Anesthesia E-ssential, March 29, 2013

Anesthesia E-ssential

March 29, 2013

New Video! Get to Know Your AANA Affinity Program Partners
The AANA Affinity Program is a unique benefit that is a win-win for the AANA and its members. Members can take advantage of exclusive promotions and services from a wide range of respected businesses, while the AANA earns nondues revenue from royalties and commissions that helps fund important programs beneficial to the profession. This popular program is rapidly growing and now features nine partners offering high-quality products and services ranging from financial planning to life insurance to credit cards to a unique retail rewards program created specifically for associations. Check out the new video to learn more about the program, and be sure to visit the AANA Affinity Program Web page,, often: New partners are coming on board all the time.


The Pulse

  • Board Approves New Eblast Policy for Candidates Running for AANA Elected Positions
  • Don't Forget: The Mid-Year Assembly is Around the Corner
  • Watch for the Annual Meeting Preliminary Schedule Insert in the March NewsBulletin
  • Mark Your Calendar! The Spring Schedule of AANA Workshops is Available at
  • AANA Journal Course #32 Available Only Online
  • CRNA-Led Study Covered in Time Magazine
  • AANALearn® Discount - Two CE Credit Pharmacology Course Still Available


AANA Foundation and Research
  • Vegas – The Stars Come Out At Night: Register Now!
  • "State of the Science” Poster Presentations, 2012 Poster Abstracts and 2013 Applications Online 
  • AANA Submits Comments to FDA on Drug Shortage Strategic Plan
  • The Joint Commission Issues Tips for Compliance: Preventing Surgical Fires
  • The Academy of Breastfeeding Medicine Issues Guideline: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2012
  • Congress Begins 2014 Budget Process, with Widely Varying Views on Health Programs
  • Avoiding Government Shutdown, Congress Bakes Automatic “Sequester” Cuts Into 2013 Budget, Including 2 Percent Medicare Cuts Coming April 1
  • What Is “Immediately Available” in Supervision? ASA Publishes Different Views on CMS Rules and Guidelines
  • MedPAC Considers Merging Medicare Physician and Hospital Payments and Equalizing Different Facility Fees
  • AANA Participates in National Quality Forum Meeting

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
Board Approves New Eblast Policy for Candidates Running for AANA Elected Positions
All candidates running for AANA elected positions who have been placed on the official ballot or are write-in candidates who have notified the Nominating Committee chair shall have the opportunity to purchase a mass email (“Eblast”) from the AANA. This email will be sent only to AANA members who became eligible to vote since the previous election and/or those members who have voted in the past two elections. At no time will membership email addresses be directly released to candidates. To view the policy, approved by the AANA Board of Directors at its February meeting, visit Various lists containing email addresses of members have been compiled and used by candidates to promote their campaigns throughout the years. The AANA has received complaints from members regarding this unauthorized use of their information. We hope that this new policy will eliminate the use of mass email lists obtained from any other source but the AANA.
Don't Forget: The Mid-Year Assembly is Around the Corner
April 14-17, Arlington, Va. The annual Mid-Year Assembly provides an invaluable opportunity for CRNAs and student registered nurse anesthetists to learn about important federal and legislative issues that affect nurse anesthesia practice. Visit to see this year's program and register.

Watch for the Annual Meeting Preliminary Schedule Insert in the March NewsBulletin
Find out about all of the exciting educational offerings and not-to-be-missed meetings and events in the Annual Meeting Preliminary Schedule, in the center of the March issue of the AANA NewsBulletin. The Preliminary Schedule, which was mailed separately to the membership in the past, is now an insert to the NewsBulletin to save money on postage, fulfillment and printing costs.

Mark Your Calendar! The Spring Schedule of AANA Workshops is Available at
In conjunction with the Mid-Year Assembly, boost your business savvy by attending the highly successful AANA Business of Anesthesia Conference, April 13, 2013, at the Crystal Gateway Marriott in Arlington, VaA.  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.”
Click here to register for the Business of Anesthesia Conference
There is still room in the May 1, 2013, AANA  Essentials of Obstetric Analgesia/Anesthesia Workshop which will be held in the AANA Foundation Learning Center in Park Ridge, IllL.  This workshop addresses clinical applications of obstetric analgesia/anesthesia.  Lecture format will cover normal and abnormal physiology of pregnancy, pharmacology, and techniques, plus case presentations will enhance lecture material.  Hurry, space is limited!
Click here to register for the OB Workshop!
Exciting revisions have been made to the AANA Advanced Pain Management Workshops 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.  Participants can register for each 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  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 a 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 AANA Comprehensive Ultrasound Guided Peripheral Nerve Block and Vascular Access Workshop. This Workshop provides a comprehensive review of current practices of peripheral nerve blocks and vascular access. Along with the basic sciences, current literature and latest techniques relating to the use of ultrasound in anesthesia practice,  this program addresses the need and gap in knowledge that many CRNAs experience with regard to regional anesthesia administration and ultrasound-guided anesthesia in their practice.
Click here to register for this exciting course!

AANA Journal Course #32 Available Only Online
AANA members can take the AANA Journal course exam free of charge using the online format from April 2 through July 31 (ending at midnight central time). The exam will be available here: (login required). In preparation for the exam, a study page with all six courses is available at: The April Journal will feature the exam, but it can only be taken online. Exam answers will appear in the August Journal.

CRNA-Led Study Covered in Time Magazine
When Ladan Eshkevari, CRNA, PhD, LAc, assistant program director of the nurse anesthesia program at Georgetown University School of Nursing and Health Studies, noticed that many of her patients who used acupuncture to treat pain reported sleeping better and feeling better able to cope with their pain, even if the needling did not relieve the pain itself, she wondered whether acupuncture might help to reduce stress. She decided to examine the relationship between chronic stress and acupuncture in rats, and the results of her study, partially funded by the AANA Foundation, appear in the Journal of Endocrinology. Read Time Magazine's March 15 article on Eshkevari's research.

AANALearn® Discount - Two CE Credit Pharmacology Course Still Available
“Perioperative Neuromuscular Blockade – Time for Another Look” is one of the newer pharmacology courses available in the AANALearn® system. Support from an unrestricted educational grant from Merck & Co., Inc., has enabled AANALearn® to offer this course at a great discount price for all members—$28 for two CE credits. The archived video content is offered free to members by clicking on the course description in the catalog; if CE credit is desired, the exam and evaluation can be purchased. There are currently six online courses providing eight pharmacology CE credits in the Pharmacology Catalog. All AANALearn® courses are available 24/7 with special 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

Vegas – The Stars Come Out At Night Register Now!
Plan to attend a fabulous and fun event on Monday, Aug. 12, 2013. Vegas – The Stars Come Out at Night will feature Kenan Thompson from “Saturday Night Live” as the emcee as well as CRNAs and SRNAs showcasing their talent and creativity, competing for fabulous prizes, and supporting the AANA Foundation’s mission of advancing the science of anesthesia through education and research. Registration is now open—be sure to buy your ticket when you register for the AANA Annual Meeting at Do you have a talent you’d like to share? If so, submit a Talent Application today. Click here to visit our event Web page, learn more about the event and access the application. If you have any questions, please contact Luanne Irvin at the AANA Foundation at (847) 655-1173 or
“State of the Science” Poster Presentations 2012 Poster Abstracts and 2013 Applications Online
Each year the AANA Foundation offers students and CRNAs the opportunity to present their research at the AANA Annual Meeting. Click on the link below to view the 2012 poster abstracts: “State of the Science” offers two opportunities—oral poster presentation with an April 1 application deadline date and general poster presentation with a May 1 application deadline date. Visit to access the applications. For more information, contact the AANA Foundation at (847) 655-1170 or

AANA Submits Comments to FDA on Drug Shortage Strategic Plan
On March 12, 2013, the AANA commented on the U.S. Food and Drug Administration’s development of a strategic plan to prevent and mitigate drug shortages. The AANA recommended specific communication elements of the strategic plan to effectively notify and inform the AANA and CRNAs about drug shortages critical to anesthesia practice. Read the comment letter under U.S. Food and Drug Administration AANA Activities.
The Joint Commission Issues Tips for Compliance: Preventing Surgical Fires
Noting that ECRI Institute estimates nearly 650 surgical fires occur every year, The Joint Commission has posted tips for preventing surgical fires. In addition to discussing Environment of Care (EC) accreditation standards that address fire safety, The Joint Commission provides recommendations from the FDA and ECRI Institute to reduce the risk of surgical fires. The Joint Commission also links to additional resources, including its Sentinel Event Alert Issue 29: Preventing Surgical Fires and ECRI Institute’s free poster, Only You Can Prevent Surgical Fires.
The Academy of Breastfeeding Medicine Issues Guideline: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2012
The Academy of Breastfeeding Medicine (ABM) has issued its guideline, Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2012, reflecting updates from its previous version issued in 2006. The National Guideline Clearinghouse has also posted a summary of the guideline. The ABM develops clinical protocols for managing common medical problems that may impact breastfeeding success. According to the ABM, these protocols are only guidelines for the care of breastfeeding mothers and infants and “do not delineate an exclusive course of treatment or serve as standards of medical care.” Read the AANA’s October 2012 press release on the topic of anesthesia and the breastfeeding mother here.

Congress Begins 2014 Budget Process, with Widely Varying Views on Health Programs
The House majority Republicans and Senate majority Democrats are proposing competing 2014 budget outlines for Uncle Sam that have substantially different outlooks on healthcare programs watched closely by CRNAs. If Congress agrees to a final budget outline later this year, it will require lawmakers and parties to bridge a big fiscal and ideological chasm.
House Budget Committee Chairman Rep. Paul Ryan (R-WI) March 12 offered a 2014 budget intended to reach balance within 10 years by repealing the Affordable Care Act, making Medicaid a state block grant, replacing traditional Medicare for persons now over 55 with “premium support” to purchase private health coverage and not raising taxes. Senate Budget Committee Chairwoman Sen. Patty Murray (D-WA) was planning the week of March 11 to issue a 2014 budget outline that reduces but does not eliminate budget deficits, keeps the Affordable Care Act, leaves Medicare and Medicaid largely intact, and cuts about $1 trillion in spending and raises about $1 trillion in taxes during the next 10 years.
Hearings on the competing outlines began on Capitol Hill in mid-March, with the House likely to have taken up its budget the week of March 18 and the Senate its resolution shortly thereafter. Budget resolutions set overall congressional targets for a fiscal year’s spending bills and for other legislation affecting revenues, such as tax or public benefit entitlement measures.
According to Politico, the President’s 2014 budget proposal is anticipated to be released in April, two months after its usual release date, likely delayed by the “fiscal cliff” and budget sequestration processes still affecting 2013 budget work six months into the current fiscal year. Both congressional parties and the White House received some mixed news on the eve of Hill budget work: the Congressional Budget Office says the federal government will borrow 25 cents of every dollar it spends this year, down from the low 40-cent-per-dollar range during the height of the 2008 economic crisis.
Read the Senate Democratic budget outline coverage here (original document not available at press time) and for further updates. Read the House Republican budget outline at
Avoiding Government Shutdown, Congress Bakes Automatic “Sequester” Cuts Into 2013 Budget, Including 2 Percent Medicare Cuts Coming April 1
Congress enacted and the President signed legislation the week of March 17 averting a threatened March 27 federal government shutdown, and baking into the 2013 federal budget some $85 billion in spending cuts this year, including a 2 percent reduction in Medicare payments affecting CRNA and physician reimbursement. The Medicare cuts are effective for services beginning April 1, according to a notice from the Medicare agency. Also slated for cuts is the Title 8 nurse workforce development program; its 5 percent reduction will chiefly fall on new 2013 grant awards due out this summer. National Institutes of Health research accounts are cut 5 percent. Government employee and contractor furloughs may affect other government operations, most famously the availability of White House public tours.
Read the legislation (HR 933) here. The Senate passed the bill March 20 by a 73-26 vote; see how they voted here. The House passed the bill March 21 by a 318-109 vote; see how they voted here.
What Is “Immediately Available” in Supervision? ASA Publishes Different Views on CMS Rules and Guidelines
Medicare says that when an anesthesiologist is supervising CRNA anesthesia services, the physician must be “immediately available” if needed, and within the operative suite or unit. But the American Society of Anesthesiologists (ASA) 2013 Relative Value Guide newly states that an anesthesiologist who is farther away than that–a specific distance or time "impossible to define"–should still be considered as “supervising.”
In the 2013 ASA Relative Value Guide, the ASA introduced this new definition: “A medically directing anesthesiologist is immediately available if s/he is in physical proximity that allows the anesthesiologist to return to re-establish direct contact with the patient to meet medical needs and address any urgent or emergent clinical problems. These responsibilities may also be met through coordination among anesthesiologists of the same group or department. Differences in the design and size of various facilities and demands of the particular surgical procedures make it impossible to define a specific time or distance for physical proximity.”
However, the Medicare interpretive guidelines to its Part A Hospital Conditions of Participation (CoP) define “immediately available” as “only if [the anesthesiologist] is physically located in the same area as the CRNA, e.g., in the same operative/procedural suite, or in the same labor and delivery unit, and not otherwise occupied in a way that prevents him/her from immediately conducting hands-on intervention, if needed.” Further, the Part B Medical Direction regulations state that in order for an anesthesiologist to bill for medical direction of a CRNA or AA, that anesthesiologist “remains physically present and available for immediate diagnosis and treatment of emergencies.”
What does it mean for CRNAs? It means that the ASA is urging a looser definition of “immediately available” than Medicare provides. AANA continues evaluating the situation.
MedPAC Considers Merging Medicare Physician and Hospital Payments and Equalizing Different Facility Fees
The Medicare Payment Advisory Commission (MedPAC) is recommending that Congress merge Medicare Part A facility and Part B physician payments, and equalize Medicare facility fees so that a service performed in a hospital is paid the same as the same service in another environment such as an ambulatory surgery center (ASC). But the panel, meeting the week of March 4, stopped short of agreeing on recommendations for Congress on these matters.
For CRNAs, activities to merge Part A facility and Part B physician and possibly anesthesia payments might hasten the development of “bundled” payment systems that drive greater local attention to activities that might improve care quality while reducing costs. While Medicare usually pays for a service with separate facility, physician and anesthesia fees, a bundled payment might wrap all three fees into one payment to the facility, for example. Under such a circumstance, facilities might look closely at the relative costs of various anesthesia delivery models, comparing services provided by anesthesiologists with medically directed CRNAs, medically supervised CRNAs and nonmedically directed CRNA-only services.
Equalizing facility fees would not appear to affect CRNA reimbursement directly. Rather, it would hasten the trend of moving procedures from the hospital setting to outpatient and ambulatory settings and to physician offices, where procedures may be provided at lower cost. Read the MedPAC hearing briefs here and transcripts at
AANA Participates in National Quality Forum Meeting
During the week of March 4, the AANA attended the National Quality Forum Conference and Member Meeting, “The Next Decade of Performance Measurement: Meeting the Needs of a Rapidly Changing Healthcare System,” in Washington, D.C. Others attending the meeting included representatives from national professional organizations, healthcare systems, insurers, accrediting organizations such as The Joint Commission and various government agencies.
Some of the overall themes discussed at the meeting included the need to develop patient reported outcomes (PROs) that will measure patient satisfaction with the outcomes of their care, and the need for overall focus on measurement of outcomes rather than of processes. There was general consensus that quality measures used by CMS and others must become more relevant to both providers and patients while reducing the burden that hospitals and healthcare professionals must bear in reporting quality measures. CMS representatives indicated that measures developed by professional organizations will probably not be allowed to substitute completely for public quality measures adopted by federal agencies and others. A primary goal of quality measurement development from the perspective of payers like Medicare is that healthcare quality measures be transparent to the public and that performance reporting be linked to providers by name.
CRNAs can become more involved in voluntarily sharing their healthcare improvement activities and ideas to the NQF Action Registry at There is no need to be a member of NQF in order to participate in the NQF Action Registry, although persons using the site for the first time will be asked to register. Registration and participation is free and can be used to showcase successful strategies in improving anesthesia and pain care.
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.


Reusable Surgical Devices Pose Cross-Contamination Risk
French researchers have determined that more than half of reusable medical equipment—including pulse oximeters, electrocardiogram cables, and laryngoscope handles—is tainted with microorganisms despite routine decontamination protocols. The study, which took swab samples from equipment after decontamination and immediately before the next use, underscores the risk of cross contamination in even the sterile setting of an operating room (OR). Although no resistant pathogens were identified during the investigation, the findings suggest a need for improved decontamination protocols as well as regular audits of the decontamination process. Researcher Pierre Diemunsch, PhD, MD, professor, and chair of anesthesia at Hopitaux de Hautepierre in Strasbourg suggested that incorporating more single-use equipment in the OR could help and should be considered for patients at an elevated risk for cross-contamination, such as those who are infectious or immunocompromised.
From "Reusable Surgical Devices Pose Cross-Contamination Risk"
Anesthesiology News (03/01/13) Vol. 39, No. 3 Vlessides, Michael

Anesthesiology Study Reveals Adult Behaviors Influence Children's Coping in the Recovery Room After Surgery
According to research from Yale-New Haven Children's Hospital in Connecticut, adult behaviors help determine how well children cope in the recovery room following surgery. The investigators videotaped 146 two- to 10-year-old patients during their stay in the post-anesthesia care unit after undergoing general anesthesia and elective surgery. Sequential analysis was used to determine how the behaviors of children and adults—both parents and nurses—influenced each other over time. According to the findings, adult use of empathy, distraction, or coping/assurance talk was more likely to keep children calm; however, children already in distress were more likely to remain that way if an adult tried to reassure them. Verbal distraction was used by adults most often—including 88 percent of the time by nurses—while criticism was rarely used—and never by nurses. "Similar studies should be continued and expanded to help anesthesiologists, nurses and especially parents understand the most effective ways to interact with children to help them have the best possible experience when they undergo surgery or anesthesia," said Mark Singleton, MD, who chairs the American Society of Anesthesiologists' Committee on Pediatric Anesthesia. The research was published in the April issue of Anesthesiology.
From "Anesthesiology Study Reveals Adult Behaviors Influence Children's Coping in the Recovery Room After Surgery"
Newswise (03/20/13)

Fewer Patients Awake During Operations
A new report from the United Kingdom's Royal College of Anaesthetists suggests that incidents of "accidental" awareness while under general anesthesia happen less frequently than earlier research has indicated. The study, which surveyed 7,125 anesthesia providers and coordinators at 329 hospitals, documented only about one case in 15,000—substantially fewer than the previously reported rate of about one in 500. Researcher Jaideep Pandit, a consultant anesthetist at Oxford University Hospitals, conceded that some underreporting was possible in the study, as many anesthesia providers may not learn about the awareness report or may forget how many cases they have seen and as some patients may forget the incident or not consider it worth mentioning. He noted that patients' descriptions of the experience varied greatly, from "very, very severe adverse experiences of a combination of pain, paralysis, terror," to anecdotal reports of patients being undisturbed and even somewhat intrigued by what is happening. He and colleagues are planning to conduct more research that would focus on patient experiences.
From "Fewer Patients Awake During Operations"
Oxford Press (OH) (03/14/13) Locke, Tim

Intubation Training Phone App Bests Lecture
Northwestern University associate professor of anesthesia Raymond Glassenberg, MD, and colleagues have developed an iPhone app that they say can teach anesthesia trainees intubation skills more effectively than an in-person lecture. Using the free software, which also is available for iPad, users can manipulate a virtual bronchoscope through a simulated airway to perform intubations under a variety of scenarios. To demonstrate the viability of iLarynx, Glassenberg randomly assigned 10 medical students to use the product for 30 minutes and another 10 students to sit through a 30-minute lecture on airway anatomy, accompanied by static images. All 20 test subjects then performed 10 bronchoscopic intubations on mannequins and underwent evaluation by an observer with no knowledge of their mode of training. The results showed that 96 percent of intubations in the iLarynx group were completed successfully, compared to 76 percent in the lecture group; and nine out of 10 initial intubations among the iLarynx users were successful, compared to only four among the lecture attendees. Additionally, the procedures were completed more quickly in the iLarynx group, at a median of 35 seconds compared to 120 seconds in the lecture group. Glassenberg said he and his colleagues were seeking a low-cost alternative to existing intubation simulators, which he said have some limitations. Moreover, "unlike a virtual reality system with handheld bronchoscopes," he noted, "the application can be practiced anywhere." Carin Hagberg, MD, executive director of the Society for Airway Management, has given the iLarynx her seal of approval, calling it "probably the easiest program that I've worked with for learning basic intubation skills."
From "Intubation Training Phone App Bests Lecture"
Anesthesiology News (03/01/13) Vol. 39, No. 3 Wild, David
Same-Day Total Joints at an ASC
A new approach toward joint replacement surgery is promising to revolutionize the healthcare sector by sending patients home just a few hours after a procedure instead of confining them to a hospital bed for days. Advanced Center for Surgery, an outpatient facility in Altoona, Pa., is leading the change with its program that pairs smaller-incision surgical methods with ultrasound-guided regional anesthesia. To effectively and optimally manage pain, patients may receive a major conduction block for total hip replacement, an interscalene block for total shoulder replacement, or a triple block for total knee arthroplasty, among other options. Patients are discharged with blocks that last for as long as two days as well as an elastomeric pain pump that constantly delivers anesthetic for an additional 48 hours. Home nurses and physical therapists continue the care at patients' homes, visiting regularly to check vital signs; administer intravenous medications, if needed; and ensure that pain is controlled. Not only do these patients reportedly experience lower levels of post-operative pain than those whose surgeries were performed in a hospital, the outpatient experience also offers lower risk of nosocomial infection and iatrogenic illness. Moreover, the use of nerve blocks eliminates many of the complications associated with general anesthesia. "When you can anesthetize the entire extremity or the region with local anesthetics, patients are not receiving IV narcotics, and there's less risk of nausea and vomiting," explains Dave Berkheimer, president and CEO of RemCare Anesthesia Solutions, which provides anesthesia services for the Altoona outfit. "In addition, the risks of other complications, such as decreased respiration and hypoxia, are dramatically reduced." Lastly, according to Berkheimer, the cost of joint replacement in an outpatient center is about a third of the cost of the same procedure in an inpatient setting.
From "Same-Day Total Joints at an ASC"
Outpatient Surgery (03/01/13) Pickles, Virginia
Appeals Court to Hear Arguments Against Lethal-Injection Drug
The backlash against lethal-injection protocols continues to grow across the country, even as states switch their formulas in the face of drug shortages. Domestic supplies of sodium thiopental—which in many states is used along with two other drugs to carry out death sentences—began to dry up after a U.S. manufacturer halted production of the anesthetic in 2009. The lack of inventory forced change on the states, some of which opted to bring the drug in from outside the country. In one unique legal challenge, death row inmates in several states are suing the Food and Drug Administration for sanctioning imports of sodium thiopental in 2010. Even though states have since switched to other drugs in place of the fast-acting sedative, the case remains in play and most recently was scheduled to go before the U.S. Court of Appeals for the District of Columbia Circuit on March 25. Meanwhile, the new drug protocols for lethal injections are likely to trigger many more new challenges, according to Death Penalty Information Center executive director Richard Dieter.
From "Appeals Court to Hear Arguments Against Lethal-Injection Drug"
Washington Post (03/24/13) Doyle, Michael

Teva to Block Drug for U.S. Execution Use as Hospira Pressured
Teva Pharmaceutical announced that after it resumes production of propofol, the Israeli company will control distribution in order to prevent the anesthetic from being used in lethal injections of U.S. prisoners. Corrections authorities in Missouri previously had indicated that they planned to use the drug in the future due to a lack of pharmaceutical alternatives for executions. Though Teva plans to supply propofol to hospitals and healthcare providers, it will set up procedures to prevent the drug from being sold to correctional facilities, taking its cue from other drug manufacturers that have taken similar action. Meanwhile, Lake Forest, Ill.-based Hospira, which also is licensed to sell propofol in the United States, remains under pressure from investors to address the lethal injection use issue. Spokesman Daniel Rosenberg said in an e-mailed statement on Feb. 4, "Hospira has long communicated that we do not support the use of any of our products in lethal injection" and has not changed its position.
From "Teva to Block Drug for U.S. Execution Use as Hospira Pressured"
Bloomberg (03/20/13) Kitamura, Makiko

More FDA Review for Merck Post-Anesthesia Drug
On March 15, Merck announced that Sugammadex sodium, a drug designed to reverse the muscle-relaxing effects of anesthesia after surgery, will require another three months of review by the U.S. Food and Drug Administration. If approved by the FDA following the additional review, the injectable drug would be the first in a new class of medicine in the United States—although it was approved by the European Medicines Agency in 2008. Sugammadex sodium was first submitted for FDA approval that same year by Schering-Plough, which was acquired by Merck in 2009, but the application was rejected due to concerns about allergic reactions and excessive bleeding in some patients during surgery. Merck has submitted new data to the FDA, as requested, and announced in January that the regulator would be reviewing the application again. Merck has expressed hope that the next phase of the review will be completed during the second half of 2013.
From "More FDA Review for Merck Post-Anesthesia Drug"
MedCity News (03/16/13) Sell, David
Physician-Patient Alliance for Health & Safety Invites Participation in the First National Survey of Patient-Controlled Analgesia Practices
The Physician-Patient Alliance for Health & Safety (PPAHS) is soliciting participation in what is believed to be the first countrywide survey on patient-controlled analgesia practices. "Data from the survey should provide valuable information that will help determine current practices and indicate practices that may be adopted to improve patient safety and health outcomes," said PPAHS executive director Michael Wong. Physicians, nurses, respiratory therapists, pharmacists, and other healthcare providers are encouraged to participate in the research, which is being conducted in cooperation with the nonprofit A Promise to Amanda Foundation. The survey can be accessed at
From "Physician-Patient Alliance for Health & Safety Invites Participation in the First National Survey of Patient-Controlled Analgesia Practices"
Albany Times Union (NY) (03/20/13)

Traditional Dental Anesthesia Is More Effective With Addition of Mannitol
A study published in Anesthesia Progress found that the addition of the drug mannitol to the most commonly used dental anesthetic—lidocaine with epinephrine—significantly increased the effectiveness of the anesthetic. In the study, the efficacy of lidocaine with epinephrine for sensation was compared with equal amounts of lidocaine with epinephrine plus mannitol. The efficacy of the two formulations was measured in terms of sensation in the teeth, pain of solution deposition, and postoperative pain. It is thought that the high failure rates of between 10 percent and 39 percent that have been reported with the traditional formulation of lidocaine and epinephrine are related to the incomplete diffusion of the anesthetic solution through the nerve trunk due to the perineurial barrier around the nerve. The addition of mannitol allows the anesthetic solution to permeate the nerve trunk in higher amounts, improving efficiency. The study found that there was no significant difference between the two treatments with regard to pain of solution deposition and postoperative pain, although the mannitol treatment was found to be more effective for all teeth.
From "Traditional Dental Anesthesia Is More Effective With Addition of Mannitol"
San Francisco Chronicle (CA) (03/21/13)

Pediatric Pain Relief Without the Pills
Cook Children's Medical Center in Fort Worth, Texas, is the first U.S. hospital to have a sensory unit called virtual platform optimized design, also known as a V-pod. The technology projects interactive, 3-D designs that reduce pain and stress by distracting children during uncomfortable or painful procedures. The V-pod's 3D images, which include roller coaster rides and relaxing bubbles, sometimes even relieve the need for medication. Mental distractions can help reduce pain, according to a 2012 report published in Current Biology.
From "Pediatric Pain Relief Without the Pills" (03/05/13) St. James, Janet

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