Anesthesia E-ssential March 17, 2014

Anesthesia E-ssential

March 17, 2014


AANA Board of Directors Update

The AANA Board of Directors (AANA BOD), as part of its financial obligation to the CRNA members, has observed trends indicating the need for increased revenues in the general operating funds. At this time the AANA BOD proposes a bylaw change, supported by the Finance and State Organizational Development Committees.

The proposed language: "Review the prior five-year median utilization of the Organizational Health Allocation/Strategic Reserve Fund (OHA/SRF), add an additional 10 percent, and replace the sum to the fund.”

Here is an actual sample of taking the prior five-year median, which was $1,070,478.41.

$1,070,478 x 10% = $107,048
$1,070,478 + $107,048 = $1,177,526
(This figure would be replaced to the SRF)

The benefits to this restructuring include:
  • Dues do NOT increase
  • OHA funding for states remains steady
  • SRF continues to grow
  • States dues allocation is unaltered


The Pulse

  • AANA Submits Comments on APRN Licensure Compact
  • Ballot Announcement
  • 2013-2014 Nominating Committee
  • Online Forum for Candidates for the AANA Board of Directors
  • Discounts on Patient Safety Courses in March
  • Business of Anesthesia
  • NEW AANA Workshop: Foundations of Advanced Pain Management
  • Registration Now Open for AANA 2014 Nurse Anesthesia Annual Congress
  • AANA Foundation - April 1 and May 1 Deadlines Approaching: Apply Online Today for Fellowships, Grants, and Poster Session Presentations
  • Orlando - The Stars Come Out Again: Event Talent Applications Due April 1, 2014
  • New Member Spotlight Story Focuses on Anesthesia in Haiti 

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
AANA Submits Comments on APRN Licensure Compact
The AANA submitted comments to the National Council of State Boards of Nursing concerning draft model legislation and regulations to implement an APRN interstate licensure compact; the comment deadline was Feb. 14, 2014. The AANA comments addressed appropriate grandfathering concerning graduate degrees; graduate level coursework requirements in advanced physiology/pathology, advanced health assessment and advanced pharmacology; and prescriptive authority. The draft models are posted on the NCSBN website at

PR Toolkit for State Association Leaders and AANA Members Available on AANA Website
The AANA Communications Division has put together an online toolkit of public relations documents designed to help state association leaders and AANA members deliver a positive, evidence-based message about CRNA practice when interacting with the public, policymakers, media, facility administrators, healthcare colleagues, and others. Click here to view the toolkit (member login and password required). Be sure to check back often. Additional documents will be added in the future.
Ballot Announcement
The AANA Nominating Committee, after reviewing the nominations for elected positions for the upcoming election at its February meeting, has announced the slate of candidates for the 2014 election of the AANA Board of Directors, Nominating, and Resolutions Committee members. Click here for the complete slate of candidates and further information about the upcoming elections (member login and password required). The order of names was determined randomly on the ballot by the Nominating Committee. Those elected will begin their fiscal year 2015 terms of office at the conclusion of the AANA 2014 Nurse Anesthesia Annual Congress in Orlando, Fl.
2013-2014 Nominating Committee
Serving on the fiscal year 2014 Nominating Committee are: Linda J. Kovitch, CRNA, MSN, RRT, Chair (Region 1); Karin E. Lundgren, CRNA, MSN, NC, USN, CAPT (ret) (Region 2); Lori R. Anderson, CRNA, MSN (Region 3); Carole V. Doyscher, CRNA, MS, BSN (Region 4); James R. Stimpson, CRNA, DNP, (Region 5); Joseph E. Lesser, CRNA, MSNA, ARNP (Region 6); Steven R. Leach, CRNA, DNP (Region 7).
Online Forum for Candidates for the AANA Board of Directors
The Online Forum for Candidates for the AANA Board of Directors will become available to members for question submission two weeks prior to the Mid-Year Assembly (March 24, 2014). This un-moderated forum will be located in the members-only section of the AANA website. All AANA members will be able to submit questions to the Forum during the voting cycle. The forum will be available for viewing until the voting cut-off date of May 20, 2014.


Discounts on Patient Safety Courses in March
In support of Patient Safety Awareness Week, AANA’s Online Continuing Education resource, AANALearn, is featuring the following courses on some of the most common patient safety challenges at a 40 percent discount during the month of March:
  • Infection Control: It’s Everyone’s Business (1 CE credit)
  • What Can the CRNA do to Improve Medication Safety and Decrease Cost in the OR? (2 CE credits)
Click here for more information.


Meetings and Workshops

Business of Anesthesia
Save the Date: The AANA Business of Anesthesia Workshop addresses critical business issues facing CRNAs and will be held July 12 in Chicago, Ill. Whether you are employed or have your own business, this workshop has the necessary information to help you navigate the changing business environment in healthcare. Register today.
NEW AANA Workshop: Foundations of Advanced Pain Management
AANA’s newest workshop, Foundations of Advanced Pain Management, will be held June 6-9, 2014, at the Regional Medical Center, Manchester, Iowa. Interventional pain management is an area of practice that demands critical assessment and knowledge to provide proper and precise treatment interventions to maximize positive patient outcomes. Foundations of Advanced Pain Management offers CRNAs practical, didactic, and hands-on content to support their practice is advanced pain management. Register now.
Registration Now Open for AANA 2014 Nurse Anesthesia Annual Congress
The AANA 2014 Nurse Anesthesia Annual Congress will be held Sept. 13-16 in Orlando, Fla. Registration opened March 3. Look for the preliminary program online or in the March NewsBulletin.
Upper and Lower Extremity Nerve Block Workshop
Registration is open for the Upper and Lower Extremity Nerve Block Workshop, to be held August 2-3, 2014, in Park Ridge, Ill.This workshop includes hands-on demonstrations to help you refresh your skills or address professional practice gaps in nerve block anesthesia. Register today.

AANA Foundation - April 1 and May 1 Deadlines Approaching: Apply Online Today for Fellowships, Grants, and Poster Session Presentations
Applications for fellowships, research grants, and State of the Science presentations are currently available on the AANA Foundation website at
Doctoral and Post-Doctoral Fellowship Opportunities – April 1 Deadline
Post Doctoral Fellowship
Funding will be awarded to CRNAs who, having been awarded the doctorate, are actively involved in the development of a research program.  The goal of this program is to support nurse anesthetists who evidence a strong commitment to nurse anesthesia and are seeking to develop a research program. Awarded up to $60,000.
Doctoral Fellowship
Supports CRNAs actively engaged in doctoral studies that evidence a strong commitment to research. Recipients possess the vision to impact the health care system as a doctorally-prepared CRNA.  Awarded up to $10,000.
Florida Association of Nurse Anesthetists Practice and Research Doctoral Fellowship – Maximum of $3,000 award.
Kay Wagner Pennsylvania Association of Nurse Anesthetists Practice and Research Doctoral Fellowship – Clinical Doctorate and Research Doctorate – Maximum of $5,000 award each.
Lorraine D. Dankowski Doctoral Fellowship - Maximum of $10,000 award.
Palmer Carrier, CRNA Scholarship
Applicants must be currently enrolled in a doctorate degree program at a nationally accredited university to enhance their professional development as a leader in research.  Awarded up to $5,000.
Grant Proposals – May 1 Deadline
General research grants are awarded to AANA member CRNAs in good standing. Research funding priorities change annually. Please refer to the research priorities on the proposal application for more information. Funding varies.
If you have any questions, please contact the AANA Foundation at (847) 655-1170 or
Orlando – The Stars Come Out Again: Event Talent Applications Due April 1, 2014
The AANA Foundation’s fundraising event, Orlando – The Stars Come Out Again, will be held on Sunday, Sept. 14, 2014, at the AANA 2014 Nurse Anesthesia Annual Congress. Last year 12 awesome acts entertained a packed house in Las Vegas. Click here to view a video recap that includes a portion of each of the performances. Now, can you picture yourself on stage in Orlando? If so, complete an application today. Visit our event webpage to learn more and access the application. Contact Luanne Irvin at the AANA Foundation at (847) 655-1173 or with any questions.


PR, Publications and eCommunications

New Member Spotlight Story Focuses on Anesthesia in Haiti
A new story in the Member Spotlight section focuses on John Welch, CRNA, and his efforts to establish world-class healthcare to rural Haiti. He’s been working with Partners in Health, an organization that strives to bring the benefits of modern medicine to those in need, supporting nurse anesthetists at a new, 300-bed hospital, the University Hospital of Mirebalais. Welch has been working to expand the organization’s anesthesia training program, from planning curricula to evaluating methods to creating clinical rotation schedules. To read the full story, click here.


Study: Women Report More Pain Than Men After Knee Replacement Surgery
Companion studies conducted by researchers at the Hospital for Special Surgery in New York have identified risk factors, including being a middle-aged woman, for experiencing severe pain following total knee replacement. The basis for the findings were the hospital records of 273 patients who underwent TKA from October 2007 to March 2010. The first investigation focused on demographic and other factors, including co-existing medical conditions. "Many factors play a role," conceded lead researcher Thomas Sculco, MD, "and our studies found that younger female patients [aged 45 to 65], particularly those with post-traumatic or rheumatoid arthritis, had the highest pain scores." Other strong predictors included obesity and higher pain levels at the time of hospital admission. In the second study, the researchers explored the impact of surgical technique on postoperative pain. They found that using general anesthesia as opposed to an epidural or spinal block, using an overly large implant, or failing to properly align the joints also translated into more pain for TKA patients following their operations. Clinicians should discuss postoperative pain with patients, especially those in the at-risk cohorts, before surgery, according to Sculco. "More aggressive pain management techniques may be necessary for these patients," he said.
From "Study: Women Report More Pain Than Men After Knee Replacement Surgery"
Newswise (03/10/14) Sakellariou, Vasilios I.; Poultsides, Lazaros A.; Ma, Yan; et al.
New Approach to Breast Reconstruction Surgery Reduces Opioid Painkiller Use
Mayo Clinic research has found that a new surgical technique for breast reconstruction reduces postoperative opioid painkiller use and cuts hospital stays down to an average of three days from four and a half. The approach is an enhanced recovery pathway developed by lead study author Michel Saint-Cyr, MD, in cooperation with anesthesia professionals, nursing staff, and pharmacists. The pathway entails a variety of pain control techniques—including preoperative and perioperative analgesics—as well as a preventative anti-nausea treatment, abstinence from postoperative opioids, avoidance of routine intensive care monitoring, and a focus on getting patients up and walking soon after the free flap breast reconstruction surgery is completed. In addition to shorter hospitalization times and reduced opioid painkiller use, the 31 patients treated with the new regimen reported less pain at 24 hours after surgery than did the 17 patients who received conventional treatment.
From "New Approach to Breast Reconstruction Surgery Reduces Opioid Painkiller Use"
Science Codex (03/05/14)
No Propofol Reactions Seen in Egg, Soy Allergic Patients
A study presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology found that patients with food allergies did not react negatively when given intravenous propofol for anesthesia during endoscopy. Dr. Harshna Mehta, an allergist-immunologist at the Icahn School of Medicine at Mount Sinai in New York, said there has been some apprehension about giving patients with soy and egg allergies the anesthetic. The drug includes lipid suspensions that contain egg lecithin/phosphatide and soy oil—which also raises concern about propofol causing a potential reaction in patients with peanut allergies, given that peanut is a legume similar to soy. Mehta and associates reviewed the charts of 563 patients who underwent endoscopies between November 2004 and January 2014. The records included 160 patients who had one or more food allergies, including 31 who had a history of anaphylaxis. There were no reported reactions to propofol in any of the patients, although many had what Mehta described as "significant allergic comorbidities." She remarked, "We are still in the process of determining the statistical confidence with which we can say how safe propofol is for administration to egg/soy/peanut allergic patients. We are also planning to test the product in the laboratory for the presence of egg protein."
From "No Propofol Reactions Seen in Egg, Soy Allergic Patients"
Family Practice News (03/02/2014) Brunk, Doug
Hypoxia After Surgery Much More Common Than Previously Believed
Researchers have presented the results of a prospective observational study that looked at hypoxia rates in hospital recovery wards. The undertaking, a subanalysis of a larger study, included an estimated 1,500 non-cardiac surgical patients who had continuous pulse oximetry for up to 48 hours after leaving the post-anesthesia care unit or the intensive care unit. The researchers masked the pulse oximetry monitors and muted the alarms in order to blind clinicians to their output, in order to determine how long patients would remain hypoxic without intervention. The study found that a larger-than-expected share of patients experienced extended periods of hypoxemia while recovering from surgery, suggesting that efforts to monitor patients' oxygen saturation are not as effective as clinicians assume. The study raised numerous questions, including the true level of risk posed by hypoxia and how it might be possible to predict which patients will reach such levels.
From "Hypoxia After Surgery Much More Common Than Previously Believed"
Anesthesiology News (03/01/14) Vol. 40, No. 3 Marcus, Adam
Post-Op Pain Common After Heart Surgery
Researchers explored the occurrence of persistent pain after heart surgery by following for two years nearly 1,000 patients who received a coronary artery bypass grafting or valve replacement procedure—or both—between Feb. 8, 2005, and Sept. 1, 2009. They examined the rate of and risk factors for pain following cardiac surgery, finding that just under 10 percent of patients still experienced persistent pain two years later. "Persistent postoperative pain" was defined as developing after surgery, not being associated with preoperative pain or pain from another cause, and lasting for a minimum of three months. The Pain Catastrophizing Scale was used to gauge pain prior to the procedure; at one week following; and at three, six, 12, and 24 months after the operation. At each measurement, the researchers also evaluated mental health. The study authors, led by Manon Choinière, PhD, of the University of Montreal's anesthesiology department, found that lingering postoperative pain can be an under-recognized surgical complication that could be predicted by the patient's pain level during the initial healing period. A connection was also found between pre-existing pain, preoperative anxiety, and persistent postoperative pain. The team noted,"Future research is needed to determine whether interventions to modify certain risk factors [...] may help to minimize or prevent persistent postoperative pain." The research was published online in CMAJ, the journal of the Canadian Medical Association.
From "Post-Op Pain Common After Heart Surgery"
Daily Rx (02/26/14) Jones, Morgan
Post-Surgery Heart Attack: '85 Percent Undetected Due to Lack of Symptoms'
Research published in Anesthesiology reports that, each year, more than 8 million adults across the globe suffer injuries or heart attacks following surgery. Fully 10 percent of them are dead within 30 days—largely because clinicians missed the heart attack due to a lack of symptoms, which can be masked by postoperative pain medication. Investigators in Canada, however, say a simple blood test can alter outcomes. They evaluated more than 15,000 surgical patients aged 45 and older during the first three days after a non-cardiac procedure. Each received a blood test measuring the protein troponin, which is released into the blood when the heart is injured. Electrocardiograms were given to patients who presented elevated levels of troponin, allowing researchers to determine which patients had in fact experienced a heart attack. Using this approach, they determined that only 15 percent of postoperative heart attacks or injuries are preceded by typical warning signs such as upper-body pain, shortness of breath, nausea, and a sensation of being lightheaded. The other 85 percent of these post-surgery events would have gone undetected were it not for the troponin monitoring.
From "Post-Surgery Heart Attack: '85 Percent Undetected Due to Lack of Symptoms'"
Medical News Today (02/18/14) Ellis, Marie
Three Perioperative Interventions Do Not Affect Quality of Life
Findings from the DeLiT (Dexamethasone, Light Anaesthesia, and Tight Glucose Control) randomized controlled trial suggest that the three perioperative interventions in the study name do not impact patient quality of life following major non-cardiac surgery. In earlier studies of cardiac surgery patients, the steroid dexamethasone is indicated for postoperative nausea and vomiting (PONV) prophylaxis as well as for reduction of airway edema in airway surgery; while anesthesia guided by bispectral index monitoring is believed to help with PONV, curb respiratory complications, and speed up the recovery process. Tight glucose control, meanwhile, reduced sepsis and improved mortality outcomes for some cardiac surgery patients; however, none of the three interventions proved beneficial for non-cardiac patients. Involving 326 patients having surgery under general anesthesia, DeLiT gauged quality of life using the SF-12v2 Health Survey. Measurements, taken preoperatively and 30 days post-op, evaluated the effect of each of the three interventions on physical and mental components of the survey that had been indicated in previous studies. No impact was seen in the physical or mental Sf-12v2 scores 30 days after surgery for any intervention, nor was there a significant effect on perioperative morbidity from the interventions—the primary outcome of the research.
From "Three Perioperative Interventions Do Not Affect Quality of Life"
General Surgery News (02/01/14) Vol. 41, No. 2 Armitage, Mandy
Hospitals Coping Better as Drug Shortages Persist
U.S. hospitals face exorbitant costs when obtaining medicines from alternate sources amid ongoing drug shortages, says a new survey by hospital group Premier Inc. The survey conservatively estimates that cost at $230 million annually for the country's 5,000 hospitals, on average, from 2011 through 2013. Shortages of drugs—in particular, low-cost, generic injectable drugs—have been on the rise since 2005, and affect hospitals, outpatient surgery centers, and cancer clinics. These shortages involve antibiotics, painkillers, anesthetics, sedatives, chemotherapy drugs, and heart drugs. Health care facilities are taking such steps as adding backup inventory, rationing certain scarce drugs, and implementing safety measures for alternative medicine choices.
From "Hospitals Coping Better as Drug Shortages Persist"
Associated Press (02/28/14) Johnson, Linda A.

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