Anesthesia E-ssential, March 15, 2012


March 15, 2012

Vital Signs

New Video Hypes Annual Meeting Event in August 2012!
The 2012 AANA Annual Meeting will be held Aug. 4-8 in one of the most exciting cities in the world—San Francisco. Watch this new video for a preview of what's in store for Annual Meeting attendees this year. Then, watch for the Preliminary Schedule and registration form included in the March issue of the NewsBulletin, or click here for registration information on the AANA website.


The Pulse

Inside the Association
  • Reminder: AANA Insurance Services Supplemental Liability Insurance Survey
  • Report Drug Shortages to the FDA
  • CDC Provides Recommendations Regarding Prevention of C. difficile Infections
  • New AANALearn® Pharmacology Course Available Online
  • HHS Issuing a Proposed Rule in June on Medicare CRNA Pain Care Reimbursement
  • Two House Panels OK IPAB Repeal
  • AANA Joins Coalition Support for Health Workforce Development
  • Time to Revalidate Your Medicare Enrollment?
  • Medicare Proposes Requiring Providers to Keep Records for 10 Years
  • Federal Health Spending Hits High Milestone, Driving Hill Concern over Budgets
  • Sec. Sebelius Discusses Administration’s Health Budgets in Rowdy Hill Hearings
  • AANA Member Named to Global Health Professional Education Forum
  • Book Your Mid-Year and Business of Anesthesia Meetings Now!
  • Join CRNA-PAC for “An Affair of State” April 15 During Mid-Year Assembly
  • Are You Involved in the Presidential Campaign?
  • Information Technology Does Not Reduce Costs, Study Says
  • Medicare Hospital Quality Reporting Unrelated to Quality Improvement, Says Study
  • Answer the Call: Care to be Counted
  • AANA Foundation 15th Annual Golf Tournament to be Held Tuesday, Aug. 7, 2012
  • State of the Science Oral Poster Application Deadline Extended to April 1, 2012
  • 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.
  • 'Call to Action' on Wrong-Route Injections in Anesthesia
  • Aromatherapy as Treatment for Postoperative Nausea: A Randomized Trial
  • Postop Opioids May Be Used Over Longer Term
  • Study Reveals How Anesthetic Isoflurane Induces Alzheimer's-Like Changes in Mammalian Brains
  • Dexamethasone Effective Antiemetic for Patients Receiving Neuraxial Morphine
  • Light-Switched Local Anaesthetic Lets Scientists Turn Pain Nerves On and Off
  • Sciatic Lateral Popliteal Block With Clonidine Alone or Clonidine Plus 0.2 Percent Ropivcaine
  • Anesthesia Alert: The Beauty of the Block Nurse
  • Hospitals Feeling the Pain of Sedative Shortage


Inside the Association


Hot Topics

Reminder: AANA Insurance Services Supplemental Liability Insurance Survey
If your employer provides your professional liability coverage, AANA Insurance Services is conducting a survey to determine if there’s a need for a policy to supplement that coverage. Does your employer’s policy provide all the types of coverage you actually need, and will it best represent your interests if you’re involved in a claim? If you do feel a supplemental policy could be beneficial, we would like your input in the development of this new policy. What coverages should it include, and how much should it cost? You can take the five-question survey, which should only take a couple of minutes to complete.

Report Drug Shortages to the FDA
The AANA continues to work closely with the U.S. Food and Drug Administration (FDA) in an attempt to alleviate drug shortages. In order for the FDA to be better informed, they must also hear directly from frontline providers regarding the availability of medications. If you, your practice, or your pharmacy are experiencing any drug shortages, difficulties obtaining products, or have any questions, please contact the FDA’s Drug Shortage Program at Sign up to receive drug shortage email updates directly from the FDA.

CDC Provides Recommendations Regarding Prevention of C. difficile Infections
C. difficile infections are linked to 14,000 deaths in the United States. CRNAs play a role in helping to prevent the spread of C. difficile by adhering to Centers for Disease Control and Prevention (CDC) recommendations. The March 2010 edition of CDC Vital Signs presents information about risk factors and prevention techniques. The CDC also provides infection control recommendations, toolkits, and checklists for healthcare providers at the CDC’s C. difficile website.

New AANALearn® Pharmacology Course Available Online
AANALearn® has responded to members’ requests for more continuing education (CE) courses providing pharmacology credit with a new course: The Conundrum of Perioperative Beta Blockade, with streaming video content presented by Mary Golinski, CRNA, PhD. The course provides one CE credit and will be offered at a special sale price for March and April.
As always, the online continuing education courses in AANALearn® are available for members 24/7 and the CE credits are automatically and quickly transferred into your CE transcript. AANA members always receive a 30 percent discount off the regular price of courses. If you are seeking a few or many CE credits for 2012 recertification, AANALearn® can provide what you need. Members are encouraged to complete their recertification CE credits early – avoid the summer rush.
Check us out now at to browse the catalogs.

For the latest AANA News, visit the AANA Facebook page and follow "aanawebupdates" on Twitter.


Federal Government Affairs and PAC

HHS Issuing a Proposed Rule in June on Medicare CRNA Pain Care Reimbursement
The Medicare agency intends to propose a rule in June 2012 to clarify its policy on direct Medicare reimbursement of CRNA pain care services, an issue raised to the agency by AANA and CRNAs since two Medicare administrative contractors, Noridian and WPS, issued bulletins in 2010 denying direct CRNA reimbursement of such services and impairing patient access to pain care.
In a Feb. 13 letter to Kansas Association of Nurse Anesthetists President Joe Conroy, CRNA, Health and Human Services (HHS)Secretary Kathleen Sebelius said that the agency would "anticipate addressing this issue in the 2013 Physician Fee Schedule rule in order to establish a consistent national policy among all Medicare contractors. In the interim, the issue will remain within Medicare contractors’ discretion."
Medicare is authorized to reimburse CRNAs for "anesthesia services and related care” provided to Medicare beneficiaries within CRNAs’ scope. The Medicare claims processing manual authorizes reimbursement of CRNAs for "medical and surgical services" including "pain management." Until Noridian and WPS published their bulletins impacting CRNAs who provide pain care in 18 Western and Midwestern states, Medicare had reimbursed CRNAs directly for chronic pain care services. In the Noridian and WPS states, the contractor bulletins limit Medicare CRNA pain care reimbursement to services "incident-to" a physician who bills for the services.
A proposed rule published in the Federal Register triggers a 60-day public comment period followed by a 60-day agency consideration period, then the publication of a final rule, in this case on or about Nov. 1, 2012, and effective Jan. 1, 2013.

Two House Panels OK IPAB Repeal
Two Medicare-writing House panels, the Energy and Commerce Committee and the Ways and Means Committee, approved legislation in early March repealing the Independent Payment Advisory Board (IPAB) provisions of the Affordable Care Act health reform law, clearing the bill for action in the full House.
The "Medicare Decisions Accountability Act of 2011" (H.R. 452) would eliminate the yet-unnamed board charged with recommending specific reductions in the per-capita cost growth of the Medicare program beginning in 2014. By law, IPAB recommendations would be transmitted to Congress and the president, and would begin taking effect the following years unless Congress enacted and the president signed legislation disproving the recommendations and ordering alternative cost controls of the same scale. However, the 15-member IPAB has not yet got out of the starting blocks: President Obama has not nominated any individuals to serve on the panel, nor have Senate Republicans indicated any willingness to confirm such nominees for service.
During consideration of the Affordable Care Act, AANA expressed concerns about the IPAB provision. While House passage of H.R. 452 appears likely, hope for the bill’s movement in the Democratic majority Senate where the provision originated is considerably dimmer.
Read more about the Energy and Commerce committee’s action from the GOP majority and a statement from the panel’s top Democrat at a July 2011 hearing on the topic, and further reportage from Kaiser Health News.

AANA Joins Coalition Support for Health Workforce Development
With healthcare budgets under considerable pressure in Washington and elsewhere, the AANA has signed onto nursing and allied health coalition initiatives to support health workforce development and research.
During the week of March 5, the AANA signed aboard the Coalition for Health Funding letter to support Title 8 nurse workforce development, traineeships and research programs; the Health Professions and Nursing Education Coalition (HPNEC) brochure in favor of allied health and nursing workforce programs; and a nursing community letter expressing appreciation for the president’s Title 8 budget request that proposes boosting nurse workforce programs $20 million or about 3 percent over FY2012 levels.
The letters will be posted on for members shortly.

Time to Revalidate Your Medicare Enrollment
Your Medicare administrative contractor (MAC) is sending all healthcare providers including CRNAs a letter directing each provider to revalidate their Medicare enrollment within 60 days of the letter’s date. MACs will be sending out these letters periodically until March 2015.
The Centers for Medicare & Medicaid Services (CMS) continues to provide lists on their website of revalidations that have been mailed to providers to revalidate their Medicare enrollment. The latest update is for revalidations mailed through January 2012. The agency states that information on revalidation letters sent in February 2012 will be posted on the CMS website in late March.
If you receive such a letter, follow the letter’s instructions immediately, and provide it to your employer or billing agent as appropriate. Failure to comply risks reimbursement for your services.
For further information on Medicare revalidation see the AANA Hotline for the week of Nov. 14, 2011,. View the revalidation lists. Or, click on the following lists:

Medicare Proposes Requiring Providers to Keep Records for 10 Years
The Medicare agency on Feb. 16 proposed requiring healthcare providers, including CRNAs, to keep reimbursement records for at least 10 years and to return Medicare overpayments within 60 days of the provider receiving an agency notice, as anti-fraud measures.
"(W)e are proposing that overpayments must be reported and returned only if a person identifies the overpayment within 10 years of the date the overpayment was received," states the agency proposed rule preamble. "We selected 10 years because this is the outer limit of the False Claims Act statute of limitations."
AANA is reviewing the proposal, including having members of the AANA Anesthesia Payment Policy Coordinating Panel and Advisory Panel review it. The proposal is open for public comment until 5 p.m. April 16, 2012.

Federal Health Spending Hits High Milestone, Driving Hill Concern over Budgets
Payments for Medicare and Medicaid will exceed all other government discretionary spending in 2013, including national security. CQ reported on Feb. 27 that the Congressional Budget Office finding drove questioning in budget hearings taking place on Capitol Hill the week of Feb. 27. For further information, read the House Budget Committee chairman’s opening statement and the Ways and Means Committee hearing guide featuring HHS Secretary Kathleen Sebelius.

Sec. Sebelius Discusses Administration’s Health Budgets in Rowdy Hill Hearings
In multiple congressional hearings held during the week of Feb. 27, HHS Secretary Kathleen Sebelius outlined the president’s health agency budget proposals, with Democratic lawmakers largely expressing support for the Administration’s efforts, and Republican officials raising concerns with spending levels, health reform implementation, or hot social issues. For further information, see one of the hearings webcast from the Energy & Commerce Health Subcommittee and the secretary’s opening statement.

AANA Member Named to Global Health Professional Education Forum
Kelly Wiltse Nicely, CRNA, PhD, has been appointed by the National Academies to represent the AANA on the Global Forum on Innovation in Health Professional Education. Nominated by the AANA for the post, Wiltse Nicely will serve on this multidisciplinary, multisectoral international group that is empanelled to advance the recommendations of the Institute of Medicine Future of Nursing and Lancet Commission reports.
The Forum intends to conduct two public workshops per year as well as an annual meeting. Health care education consortiums in North America, South America, Africa and Asia will participate in the workshops along with Dr. Wiltse Nicely and members of the Global Forum.
Wiltse Nicely is an assistant professor of Nurse Anesthesia at the University of Pennsylvania and currently serves as president of the Pennsylvania Association of Nurse Anesthetists. She received a bachelor of science in nursing from the University of Pennsylvania, a master of science in nursing from the University of Pittsburgh and a doctor of philosophy in nursing from the Center for Health Outcomes and Policy Research at the University of Pennsylvania.

Book Your Mid-Year and Business of Anesthesia Meetings Now!
Now’s the time to book your seat at the AANA Business of Anesthesia conference Apr. 14, and the AANA Mid-Year Assembly Apr. 15-18, both in your Nation’s Capital!
The AANA’s first-ever Washington-based Business of Anesthesia conference provides AANA members practical, fundamental education on developing an anesthesia practice, and looking into the economic and policy crystal ball shaping CRNA reimbursement.
AANA’s Mid-Year Assembly is the association’s premier conference for education and advocacy on federal policy issues. Learn the issues shaping CRNA practice and how to effectively advocate for them on Capitol Hill on Sunday, participate in AANA professional association business Monday featuring leaders running for national office in the organization, and then hear from leaders from Congress and the administration before bringing CRNA issues directly to your members of the House and Senate Tuesday afternoon and Wednesday. If you can learn how to bring your issues to members of Congress in the U.S. Capitol during Mid-Year Assembly, what’s to keep you from bringing CRNA issues to other healthcare leaders in your state, community, hospital or healthcare facility?
In addition, on Monday afternoon, members of the AANA will join in the interment ceremony for Ira Gunn, CRNA, MLN, FAAN, at Arlington National Cemetery. Attendees will gather at the Arlington Cemetery administration building at 12:30 p.m., and the ceremony begins at 1 p.m. Long recognized for her passion for the anesthesia profession in the regulatory and legislative arenas, the AANA established the Ira P. Gunn Award for Outstanding Professional Advocacy in 2000.
Learn more and register at; click on "Meetings" up top.

Join CRNA-PAC for "An Affair of State" April 15 During Mid-Year Assembly
Enjoy a night of elegance at an enclosed rooftop event offering a spectacular view of the White House from one of the most historic and prestigious hotels in Washington, the Hay Adams. Participants at "An Affair of State" Sunday evening April 15 will have the opportunity to visit with colleagues indoors or out, enjoy musical entertainment, bid in the signature CRNA-PAC silent auction, and have professional photos taken. Ticket availability is limited; priced at $250 for CRNAs and $125 for student nurse anesthetists, tickets can be purchased on the Mid-Year Assembly registration form. Buses leave the Mid-Year Assembly hotel main registration area at 6:15 pm and will return around 9 pm. Ticket purchases will count as contributions towards CRNA-PAC’s Care to be Counted campaign. Please note that previous contributions to CRNA-PAC given through other means outside of the Mid-Year Assembly Registration form cannot be credited for ticket purchases.

Are You Involved in the Presidential Campaign?
Are you involved at the local or state level in the GOP Presidential contest, or in support of the re-election of the Obama-Biden ticket? Let us know; we’d be delighted to hear your story, and to encourage other AANA members to participate. Send your information to

Information Technology Does Not Reduce Costs, Study Says
Health information technology does not reduce test orders or healthcare costs, reports a study in the March issue of Health Affairs. The findings are challenging to policy efforts that count on health information technology investments to aid in care coordination, quality improvement and cost savings. See a summary.

Medicare Hospital Quality Reporting Unrelated to Quality Improvement, Says Study
Medicare hospital quality reporting does not improve quality of care, reports a study in the March issue of Health Affairs. The study showed no improvement beyond current trends in heart attack and pneumonia care, and slight improvement in outcomes for heart failure care that may or may not be related to quality reporting systems. See a summary.

Answer the Call: Care to be Counted
To continue strengthening CRNAs’ voice in Washington during this major election year, the CRNA-PAC has kicked off its Care to be Counted 2012 campaign with the release of a new video that underscores the importance of every AANA members’ contribution. If you’ve contributed within the past couple of years, you may get a call from the CRNA-PAC asking you to support the Care to be Counted campaign once again. If you have any questions about the call, please contact AANA FGA at To contribute to the CRNA-PAC, click and enter your AANA member login and password.

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 U.S. Citizen.


AANA Foundation and Research

AANA Foundation 15th Annual Golf Tournament to be Held Tuesday, Aug. 7, 2012
Join CRNAs and student registered nurse anesthetists from across the country at San Francisco’s Presidio Golf Course, one of the nation’s top public courses. The 18-hole course offers 6,500 yards of challenging golf, winding through beautiful eucalyptus and Monterey pine trees. The early-bird golf registration fee is $215 for those who register between March 1 and June 15, 2012. After June 15, 2012, the golf registration fee is $250. Take advantage of the early bird rate and register now for the Golf Tournament when you register for the AANA Annual Meeting. For more information, visit the AANA Foundation 15th Annual Golf Tournament webpage or contact the AANA Foundation at (847) 655-1170.

State of the Science Oral Poster Application Deadline Extended to April 1, 2012
If you are interested in participating in the State of the Science during the 2012 Annual Meeting there is still time to apply.
State of the Science Oral Poster Presentation: Completed and final abstract must be received in the AANA Foundation office by April 1.
  • PowerPoint Presentation Length: 10-12 minutes
  • Speaker assumes full financial responsibility associated with meeting attendance.
  • 8-10 posters will be awarded $1,000 to defray the expenses of travel. Preference will be given to student registered nurse anesthetists and nurse anesthetists.
  • Oral Presentations will occur on Monday, Aug. 6, 2 p.m. to 5:10 p.m.
State of the Science – General Poster Presentation—completed and final abstract must be received in the AANA Foundation office by May 1.
  • Display your poster on 8’ wide x 4’ high corkboard.
  • Posters will be displayed for the general membership starting on Aug. 5 at 3:15 p.m., but must be set up before 11 a.m. on Aug. 5.
  • Presenters are asked to be with their posters to answer any questions on Aug. 5 from 3:15 p.m. to 6 p.m.
  • Posters will remain in the AANA Exhibit Hall until Aug. 7 when the Exhibit Hall closes.
  • Neither the AANA nor the Convention Center will be held responsible for posters or materials displayed.
This application is available online at If you have questions, please call the AANA Foundation at (847) 655-1170 or email





Healthcare Headlines

'Call to Action' on Wrong-Route Injections in Anesthesia
A global revamp of catheter system design must occur in order to stop the epidemic of wrong-route anesthesia injections, argue U.S. and U.K. experts in a special editorial published in the March issue of Anesthesia & Analgesia. Grave complications arise when anesthetics meant to be delivered intravenously instead are mistakenly injected into the spine or epidural area or, worse, when epidural drugs are erroneously introduced into the general circulation. Despite previous calls to address this well-known risk, little progress has been made—even as new catheter designs have greatly mitigated the problem for other types of accidental drug administrations. David Birnbach, MD, MPH, of University of Miami Miller School of Medicine, and Charles Vincent, PhD, of Imperial College London, note that systems designed "to prevent the proverbial round peg from being placed in the square hole" have been proposed for spinal and epidural catheters as well; but none have been developed. In their editorial, timed to publish ahead of the World Congress of Anaesthesiologists in Buenos Aires, they urge immediate action on the issue. "What is essential at this point," they conclude, "is that all concerned parties must meet, that a consensus regarding the most effective solution be developed, and that all epidural and spinal kits use this new safer alternative to epidural catheter design." Anything less than that, write Birnbach and Vincent, is simply "irresponsible" from a patient safety standpoint.
From "'Call to Action' on Wrong-Route Injections in Anesthesia"
News-Medical (03/01/12)

Aromatherapy as Treatment for Postoperative Nausea: A Randomized Trial
The findings of a small study on the benefits of aromatherapy in treating postoperative nausea (PON), a common side effect of anesthesia and surgery, suggest that larger-scale research is warranted. Led by Dr. Ronald Hunt of the Carolinas Medical Center University in Charlotte, N.C., investigators evaluated 301 subjects who experienced nausea symptoms after having ambulatory surgery. Patients reporting a nausea level of one to three on a verbal descriptive scale were given a gauze pad saturated with one of three aromatherapy agents or with a saline placebo. The randomly selected agents included essential oil of ginger; a blend of essential oils of ginger, spearmint, peppermint, and cardamom; or isopropyl alcohol. Patients were instructed to inhale deeply three times and then report on their level of nausea again five minutes later. The essential oil of ginger alone, as well as the blend of essential oils, made a marked difference in nausea levels compared to the saline, although the alcohol did not. Patients who inhaled the oils also requested fewer anti-emetic medication, which can alleviate nausea in higher-risk patients but does not do so reliably, than did those who inhaled only saline. The researchers concluded that aromatherapy may be a viable treatment for PON that is also inexpensive, noninvasive, and easily administered and controlled by patients as necessary.
From "Aromatherapy as Treatment for Postoperative Nausea: A Randomized Trial"
Anesthesia & Analgesia (03/12) Hunt, Ronald; Dienemann, Jacqueline; Norton, H. James; et al.

Postop Opioids May Be Used Over Longer Term
Use of opioids after minor surgery can significantly raise the likelihood of opioid use one year later, a team of Canadian investigators reported. Older patients who received opioids within seven days of surgery were 44 percent more likely to be using opioids a year after the surgery. In their study, the researchers sought to determine the frequency of long-term analgesic use after minor surgery. They examined medical records of Ontario residents 66 years and older who underwent short-stay surgery between 1997 and 2008. Surgeries included cataract surgery, laparoscopic cholecystectomy, transurethral resection of the prostate, and varicose vein stripping. None of the patients had prior opioid use. Of the 391,139 patients included in the final analysis, 27,636 (7.1 percent) received opioids within seven days. Of these patients, 2,857 (10.3 percent) were still using opioids a year later. Oxycodone use specifically increased from 5.4 percent of patients within a week of surgery to 15.9 percent at one year. Use of non-steroidal anti-inflammatory drugs (NSAIDs) within seven days of surgery was associated with an odds ratio of 3.74 for prescription NSAID use at one year, a nearly fourfold increase. In the Archives of Internal Medicine, the researchers wrote: "As rates of ambulatory surgery among elderly populations increase, preventing analgesic therapy initiation could have far-reaching implications for those involved in the perioperative care of this population."
From "Postop Opioids May Be Used Over Longer Term"
MedPage Today (03/12/12) Bankhead, Charles

Study Reveals How Anesthetic Isoflurane Induces Alzheimer's-Like Changes in Mammalian Brains
A study from Massachusetts General Hospital researchers, scheduled for publication in Annals of Neurology, shows that the administration of isoflurane negatively impacted the performance of lab mice in a common learning and memory test. The negative impact, believed to be caused by the drug's affect on mitochondria, was not apparent in lab subjects that were given another anesthetic, desflurane. The investigators found that isoflurane increased the permeability of the mitochondrial membrane and interfered with the balance of ions on each side of that membrane while causing the levels of the enzyme ATP—which powers cellular functions—to fall and levels of the enzyme caspase—which causes cell death—to climb. In measuring the performance of the mice with the standard behavior test, significant decline was seen between two and seven days after isoflurane was administered; but those cellular and behavioral effects were not observed in the control group or in mice given desflurane. The same research team had another study published in the February issue of Anesthesia and Analgesia that showed a quarter of the patients receiving isoflurane in a 45-person study showed some level of cognitive dysfunction a week after surgery while those given desflurane or spinal anesthesia did not; however, results need to be confirmed in a substantially larger test population.
From "Study Reveals How Anesthetic Isoflurane Induces Alzheimer's-Like Changes in Mammalian Brains"
Science Codex (03/01/12)

Dexamethasone Effective Antiemetic for Patients Receiving Neuraxial Morphine
Researchers have found that dexamethasone is an effective anti-emetic for patients who receive neuraxial morphine for cesarean delivery or abdominal hysterectomy. The doses enhanced postoperative analgesia compared with placebo, but dexamethasone was ineffective for preventing against neuraxial morphine-induced pruritus. The researchers conducted a systematic review on dexamethasone's efficacy in reducing post-operative nausea, vomiting, and pruritus, and for enhancing postoperative analgesia from neuraxial morphine. The research is published in Anesthesia & Analgesia.
From "Dexamethasone Effective Antiemetic for Patients Receiving Neuraxial Morphine"
Becker's ASC Review (02/12) Fields, Rachel

Light-Switched Local Anaesthetic Lets Scientists Turn Pain Nerves On and Off
Local anesthetics block sensory nerves by shutting off the flow of sodium ions across neuronal cell membranes, thus preventing the transmission of electrical signals. The disadvantage is that the drugs are not highly selective and their effects can linger longer than they are needed; but an international team of researchers has developed a new option that could allow more precise control over which nerve is blocked, and for how long. In Nature Methods, U.S., German, and French investigators describe a fairly large molecule known as quaternary ammonium-azobenze-quaternary ammonium (QAQ) that closely resembles the common local anesthetic lidocaine. The molecule's trans form represents as a straight chain but mutates into an "L" shape, or the cis form, when exposed to 380 nm light. It can be returned quickly to the trans form by illuminating it with 500 nm light or, more slowly, by simply placing it in the dark. Placed inside of a cell, QAQ in the trans form is able to block many ion channels—including TRPVI, which is commonly found in pain-sensing neurons. When activated for a prolonged period, TRPVI receptors widen; and the pore in the ion channel opens enough for bigger molecules such as QAQ to pass through into the cell. Because TRPVI is not present on other kinds of sensory nerves, the QAQ can be directed specifically into nerve cells that are actively sensing pain, where they then be switched on and off with different wavelengths of light. The researchers see a future for QAQ as a targeted analgesic.
From "Light-Switched Local Anaesthetic Lets Scientists Turn Pain Nerves On and Off"
Ars Technica (02/28/12) Gitlin, Jonathan M.

Sciatic Lateral Popliteal Block With Clonidine Alone or Clonidine Plus 0.2 Percent Ropivcaine
Researchers assessed the sole use of clonidine or clonidine in combination with 0.2 percent ropivacaine in 66 children to determine effective analgesia following mild to moderate painful foot surgery, after combined sciatic lateral popliteal block (SLPB) plus femoral block. Patients were randomized into three groups to receive placebo, clonidine, and clonidine plus ropivacaine. Kaplan-Meier and the log-rank test were employed to analyze time to first analgesic request in the groups. Clonidine administered alone in the SLPB shows promise by maintaining intraoperatively the hemodynamic parameters arterial systolic and diastolic pressure, heart rate to the lower normal values so that no patient required nalbuphine under 0.6 MAC sevoflurane anesthesia, and postoperatively without analgesic request for an average time of six hours. Furthermore, clonidine received as an adjuvant augments ropivacaine's analgesic effect for the first postoperative day. In addition, the parents of children in the clonidine and clonidine plus ropivacaine groups were satisfied with perioperative management of their children, with satisfaction scores of 9.74 plus or minus 0.45 and 9.73 plus or minus 0.70, respectively. All parents whose children were in the control group needed rescue nalbuphine in the recovery room, and postoperatively, along with high incidence of postoperative nausea and vomiting, and children's parents expressed a low satisfaction score.
From "Sciatic Lateral Popliteal Block With Clonidine Alone or Clonidine Plus 0.2 Percent Ropivcaine"
BMC Anesthesiology (02/12) Vol. 12, No. 2, P. 1471 Petroheilou, Kalliopi; Livanios, Stavros; Zavras, Nikolaos; et al.

Anesthesia Alert: The Beauty of the Block Nurse
A new nursing specialization, the block nurse, is emerging as the practice of regional anesthesia spreads. This clinician is responsible for conducting the preoperative assessment, preparing the block room, ordering supplies to patient follow-up, and much more. In addition to taking some of the burden off the shoulders of the rest of the anesthesia team, the block nurse is a strong advocate for the patient. Educating the patient and the patient's family about anesthesia care, for example, is another important task. An ideal candidate will possess appropriate clinical skills—such as familiarity with the properties of various local anesthetics, reversal agents, and lipid rescue treatments. A block nurse's knowledge of correct injection pressure, the ultrasound and nerve stimulator, and ideal syringe sizes for local anesthetic injections, meanwhile, can benefit patient safety by lowering the likelihood of nerve injuries. In addition to a clinical background, block nurses should have stellar communication and organization skills and should be committed to ensuring that every patient that could benefit from regional anesthesia does.
From "Anesthesia Alert: The Beauty of the Block Nurse"
Outpatient Surgery (03/01/12) DeBusk, Emily

Hospitals Feeling the Pain of Sedative Shortage
Hospitals nationwide are seeing shortages in the supply of vital drugs, including sedatives and anesthetics. The reasons for the tight supplies are not clear but are linked to drug makers exiting the market, production issues, and indefinite plant closures. The end result is a logistical headache for hospitals and clinics as they try to adapt with substitute drugs and by stretching stock to the limit; but many are facing ethical dilemmas as hoarding, rations, and "gray market" buying begin to become part of the complex situation. Anesthetic agents like diazepam, lorazepam, and midazolam are in short supply according to the Food and Drug Administration's list of at least 115 affected drugs. Anesthesia providers have some workarounds that help them deal with the shortages, but other clinicians—like gastroenterologists who rely heavily on benzodiazepines in tandem with opioids—have been harder hit. The effects of the shortages could cause these providers to limit the number of endoscopic procedures or change sedation methods, which in turn could lead to inflated costs for the procedure if they are forced to use propofol and have an anesthesia provider present at the procedure to perform monitored care. In mid-January the FDA issued an interim rule requiring the sole manufacturers of certain drugs to report to the agency six months in advance if there will be a stop or interruption in production. There are currently no fines associated with failure to provide notice under the FDA rule, although Senate Bill 296 and House Bill 2245, which are waiting committing action, include fines.
From "Hospitals Feeling the Pain of Sedative Shortage"
Anesthesiology News (03/01/12) Vol. 38, No. 3 Marcus, Adam; Ochoa, George
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