Anesthesia E-ssential

March 15, 2013 

Vital Signs

AANA Election Slate Announced
The AANA Nominating Committee, after completing candidate deliberations at its February meeting, has announced the slate of candidates for the upcoming 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 on the ballot was determined through the use of a random number generator by the Nominating Committee. Those elected will begin their fiscal year 2014 terms of office at the conclusion of the Annual Meeting in Las Vegas.


The Pulse

  • AANA Seeking Committee Members for FY2014
  • Members Promote Profession in Big Way During NNAW 2013
  • Don’t Get Ripped Off: Buy AANA Books from the AANA
  • Annual Meeting Registration is Open
  • Pre-Order Your Annual Meeting Shirts!
  • Join us for exciting AANA Workshops Being Offered in April, May and June!
  • AANALearn® Offers Six New CE Courses
State Government Affairs
  • AANA Webpage Links to ACO Resources
  • AANA Webpage Links to ACO Resources
  • Update: AANA and CRNAs Respond to McCaughey Statements
  • AANA in the News: Releases Inform, Generate Interest
  • 2,200 and Counting!
  • Save the Date!  COA Doctoral Workshop at AANA Annual Meeting
  • Automatic “Sequester” Cuts Coming for Medicare Services Beginning April 1
  • Federal Agencies Release Five Affordable Care Act Regulations; One Addresses Provider Nondiscrimination in Some Plans
  • With 26 States Planning to Use Federal Exchange, HHS Issues “Essential Health Benefits” Rule
  • AANA Supports CRNA Coverage in Medicaid Alternative Health Plans
  • AANA Participates in AMA CPT Moderate Sedation Workgroup
  • AANA Plays Key Role in “Partnership for Patients”
  • AANA Joins Nursing Community in Support of Title 8 Nurse Workforce Development Funding
  • Physician Payment Commission Urges Boost to Evaluation & Management, Cuts to Procedures, and End to Fee for Service
  • State Reimbursement Director is Now State Reimbursement Specialist
  • CRNA-PAC Kicks Off 2013 Care to be Counted Development Program
  • Thanks for Joining Us at Assembly of School Faculty
  • When AANA or Its Affiliates Call, It May Call a Number You’ve Provided
  • FEC-Required Legal Notification for CRNA-PAC

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 Seeking Committee Members for FY2014
Positions are available on AANA Committees for CRNAs and student registered nurse anesthetists. Check out the committee page on the AANA website to read about the various opportunities. Deadline for submission of a committee request is April 20, 2013.
Members Promote Profession in Big Way During NNAW 2013
Once again, National Nurse Anesthetists Week (NNAW), Jan. 20-26, 2013, generated tremendous exposure for the nurse anesthesia profession thanks to the thousands of CRNAs and student registered nurse anesthetists who participated across the nation. Check out some of their efforts at

Don’t Get Ripped Off: Buy AANA Books from the AANA
Before you purchase an AANA published book from an online seller other than the AANA, be sure to price compare. Books sold through other sellers are usually marked up from the AANA’s selling price. Visit the AANA Bookstore to receive the best prices available on new AANA books:

Annual Meeting Registration is Open
Online registration is now open for the AANA Annual Meeting, to be held August 10-13, 2013, at the Mirage in Las Vegas. Visit the Annual Meeting webpage at for more information.

Pre-Order Your Annual Meeting Shirts!
Check out the stylish and comfortable Annual Meeting 2013 shirts at Your order will be shipped to your home in July, in time for Annual Meeting. The order deadline is July 1.

Join us for Exciting AANA Workshops Being Offered in April, May and June!
  • In conjunction with the Mid-Year Assembly, boost your business savvy by attending the highly successful Business of Anesthesia Conference, April 13, 2013, at the Crystal Gateway Marriott in Arlington, VA. Here is what past participants have to say about this valuable conference: “Excellent, best money ever spent at an AANA meeting” “Excellent content” “Great speakers.” Register for the Business of Anesthesia Conference.
  •  On May 1, 2013, Essentials of Obstetric Analgesia/Anesthesia Workshop will be held in the AANA Foundation Learning Center in Park Ridge, IL. This workshop addresses clinical applications of obstetric analgesia/anesthesia. Lecture format will cover normal and abnormal physiology of pregnancy, pharmacology, and techniques plus case presentations will enhance lecture material.
  • Immediately following the above workshop, the Spinal and Epidural workshop will be held on May 2-4, 2013, also at our AANA Foundation Learning Center. Discussion includes pertinent anatomic knowledge necessary for performing spinal and epidural anesthesia, comparisons of the differences and similarities between spinal and epidural anesthesia, review of the clinical use of various local anesthetic and adjunct drugs for spinal anesthesia. “Hands-on” sessions will be offered for attendees to put into practice what they have learned. Register for the OB and Spinal/Epidural Workshops
  • Exciting revisions have been made to the Jack Neary Advanced Pain Management Workshop to better serve our members and to respond to requests by past attendees! We are now offering a series of workshops all focusing on various aspects of importance to the pain practitioner. Each workshop can be registered for separately, but the biggest impact comes from taking them all together as a training plan. We are now offering:
    • AANA Physical Assessment for APRNs Workshop – May 3, 2013
    • AANA Jack Neary Advanced Pain Management I Workshop – May 4-5, 2013
    • AANA Jack Neary Advanced Pain Management II Workshop – May 6-7, 2013
    • Neuroanatomy Prosection Workshop – May 8, 2013
  • Sign in as member at to access the registration form.
  • June 1-2, 2013, join us at the beautiful Grand America hotel in Salt Lake City, Utah, for the Comprehensive Ultrasound Guided Peripheral Nerve Block and Vascular Access Workshop. Watch the AANA website at for more information as it becomes available!
  • Space is limited for all these workshops so register early!
AANALearn® Offers Six New CE Courses
The AANA presents the Wellness and Chemical Dependency in the Nurse Anesthesia Profession courses–6 modules designed specifically for nurse anesthetists. Each module can be purchased separately in AANALearn® and will provide 1 CE credit upon completion. Each course will increase awareness and knowledge for CRNAs of the need to be healthy and well, with helpful information, resources, and references related to health, stress, and chemical dependency. All AANALearn® courses are available 24/7 with discounted pricing for AANA members. Credits transfer to the transcript file within the same day. Now is the time to consider completing the CE credits required for recertification in 2013! Check out the catalogs now at

AANA Webpage Links to ACO Resources
In an attempt to control healthcare costs, the Affordable Care Act has created an Accountable Care Organization (ACO) pilot program. ACOs could end up just being a passing fad, or they could represent the model of the future for healthcare delivery. Either way, they are generating a great deal of interest within the healthcare industry. The AANA has created a webpage with links to resources that may help answer questions CRNAs have regarding ACOs.

April 1 and May 1 Application Deadlines Approaching Fast
Scholarship, fellowship, grant, and “State of the Science” application dare currently available at Deadline dates:
  • April 1: Student scholarships, State of the Science oral presentations, Dean Hayden student research scholarship, and doctoral and post doctoral fellowships.
  • May 1: Research grants and “State of the Science” general poster presentations.
If you have any questions, please contact the AANA Foundation at (847) 655-1170 or
Attention Starlets, Dancers, Singers, Actors, and Performers: Talent Applications due April 1, 2013
i>The AANA Foundation presents… Vegas – The Stars Come Out At Night Monday, Aug. 12, 2013 Now is your chance to get up on stage with Saturday Night Live’s Kenan Thompson, showcase your talent, and compete for great prizes. Click here to visit our event webpage, learn more about the event, and access a Talent Application. If you have any questions, please contact Luanne Irvin at the AANA Foundation at (847) 655-1173 or
Update: AANA and CRNAs Respond to McCaughey Statements
In February, former New York Lt. Gov. Betsy McCaughey made inflammatory and inaccurate statements about nurse anesthesia during her appearance on the Neil Cavuto show on Fox News. In addition to a formal rebuke from AANA President Janice Izlar, CRNA, DNAP, the AANA issued a media alert calling on members to write Fox, Cavuto, and/or McCaughey. While Fox has yet to yield a retraction or equal time, the swift response from AANA members left no doubt with Fox that the nurse anesthesia community is out there watching…and paying attention.Members can hear McCaughey’s offensive remarks, read President Izlar’s response, and read a sampling of more than 30 CRNA letters here. Kudos to the many CRNAs who took the time to write, call, and be heard.
AANA in the News: Releases Inform, Generate Interest
  • A press release on the AANA’s new Position Statement 2.18: Mobile Device Use was disseminated electronically to more than 2,000 media outlets across the country in February and generated coverage by Outpatient Surgery and Becker’s ASC Review, and an NPR interview with AANA’s new senior director of Professional Practice, Lynn Reede, CRNA, MBA.
  • The AANA press release “Does Anesthesia Affect a New Mom’s Ability to Breastfeed?” generated more than 2,000 pickups by newspapers and magazines across the country through the North American Precis Syndicate (NAPS), an all-time high for an AANA-generated NAPS release.
  • AANA publicized its support of the National Patient Safety Foundation’s 2013 Patient Safety Awareness Week with this release, disseminated on March 1.
2,200 and Counting!
Since late November, more than 4,200 people have downloaded the free AANA Journal mobile app for Apple and Android smart phones and tablets. Have you? Download yours now at

Save the Date!  COA Doctoral Workshop at AANA Annual Meeting
The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is offering The Nuts and Bolts of Developing a Professional Doctoral Degree Offering on Friday, August 9, 2013, in Las Vegas.This one-day workshop provides information on the key activities to establish doctoral degree offerings consistent with the COA’s Additional Criteria for Practice-Oriented Doctoral Degrees contained in the Standards for Accreditation, and COA Policies and Procedures.  The content is valuable for programs establishing both entry level and CRNA post-master’s doctoral degrees.Topics include a dean’s perspective, key considerations in getting started, developing a curriculum that meets national standards for similar degrees, interpreting the COA’s additional criteria for doctoral degrees, and tips for success in the submission and review of doctoral applications.
Who should attend?
  • Nurse anesthesia program administrators
  • Deans of academic units affiliated with nurse anesthesia programs
  • Nurse anesthesia faculty
The fee is $275 per person. CE credits will be available. Registration will open soon. Space is limited so sign up early to avoid getting closed out! 
Program details and registration information will be posted soon on the COA website at!

Automatic “Sequester” Cuts Coming for Medicare Services Beginning April 1
Because Congress and the Obama Administration could not agree on how to apportion $1.2 trillion in federal deficit reduction, on March 1 the administration approved an outline for across-the-board “budget sequestration” spending cuts that include a 2 percent cut for Medicare Part B and a 5 percent reduction in Title 8 nurse workforce development and National Institutes of Health research accounts.
According to a Health and Human Services (HHS) agency spokesperson quoted in the industry publication Modern Healthcare, the Medicare cuts would take effect for services beginning April 1, 2013, and the Medicare agency is anticipated to notify Medicare providers of the change in writing. With the implementation beginning one month later than previously anticipated, AANA estimates that the cuts will reduce an average CRNA’s Medicare reimbursements this year by some $1,229.
The cuts of 5 percent from Title 8 accounts could reasonably be expected to affect grant awards that the agency makes during the summer months--including advanced education nursing grants and nurse anesthetist traineeships. The likelihood that the cuts might be reversed appears dim, since congressional budget rules require any reversed cuts to be funded by reductions from elsewhere or from revenue increases. Meanwhile, funding for many aspects of the federal government runs out March 27, and Congress is initiating work on the continuing resolution (CR) appropriations for many departments including HHS.
A further “CR” adopted by the House March 6 (HR 933) would continue funding for Title 8 at the new, reduced levels. Read the administration’s detailed memo on budget sequestration here, the "CR” here, and an explanation here.
Federal Agencies Release Five Affordable Care Act Regulations; One Addresses Provider Nondiscrimination in Some Plans
On March 1, federal agencies released five regulations implementing major provisions of the Affordable Care Act (ACA). While some of these regulations do not pertain to CRNAs, the Office of Personnel Management (OPM) released one of particular CRNA interest-- the final rule establishing the Multi-State Plan Program (MSPP). The ACA created the MSPP to foster competition among plans competing in the individual and small group health insurance exchange markets on the basis of price, quality, and benefit delivery.
While the AANA had urged the agency (AANA member login and password required to access letter) to require anesthesia and pain management services to be included in the 10 categories of essential health benefits provided by multi-state plan program issuers and multi-state plans offered through exchanges, the final rule leaves it up to MSPP issuers to determine precisely what services must be covered by plans marketed through exchanges. The AANA also requested that the OPM require multi-state plans participating in exchanges to align their payment systems to comply with state and federal nondiscrimination provisions. In the final rule, the OPM stated that the rule “clearly bars discrimination against certain health care providers of the MSPP issuer,” an important safeguard for CRNAs.
Also of interest to CRNAs and in response to AANA comments, the agency further stated, “We acknowledge the importance of having standards in place to prevent discrimination against specific provider types, because a variety of providers is important for accessing services. However, we believe that the non-discrimination standards set forth in §§ 800.101 and 800.102 adequately prohibit discrimination against specific provider types. OPM will reinforce these protections through its contract negotiations with MSPP issuers.”
The AANA is also reviewing a proposed rule on small business exchanges; a proposed rule on a health insurer tax; a notice of 2014 benefit and payment parameters; and an interim final rule on amendments to that notice.
With 26 States Planning to Use Federal Exchange, HHS Issues “Essential Health Benefits” Rule
With more than half of all states planning to use the federal exchange or marketplace to offer subsidized coverage to beneficiaries under the Affordable Care Act, the U.S. Department of Health and Human Services issued a final rule on Feb. 20 outlining the “essential health benefits” (EHB) such plans are required to offer. While the AANA had urged the agency in regulatory comments (AANA member login and password required to access comments) to specifically name CRNA anesthesia and pain management services among those benefits, the final rule leaves to states the precise determination of what services that plans marketed through exchanges must cover.
Section 1302 of the Affordable Care Act provides for the establishment of an EHB package that includes coverage of EHBs. The law directs that EHB cover at least the following 10 general categories: Ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. Anesthesia services fall into many of these categories.
Under the final rule, the agency directs plans to offer the 10 statutory EHB categories while allowing the state to select the specific details of their EHB coverage by reference to one of a range of popularly selected plans offered in the state or as part of the FEHBP. Accordingly, the states continue to maintain their traditional role in defining the scope of insurance benefits and may exercise that authority by selecting a plan that reflects the benefit priorities of that state.
AANA Participates in AMA CPT Moderate Sedation Workgroup
The American Medical Association Current Procedural Terminology (AMA CPT) Moderate Sedation Workgroup met in late February with AANA representation present. The primary issue being considered relates to how to define the CPT code for moderate sedation when administered by a procedural physician or when given by a second provider (non-anesthesia). The Moderate Sedation Workgroup is a subset of the AMA CPT Editorial Board. Strategically the AANA seeks to have a greater voice in decisions related to coding and reimbursement. The CPT Manual is widely used for coding reimbursable procedures, and the AMA Relative Value Update Committee (RUC) provides recommendations on the relative value of the CPT codes. Medicare and private insurers take under advisement RUC recommendations when determining reimbursement.
AANA Plays Key Role in “Partnership for Patients”
Since the inception of the CMS Partnership for Patients initiative as part of the Affordable Care Act, the AANA has supported it and is represented on a part of this effort, the CMS Partnership for Patients Affinity Group for Procedural Harm. As a co-leader in this activity, the AANA has joined other perioperative stakeholders in creating innovative materials for Hospital Engagement Networks (HENs) aimed at reducing harm in operating rooms and other areas throughout the hospital. This week, the AANA in conjunction with key partners, began working on a new initiative to develop an OR Safety Interactive Guide that maps the continuum of care throughout the surgical environment, including points of risk and links to resources describing best practices for safety and error prevention.
AANA Joins Nursing Community in Support of Title 8 Nurse Workforce Development Funding
With Congress turning to completing the Fiscal Year 2013 budget process, and the Obama Administration preparing to release its 2014 budget proposal, the AANA joined more than 40 organizations in The Nursing Community to express support for the value of Title 8 nurse workforce development programs and federal health research initiatives.“We understand the difficult decisions before you concerning the fiscal climate and the challenges you face to decrease the national deficit,” stated the Feb. 28 letter to congressional leaders signed by the AANA and 42 national nursing groups. “However, we urge you to consider the devastating impact to our nation’s healthcare system, and ultimately our patients, if funding for Title 8 is not preserved. Americans need more nursing care, and cuts to Title 8 would jeopardize their access to care.” The AANA also joined in congratulation Rep. David Joyce (R-OH) on being named co-chair of the bipartisan House Nursing Caucus. The Democratic co-chair continues to be Rep. Lois Capps (D-CA). Read the March 1 letter regarding FY14 nursing budget priorities here.
Physician Payment Commission Urges Boost to Evaluation & Management, Cuts to Procedures, and End to Fee for Service
Congress should act to repeal the “sustainable growth rate” (SGR) funding formula problem, boost evaluation and management payment, seek to reduce Medicare outlays for procedures, and end the fee-for-service payment system, according to a report issued on March 4 by the National Commission on Physician Payment Reform (NCPPR) convened by the Society of General Internal Medicine.
The national medical society of 3,000 academic internal medicine physicians established the NCPPR to develop recommendations relative to physician payment with a goal of reducing health spending and improving quality of care. According to a member of the commission, which was a private and not a government body, the group did not discuss advanced practice registered nurses as part of their deliberations, and physician representation on the group was limited to various specialties within internal medicine. The commission did not seek input from surgeons nor from hospital-based specialties such as anesthesiologists, radiologists or pathologists.
Highlights from the recommendations presented at the unveiling of the report on Capitol Hill with AANA DC personnel present include ending fee for service (FFS) payment by the end of this decade, eliminating FFS now for patients with multiple chronic conditions and hospital based procedures, increasing reimbursement for evaluation and management codes and freeze payment for procedural codes, and eliminating disparate procedural payment for hospitals vs. ASCs vs. office locations.
State Reimbursement Director is Now State Reimbursement Specialist
The AANA Board of Directors the week of Feb. 25 approved a name change for each state’s reimbursement policy contact from State Reimbursement Director (SRD) to State Reimbursement Specialist (SRS). The change came at the urging of antitrust counsel.
While professional associations may legitimately advocate on behalf of their membership to other business entities, they may never negotiate on behalf of their members or work to coordinate the business decisions or activities of association members. The AANA is a professional association that neither employs CRNAs in clinical roles, nor collectively bargains on CRNAs’ behalf in the manner of a labor union. Since care should be taken to avoid creating the impression that a state reimbursement person can “direct coordinated action” on the part of the state associations or the AANA, counsel suggested that we should consider changing from the word “director,” which may be incorrectly perceived as “directing” reimbursement negotiations, to the safer alternative “specialist.”
We ask that presidents of states associations of nurse anesthetists that have not yet identified their SRS please do so and submit the SRS’s name and contact information to with the subject line: State Reimbursement Specialist. We are also planning a meet & greet for all state reimbursement specialists at the Mid-Year Assembly and would like to make sure that everyone is included in the invitation. Read more CRNA reimbursement essentials here (requires AANA member login and password).
CRNA-PAC Kicks Off 2013 Care to be Counted Development Program
Following a record-setting 2011-2012 election cycle, the CRNA-PAC has launched its 2013 Care to be Counted development campaign with emails to all AANA members and a refreshed Care to be Counted PAC and Grassroots website.
The campaign’s next step features the PAC’s annual telemarketing campaign, now under way through the end of April. Calls will focus on upcoming cuts to CRNA reimbursement in Medicare as well as threats to CRNA scope of practice -- and AANA members will be asked to make a suggested contribution of a dollar a day ($365) or more to CRNA-PAC. The work of CRNA-PAC could not be more important than it is now.
Budget cuts and efforts of organized medicine in Washington threaten CRNA practice, some 90 new members of Congress must be educated about CRNA issues, and already seven U.S. Senators have announced plans to retire, creating open 2014 election contests where CRNA-PAC can identify and support the profession’s new friends for the future.
Thanks for Joining Us at Assembly of School Faculty
The AANA FGA team hosted a booth at the AANA Assembly of School Faculty meeting in Tucson the week of Feb. 18, updating members on health policy issues affecting CRNA educators, hosting a listening session among nurse anesthesia faculty and students, and raising money for the CRNA-PAC via a silent auction.Thanks to members’ generous voluntary contributions, more than $14,000 was raised for the CRNA-PAC at Assembly of School Faculty – helping to keep the voice of nurse anesthesia strong in Washington at a critical time. To learn more about CRNA-PAC, see (requires AANA member login and password)
When AANA or Its Affiliates Call, It May Call a Number You’ve Provided
The AANA and its affiliates periodically reach out and touch AANA members on the phone – and when they do, they call utilizing the phone numbers that the member provided during the course of establishing or renewing AANA membership and entered into the member profile. The Federal Communications Commission requires organizations to obtain “express consent” to contact persons by their cell phone. Therefore, if one of the telephone numbers you have provided in your profile is a cell phone, we are handling this as having given AANA “express consent” to call you on that number. So many of our members only utilize cell phones rather than traditional land lines this is necessary to ensure continued communication. Moving forward, the AANA membership renewal process will be revised to more clearly reflect this consent.
However, in the interim, if any member would like to change their phone number or remove their cell phone from their membership profile, please click, click the Member Center, login with your username and password, and click Member Profile to update your information.
FEC-Required Legal Notification for CRNA-PAC
Gifts to political action committees are not tax deductible. Contributions to CRNA-PAC are for political purposes. All contributions to CRNA-PAC are voluntary. You may refuse to contribute without reprisal. The guidelines are merely suggestions. You are free to contribute more or less than the guidelines suggest and the association will not favor or disadvantage you by reason of the amount contributed or the decision not to contribute. Federal law requires CRNA-PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. Each contributor must be a US Citizen.


Anesthesia During Colonoscopy May Cause Aspiration
New research concludes that there is a slightly more elevated risk of complications—especially for aspiration pneumonia—when anesthesia is used during a colonoscopy. A team from Cleveland's Case Western Reserve University conducted a large, population-based study, finding that the overall rate of complication was greater in patients who received anesthesia for the procedure than it was in patients who were not put under. Deep sedation, the investigators speculate in a report published online March 11 in JAMA Internal Medicine, may trigger complications by hindering normal patient responses. In an editorial accompanying the paper, Karen Wernli, PhD, and John Inadomin, MD, of the University of Washington School of Medicine in Seattle call the research findings "intriguing" and note that they raise a number of questions. "One is whether the decision by the Center for Medicare & Medicaid Services to require anesthesia professionals to administer propofol will result in fewer complications," they write.
From "Anesthesia During Colonoscopy May Cause Aspiration"
Medscape (03/11/13) Pullen, Lara C.

DEX Sedative Is Safe, Effective for Pediatric Imaging Patients
Dexmedetomidine (DEX) presents itself as a safe, effective, and efficient alternative to sedatives currently used in pediatric nuclear medicine imaging, according to a new study that set out to determine how DEX affected the outcomes of bradycardia, hypotension, and hypertension on 669 patients. DEX was administered by radiologist nurses as an intravenous bolus over a 10-minute period, followed by a continuous fusion at a rate of 1 µg/kg/h until imaging was complete. The outcomes indicated that sufficient sedation was accomplished within 8.6 minutes with a total recovery time of 41 minutes. In contrast, other sedatives can average recovery times of 100 minutes. The researchers report that six patients experienced brief periods of oxygen desaturation without requiring airway intervention, while hypotension, hypertension, and bradycardia occurred in 58.7 percent of patients; however, none of these fluctuations called for pharmacologic treatment. The researchers note that DEX is the only sedative that stimulates natural non-rapid eye movement and preserves spike activity during electroencephalography. The study was published in the February edition of the journal Radiology.
From "DEX Sedative Is Safe, Effective for Pediatric Imaging Patients"
Molecular Imaging (03/07/13) Pedulli, Laura

In Operating Room, a Switch to Prefilled Syringes Pays Off
After identifying a number of problems related to how anesthesia providers labeled, administered, and disposed of medications at Barnes-Jewish Hospital in St. Louis, researchers revamped the protocol for handling the drugs. They found that shifting to standardized, ready-to-use (RTU) syringes of eight common anesthetics improved proper labeling of the medications. Prior to the intervention, just 31 percent of clinicians included the medication concentration on the label along with the drug name; but that number climbed to 78 percent after changing protocol. The switch to pre-filled syringes mixed by a compounding pharmacy also practically ended medication waste, which often occurred when anesthetics were prepared for emergent scenarios but either were discarded when they ultimately were not needed or inappropriately kept past their expiration date for future use. Waste was reduced 96 percent for atropine and phenylephrine and by almost 95 percent for succinylcholine, according to lead researcher Rachel Stratman, PharmD. Moreover, the cost of outsourcing the medications was offset by the savings from drugs that would have been wasted otherwise. Stratman, who said Barnes-Jewish undertook the study in hopes of complying with the Anesthesia Patient Safety Foundation's 2010 medication safety paradigm, presented the study results at the Society of Critical Care Medicine's annual congress.
From "In Operating Room, a Switch to Prefilled Syringes Pays Off"
Anesthesiology News (03/01/13) Vol. 39, No. 3 Blum, Karen
According to a study by Dr. Ah-Reum Cho of Pusan National University in Korea, published in the March issue of Anesthesia & Analgesia, the choice of anesthetic used during a mastectomy for women with breast cancer may affect their risk of developing long-term postoperative pain. Chronic pain after mastectomy for breast cancer was assessed in 175 women who received either propofol or sevoflurane. Up to four years after surgery, 56 percent reported having chronic pain and of those, only 44 percent were patients who received propofol anesthesia. When the results were adjusted for other factors that increased the risk of chronic pain—including younger age, more extensive surgery, and more morphine for pain relief—it was found that women in the sevoflurane group were about 50 percent more likely to develop chronic pain after mastectomy. Cho and colleagues emphasize that chronic pain risk is also influenced by factors other than chosen anesthesia, and they are calling for further research to confirm their "provocative" finding.
From "Anesthetics During Breast Cancer Surgery May Affect Development of Chronic Pain"
News-Medical (02/28/13)
For Pain Control During Early Labor, Combined Spinal-Epidural Analgesia Is Best: Study
New research finds that women who receive a combined spinal-epidural (CSE) experience pain relief more quickly and to a greater extent at the onset of labor than women who receive conventional epidural anesthesia. As reported in the March issue of Anesthesia & Analgesia, Dr. David Gambling and colleagues at San Diego's Sharp Mary Birch Hospital for Women and Newborns compared CSE, which starts with medications injected into the intrathecal space, against epidural analgesia in 800 healthy women during childbirth. After initial epidural or intrathecal injection, both groups received patient-controlled epidural analgesia and were asked to evaluate the effectiveness of pain relief on a scale of 0 to 10 at different times during labor and delivery. During the first phase of labor, the typical pain score was 1.4 for women receiving CSE versus 1.9 for those receiving standard epidural analgesia—a statistically significant difference—although there was little to no difference during the second stage or at delivery. For women in the CSE group, the average time to complete pain control was 11 minutes faster than for the epidural group, and these patients were less likely to need further epidural doses to maintain pain control. While the results suggest that CSE provides significantly faster and better pain relief during the first stage of labor, compared to the traditional epidural technique, Drs. Jessica Booth and Peter Pan of Wake Forest University School of Medicine, wrote in an accompanying editorial that the research underscores that "both CSE and epidural analgesia are an excellent analgesic option during labor."
From "For Pain Control During Early Labor, Combined Spinal-Epidural Analgesia Is Best: Study"
Science Daily (02/27/2013)
Beware the Hidden Dangers of Anesthesia
According to the Invisible Risk initiative, a new healthcare safety campaign from Teleflex Medical, recovery room nurses may be at risk of exposure to waste anesthesia gas and also may not realize the potential health complications they face as a result. The effort seeks to educate surgical professionals about the dangers of anesthetic gases exhaled by patients in the post-anesthesia care unit. According to the Occupational Safety and Health Administration (OSHA), the cumulative effect of these gases on recovery staff can potentially cause miscarriages, birth defects, sterility, cancer, dizziness, fatigue, headaches, irritability, liver and kidney disease, and nausea. The National Institute for Occupational Safety and Health's (NIOSH) publication on the hazards of waste anesthesia gases cites an elevated risk for surgical staff who work in facilities where the operating room is not equipped with automatic ventilation or scavenging systems. NIOSH recommends that facilities improve air quality in these areas by installing systems that circulate and replenish air at least six times per hour and conduct a minimum of two air changes of fresh air every hour. In addition, according to NIOSH, facilities should develop monitoring programs that frequently measure concentrations of anesthetic gas in the breathing zones of the most heavily exposed workers.
From "Beware the Hidden Dangers of Anesthesia"
Outpatient Surgery (02/26/13) Cook, Daniel

Anesthesia Care and Web-Surfing May Not Mix, Nurses Saye
There is a growing debate over the personal use of smartphones in the operating room, with some critics saying the devices should be prohibited because the distraction they cause presents a risk to patient safety. The American Association of Nurse Anesthetists (AANA) believes that smartphones actually do have a place in the OR, as staff tap the devices to look up medications or rare diseases or even to get in touch with a patient's family. "The challenge," according to the organization's Lynn Reede, "is to keep the mobile device focused on the issue at hand." That being said, AANA has instated a new policy urging OR workers to limit smartphone use to job-related business, avoiding social media, games, personal Web surfing, and like activities.
From "Anesthesia Care and Web-Surfing May Not Mix, Nurses Say"
National Public Radio (NPR) (02/26/13) Shute, Nancy

'Shelf Life' of Blood Is Shorter Than We Think
Evidence is mounting that red blood cells stored beyond three weeks start to lose their capacity to deliver oxygen-rich cells, with the latest data coming from a small Johns Hopkins study published online in the journal Anesthesia & Analgesia. Lead researcher Steven Frank, MD, associate professor of anesthesiology and critical care medicine at Johns Hopkins, acknowledged that blood banks do not carry sufficient stores of fresh blood to cover all patients and that requiring shorter storage periods would diminish the available supply. He suggested that the acceptable storage timeframe—currently six weeks—may need to be reconsidered, based on the findings of his team. Sixteen patients scheduled to have spinal fusion surgery, a type of operation that usually requires blood transfusions, were involved in the study. Researchers took samples from every bag of blood used and measured the flexibility of the red blood cells. Blood older than three weeks tended to have red blood cells with less flexible cell membranes, which would make it more difficult for the cells to deliver oxygen to tissue. Samples taken from patients three days following the surgery showed that the damage to red blood cells was not reversible, despite being returned to a biological environment, and those damaged cells would likely remain dysfunctional for their life cycle limit. Frank noted that those study patients who received fewer units of blood had healthier red cells overall, suggesting that having a small amount of these problem cells made less of a difference than when larger numbers of damaged cells are present. Two large randomized controlled studies are underway in the United States and Canada that are trying to determine the relative safety of older versus newer blood; results are expected in 2014.
From "'Shelf Life' of Blood Is Shorter Than We Think" (03/04/13)
Checklists, Hand Hygiene Star in AHRQ's Top 10 Safety List
The Agency for Healthcare Research and Quality (AHRQ) has furnished a list of patient safety strategies that can improve healthcare quality through immediate implementation. Among the strategies are preoperative checklists, proper hand hygiene and barrier precautions to prevent healthcare-associated infections. AHRQ issued the study as an updated follow-up to its 2001 analysis of patient-safety practices. The study involved the review of 41 safety practices, culled from an initial list of over 100. A panel of healthcare stakeholders identified 10 of those practices as "strongly encouraged" for adoption, including prevention bundles for central line-associated bloodstream infections and ventilator-associated pneumonia. An additional 12, such as medication reconciliation, team training, practices to reduce radiation exposure and computerized provider order entry, were classified as "encouraged" for adoption. The wide adoption of the top 10 strategies could lead to meaningful safety gains and better patient outcomes, AHRQ officials say. The report authors' reviews of the top 10 strategies are
From "Checklists, Hand Hygiene Star in AHRQ's Top 10 Safety List"
Modern Healthcare (03/05/13) McKinney, Maureen

CDC Sounds Alarm on Deadly, Untreatable Superbugs
A class of untreatable, often fatal bacteria is proliferating throughout U.S. hospitals, creating a nightmare scenario through their resistance to antibiotics, their high mortality rate, and their ability to share their resistance genes with other bacteria. Centers for Disease Control and Prevention (CDC) Director Thomas Frieden warns that failure to contain the spread of carbapenem-resistant Enterobacteriaceae (CRE) will soon make treatment of even common infections impossible. He says immune-compromised people who are hospitalized for a prolonged period or are living in a nursing home are particularly prone to CRE infection. Twelve years ago, just 1.2 percent of the common family of bacteria, Enterobacteriaceae, were resistant to carbapenem antibiotics, but that figure had increased to 4.2 percent by 2011. The CDC has outlined a six-step plan for hospitals. Among the practices hospitals should implement to contain CRE infections is finding out which, if any, of their patients have CRE; using precautions such as gloves and gowns to prevent contagion; removing catheters and other invasive devices as soon as possible; and having patients reconsider using antibiotics.
From "CDC Sounds Alarm on Deadly, Untreatable Superbugs"
USA Today (03/05/13) Szabo, Liz; Eisler, Peter

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