were less likely to breastfeed six or more times within the first 24 hours, and this could affect breastfeeding duration. They suggest that "working closely with an intraprofessional team of perinatal administrators, nurses, lactation consultants, obstetricians, nurse anesthetists, and [anesthesia providers] particularly in the first 12 hours postcesarean birth may improve initial pain management postoperatively and subsequently facilitate early initiation of breastfeeding, decrease or eliminate supplemental feedings, and increase the frequency of breastfeeding,"
 
From "A Cross-Sectional Analysis of the Effect of Patient-Controlled Epidural Analgesia Versus Patient Controlled Analgesia on Postcesarean Pain"
Journal of Obstetric, Gynecologic, & Neonatal Nursing (06/12) Vol. 41, No. 3, P. 339 Woods, Anne B.; Crist, Barbara; Kowalewski, Shirley; et al.
 
Drug Combination Improved Local Analgesia After Cesarean
The addition of the nonsteroidal anti-inflammatory drug ketorolac to bupivacaine can work better than bupivacaine alone to reduce pain and inflammation after cesarean delivery, a new study suggests. "Giving a low dose peripherally of nonsteroidal ketorolac has both an anti-inflammatory and an analgesic effect," said lead author Dr. Brendan Carvalho. "This suggests that there is a local mediation effect—this is not a systemic effect—and it may give birth to the whole concept of being able to give very small doses directly in the wound." Carvalho reported the findings at the annual meeting of the Society for Obstetric Anesthesia and Perinatology. The study found no significant improvements when subcutaneous hydromorphone, rather than ketorolac, was added to bupivacaine. The 60 women involved in the study all underwent elective cesarean delivery with spinal anesthesia. Each participant received elastomeric ON-Q pumps subcutaneously in the incisional wound. For 48 hours after surgery, the women were randomized to receive either bupivacaine at 10 mg per hour only (an active control), bupivacaine plus ketorolac at 0.6 mg per hour, or bupivacaine plus hydromorphone at 0.04 mg per hour. Researchers measured pain at four, 24, and 48 hours after surgery, using the verbal pain scale of 0 to 10. The area under the curve for postoperative pain scores while sitting was about 250 for women who received bupivacaine only, compared to 175 for women who received bupivacaine plus ketorolac. Compared with bupivacaine alone, the addition of ketorolac was also associated with lower levels of inflammatory markers interleukin-6 and interleukin-10 in wound exudate. Women in the bupivacaine-ketorolac group also had less supplemental opioid analgesic use after surgery, compared with 40 mg for those in the bupivacaine-only group.
 
From "Drug Combination Improved Local Analgesia After Cesarean"
OB GYN News (06/07/12) London, Susan  
 

June Anesthesiology Studies Show Promise for Alpha-2 Agonists to Reduce Opioid Use, Challenge Effectiveness of Simulator Manikins for Airway Training
A research team from Geneva University Hospital in Switzerland has found evidence that the use of alpha-2 agonists in tandem with opioids decreases opioid use in surgical patients. Investigators reviewed data from 30 previous studies encompassing 1,792 patients—933 of whom were given clonidine or dexmedetomidine, both of which are alpha-2 agonists. Patients who received the former consumed 25 percent less morphine at 24 hours after surgery, while those on the latter consumed 30 percent less of the opioid. The alpha-2 agonists also led to lower reported pain scores and a reduction in postoperative nausea, but their pain-relieving impact evaporated after 48 hours. The study was unable to confirm the effect of alpha-2 agonists on chronic post-surgical pain, and the lead author noted that more research is needed before alpha-2 agonists can be recommended for regular use by anesthesia providers. A second, pioneering trial on airway management—a critical skill for those in the anesthesia community—has demonstrated, meanwhile, that widely used patient simulator manikins do not accurately reflect the anatomy of the human upper airway. CT scans were used on 20 adult patients without injuries and compared to scans of four patient simulators and two airway training devices. The Austrian researchers found that the measurements of the pharyngeal airspace differed markedly between actual patients and all of the simulators and also that there were differences in the measured size of the oral airspace, the horizontal diameter of the tongue, and the distance from the epiglottis to the back of the pharyngeal wall. The results have cast doubt on the validity of studies conducted on the simulators. The lead author has called for the manikins to be improved as quickly as possible to better reflect the anatomic details of humans.
 
From "June Anesthesiology Studies Show Promise for Alpha-2 Agonists to Reduce Opioid Use, Challenge Effectiveness of Simulator Manikins for Airway Training"
Newswise (05/23/12)
 

Anesthesia in Children Linked to Learning Disabilities?
The effects of anesthesia on young children who undergo surgery are still not clear, says Dr. Constance S. Houck, senior associate in perioperative anesthesia, Children's Hospital Boston, and associate professor of anesthesia, Harvard Medical School. Houck notes that some recent studies have suggested that inhaled and intravenous anesthetics are potentially neurotoxic to young animals, although some researchers attribute the findings to species-specific toxicity as well as differences in monitoring practices between animals studies and human care. A 2009 study in Anesthesiology investigated the effects of anesthesia on young children. The study included 5,357 children from Olmstead County, Minn., of whom 593 had a general anesthetic before age four. If the children had received only one anesthetic, there was no increased risk of learning disabilities, but those who received two or more anesthetics before age four showed an increased risk of a learning disability. This risk also increased with longer cumulative anesthesia duration. However, the evidence was inconclusive as to whether this increased risk was connected with the anesthesia or to the underlying medical problems that warranted the anesthesia use. Meanwhile, a Dutch study, published in Twin Research and Human Genetics in 2009, looked at 71 pairs of monozygotic twins in which only one twin had received anesthesia. The twins who had been exposed to an anesthetic before age three years had lower educational achievement scores at age 12. However, the twins who were not exposed to an anesthetic had the same learning-related outcomes. SmartTots (Strategies for Mitigating Anesthesia-Related Neuro-Toxicity in Tots) is a partnership between the U.S. Food and Drug Administration and the International Anesthesia Research Society to support researchers looking at neurotoxicity in children. Four current studies include the Pediatric and Anesthesia Neurodevelopment Assessment, the GAS studies, the Rochester Epidemiology Study, and the Arkansas Children’s Study.
 
From "Anesthesia in Children Linked to Learning Disabilities?"
Modern Medicine (05/23/12) Charters, Lynda
 
The Effects of Active Warming on Patient Temperature and Pain After Total Knee Arthroplasty
Researchers recommend that nurses make sure all surgery patients receive effective warming methods. This is particularly important for patients with compromised thermoregulatory systems and individuals undergoing especially painful surgeries, such as total knee arthroplasty (TKA). TKA carries risks of inadvertent perioperative hypothermia, which could affect patients' experience of postoperative pain. The researchers conducted a study to determine the efficacy of a patient-controlled active warming gown to help optimize patients' perioperative body temperature. The study included 30 patients undergoing TKA, randomized to receive either a standard hospital gown and prewarmed standard cotton blanket or a patient-controlled, forced-air warming gown. The two groups did not have significantly different pain scores. However, the patients who received warming gowns had higher temperatures postanesthesia, used less opioids after surgery, and reported higher satisfaction with their thermal comfort compared to patients who received standard blankets.
 
From "The Effects of Active Warming on Patient Temperature and Pain After Total Knee Arthroplasty"
American Journal of Nursing (05/01/2012) Vol. 112, No. 5, P. 26 Benson, Ember E.; McMillan, Diana E.; Ong, Bill 
 

National Quality Forum Endorses Surgical Quality Alliances Patient-Focused Surgical Survey
The National Quality Forum's (NQF's) endorsement of a Consumer Assessment of Healthcare Providers and Systems (CAHPS) Surgical Care Survey measure took effect on June 1. The American College of Surgeons, partnering with other organizations and the Agency for Healthcare Research and Quality's CAHPS Consortium, developed the survey to assess patient experiences before, during, and after surgical procedures. The results of the survey are intended to help find ways to improve care, surgical outcomes, public reporting, and patient satisfaction. Survey data will capture patients' thoughts on several experience issues, such as how well they were prepared for their operations, their opinions on the surgeons' communications, and what information they received to help during recovery. Experts previously noted that surveys lacked critical surgical areas, including consent, shared decision making, anesthesia care, and postoperative instructions. The surgical-care survey is one of nine new quality measures on surgical care used in hospitals and outpatient facilities that received NQF endorsement.
 
From "National Quality Forum Endorses Surgical Quality Alliances Patient-Focused Surgical Survey"
Newswise (06/05/12)
 

Drug-Free Distractions for Kids With Cancer
SAIT Polytechnic in Calgary has developed a new approach to cancer treatment for Alberta Health Services (AHS) that reduces the number of pediatric oncology patients who need to be sedated before they receive radiation. Often, children with cancer are sedated to prevent fidgeting and anxiety during radiation therapy, but healthcare workers have questioned whether there were better methods to distract patients and lessen the stress on families. Over the past year, AHS healthcare workers have removed the need for sedation for five out of eight patients aged four to seven years through the use of tablets computers such as iPads. Children can watch a show on these tablets, mounted on a specially designed arm, that keeps their minds distracted and their bodies still. Mona Udowicz, radiation therapy manager at the Tom Baker Cancer Center in Calgary, said that sedation's effects can outlast the treatment period and often makes the children too groggy to play or go to school. In a 2011 study published in the Journal of Pediatric Hematology/Oncology, researchers noted that three commonly used types of sedation—minimal, moderate, and general anesthesia—can have side effects such as agitation, hypertension, nausea, vomiting, hallucinations, and respiratory problems. Distraction can be "a powerful coping strategy," they said.
 
From "Drug-Free Distractions for Kids With Cancer"
Toronto Globe & Mail (Canada) (06/06/12) Walton, Dawn
 

Unsafe Injections Put at Least 130,000 Patients at Risk of Serious Illness
At least 130,000 individuals have been potentially exposed to hepatitis and HIV as a result of unsafe injection practices in U.S. healthcare settings since 2001, according to a new study in Medical Care. The research cites 35 patient notification events that involved at least 17 states between 2001 and 2011. The events stem from a number of unsafe injection practices, such as reuse of syringes, mishandling of medication vials and containers, and reuse of single-dose vials. The Safe Injection Practices Coalition, led by the Centers for Disease Control and Prevention (CDC), has unveiled a toolkit to help educate healthcare providers about safe injection practices. The Healthcare Provider Toolkit features a narrated PowerPoint presentation on injection safety, an injection safety checklist, posters, brochures, and a flyer about misperceptions. "Outbreaks and research studies tell us that many healthcare providers believe they follow safe injection practices, but when we look closer, they are not actually following accepted standards," said Joe Perz, an epidemiologist at the CDC. "It is critical that all clinicians fully understand and implement CDC’s safe injection practice guidelines. Syringe reuse and related errors put patients at risk for life-threatening illnesses and must be eliminated."
 
From "Unsafe Injections Put at Least 130,000 Patients at Risk of Serious Illness"
OneandOnlyCampaign.org (05/30/12)
 
 
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