Anesthesia E-ssential, May 15, 2012

Anesthesia E-ssential

May 15, 2012

 

Vital Signs

AANA 2012 Election Begins
The 2012 AANA Election process began on Tuesday, May 8, 2012. AANA members should have received their ballot materials, including their E-signature and voting instructions, electronically by now from Survey and Ballot Systems (AANA’s election services coordinator). Those who requested a paper ballot will receive it shortly in the mail. If you cannot locate your e-signature, or if you have difficulty with the voting site, please call 952-974-2339 (Monday-Friday, 8 a.m. - 5 p.m. CT) or email support@directvote.net. Please note that the email with your voting credentials originates from noreply@directvote.net.
 
Candidate information, including a photograph, biographical sketch, and position statements (for Board of Directors’ candidates only) is available on the AANA members-only section of the website. (AANA member login and password required.)
 
Video Recordings of Candidates’ Speeches
Video recordings of speeches given by candidates for the AANA Board of Directors during the Mid-Year Assembly in April are also available on the AANA website with the other candidate information.
 
Voting Deadline
Members will be able to vote through June 19, 2012, 12 noon CDT.
 

 
 

Vital Signs

 

The Pulse

Inside the Association
  • U.S. Senate Committee Investigating Drug Company Ties to Pain Professional and Advocacy Groups
  • AANA endorses CDC's Restatement of Safe Injection Practice Guidelines
  • AAAHC Launches New Hospital Accreditation Program
  • View Ira P. Gunn Memorial Photos and Video on AANA Website
  • Call for Entries: Public Relations Recognition Award
  • Annual Meeting Walk/Run News
  • Volunteers needed in Bhutan
  • PCORI Revises Draft National Priorities for Research and Research Agenda
  • Participate in the AANA's Social Network
  • Four State Hospital Associations Urge CMS to Restore Patient Access to CRNA Pain Care
  • AANA Posts Reimbursement Advocacy Toolkit for State Associations
  • AANA Foundation Program Director’s Outstanding Student Researcher Award
  • Register Now for AANA Foundation Events at the Annual Meeting
  • COA Composition: CRNA Practitioner
  • AANA Attends Nurse Organizations Briefing on Health Reform Implementation
  • AARP, AANA and 44 Nurse Groups Commend Federal Trade Commission for Supporting Patient ?Access and Choice in Healthcare
  • National Election Update for CRNAs
  • FEC REQUIRED LEGAL DISCLAIMER FOR CRNA-PAC
 
  • Visit the CRNA Career Center
 

Healthcare Headlines

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

Hot Topics

U.S. Senate Committee Investigating Drug Company Ties to Pain Professional and Advocacy Groups 
The Medicare-writing Senate Finance Committee has opened an investigation into opioid manufacturers’ links to healthcare professional and advocacy organizations, according to a statement on the committee website dated May 8, 2012. Though neither the AANA nor CRNAs are the subject of the committee’s investigation, the issue is of interest to CRNAs as members of the profession provide pain management services to patients.
 
According to the website, the committee has sent requests for information to Purdue Pharma, The Joint Commission, the Wisconsin Pain and Policy Studies Group, the American Academy of Pain Medicine, the American Pain Society, the Center for Practical Bioethics, Johnson & Johnson, and Endo Pharmaceuticals. AANA has not received such a letter, and the committee does not report having sent similar letters to other nursing or medical organizations involved in chronic pain management care.

The investigative journalism collaborative ProPublica also published an article on May 9 indicating that the American Pain Foundation has shut its doors in response to scrutiny leading up to the congressional investigation.

The letters the committee sent to the organizations listed above are found along the right column of the committee’s webpage. See the letter sent to the American Academy of Pain Medicine May 8. (This organization is distinct from the American Academy of Pain Management, also AAPM, with which some AANA members are diplomats or fellows.)

The AANA and CRNAs have played a leadership role in preventing drug diversion and misuse, including participation with the Food and Drug Administration’s (FDA) Risk Evaluation and Mitigation Strategies (REMS) programs. Learn more about REMS from FDA.
 
AANA endorses CDC's Restatement of Safe Injection Practice Guidelines
In an effort to ensure clinicians are clear about Centers for Disease Control and Prevention (CDC) guidelines, the agency is restating its position on the use of single-dose/single-use vials and also seeks to dispel inaccuracies being disseminated to healthcare providers. As a founding member of the Safe Injection Practices Coalition (SIPC), the AANA has endorsed the CDC's restatement of these principles. Access the CDC's position in its entirety here.
 
AAAHC Launches New Hospital Accreditation Program  
On April 25, 2012, the Accreditation Association for Ambulatory Health Care (AAAHC) announced that it is launching a new accreditation program aimed at small hospitals. For more information, please access the AANA website.
 
View Ira P. Gunn Memorial Photos and Video on AANA Website
Legendary advocate and nurse anesthetist Ira P. Gunn, CRNA, MLN, FAAN, was laid to rest Monday, April 16, in Arlington National Cemetery. An account of the memorial ceremony, along with photos and a video, can be found on a special page of the AANA website.
 
Call for Entries: Public Relations Recognition Award
Deadline is July 9, 2012
The AANA Public Relations Committee is seeking entries for the 2012 PR Recognition Award Competition. Guidelines and an entry form are available on the AANA website.
 
Now in its 32nd year, the award recognizes outstanding public relations efforts in the following categories:
  1. Best overall public relations effort for the past year, to be awarded to an individual, organization, or state association.
  2. Best public relations effort by a small state association (small state association as defined by the Ad Hoc State Organizational Development Committee).
  3. Best promotional effort for National Nurse Anesthetists Week, to be awarded to an individual, organization, or state association.
  4. Best public relations effort by an individual, small group, organization or company not affiliated with a state association.
A PR Recognition Awards Contest Entry Form must be submitted with each entry. Entrants must specify which category they are entering (more than one category can be entered). Winners in each category will be chosen by the AANA PR Committee during the Annual Meeting, and presented on stage at Opening Ceremonies.
 
New this year – we are accepting electronic submissions only. Prepare an electronic submission of your entry to present the results of your PR campaign or activities. The submission may contain electronic copies of press clippings, photographs, plans, letters, memoranda, slides, media transcriptions, videotape, PowerPoint presentations, or other related material. The submission should be compiled in an organized manner, and all written materials be typed (scanned hand-written notes will not be considered).
 
The guidelines and entry form can also be found on the AANA website.
The deadline for entries is July 9, 2012.  If you have any questions please contact Karen Sutkus via email at klsutkus@aana.com or (847) 655-1140.

Annual Meeting Walk/Run News
Here is a Link to information about the seventh annual traditionally great walk/run event! New this year—a charitable benefactor and sponsorship opportunities too!
 
Volunteers Needed in Bhutan
Health Volunteers Overseas (HVO) needs a CRNA or MD for a one-month assignment in July 2012. Volunteers provide continuing education and training to the local anesthesia providers. Other opportunities will be available in 2013. Please contact the HVO program department for more information.
 
PCORI Revises Draft National Priorities for Research and
Research Agenda
The Patient- Centered Outcomes Research Institute (PCORI) amended its draft National Priorities for Research based on public comments it received from more than 470 stakeholders, including the Coalition for Patients’ Rights (CPR). After reviewing input from CPR and other organizations, PCORI added language about the importance of studying new and expanded roles for the full range of healthcare providers to its priorities recognizing the value of multidisciplinary care and the full range of care providers. In addition, PCORI incorporated language emphasizing the importance of care coordination across healthcare services or settings. More detailed information on the revisions is posted  on the PCORI website (See #12 for care providers and #4 for care coordination). PCORI is scheduled to vote on adopting the priorities at its May 21 board meeting.
 
Participate in the AANA's Social Network
AANA members can be a part of the discussion on President Malina's Blog and in the Clinical Hot Topics Community at MyAANA. There is no need to "join" these public groups—all members have automatic access by virtue of their membership in the AANA. Just enter and participate by contributing to or reading the ongoing discussion. More discussion groups will be added soon. Check back often! (Login required.)


State Government Affairs

Four State Hospital Associations Urge CMS to Restore Patient Access to CRNA Pain Care
Spurred by news that Medicare administrative contractor WPS sought recoupment of Kansas hospitals’ Medicare Part B CRNA pain care services reimbursements, four state hospital associations wrote the Medicare agency April 24 urging it to restore direct reimbursement of CRNA pain care services and to reverse the threatened recoupments.
 
"If CRNAs are no longer reimbursed for performing chronic pain services, their current patient population would be forced to drive long distances and contend with extended wait times for pain management procedures,” wrote the presidents of the hospital associations of Kansas, Iowa, Missouri and Nebraska.   “It is in the best interest of our patients to provide healthcare solutions that do not impede, but rather enhance patient access to quality care…. (W)e are requesting your assistance to instruct WPS to revert back to the long-standing CRNA reimbursement policy until CMS’ permanent policy on this topic is made available for review and comment and then promulgated through the 2013 Physician Fee Schedule final rule."
 
The hospital associations’ action represents further evidence of support for AANA’s view that Medicare should restore patient access to pain care that has been threatened by the actions of the Noridian and WPS MACs affecting patients in 18 Western and upper Midwestern states.

 
AANA Posts Reimbursement Advocacy Toolkit for State Associations
In response to state nurse anesthetist association interest in resource materials to promote the profession before Medicaid agencies and commercial health plan leaders, the AANA has published a State Nurse Anesthesia Reimbursement Advocacy toolkit online.
 
Developed in collaboration between the AANA Federal and State Government Affairs divisions and piloted among three state associations over the winter, this new toolkit is intended to be a resource guide for state associations to build and strengthen their professional relationships with entities influential to CRNA practice—Medicaid agencies, state-based insurance exchanges, insurance commissioners and commercial carriers.
 
The release for state association leaders immediately follows the publication of another resource guide for AANA members, a new online document titled “Issue Briefs on Reimbursement and Nurse Anesthesia.”
 
See the new toolkit (requires AANA member login and password). Upload the new Reimbursement Issue Briefs (requires AANA member login and password). Your comments on the Briefs are welcome.
Return to Headlines
 
 

 

AANA Foundation and Research

AANA Foundation Program Director’s Outstanding Student Researcher
Award
Attention Program Directors…
 
The AANA Foundation would like to honor your outstanding student researchers. The Program Director’s Outstanding Student Researcher Award is presented to a nurse anesthesia student in recognition of their work in research and their commitment to the nurse anesthesia profession. To be eligible for this award, a student must be a senior, ready to graduate within six months of receipt of the application and must be nominated by their program director.
 
The application is available on the AANA Foundation websiteon the front page under the column heading “Foundation News and Programs.” If you have a student who is about to graduate. and you would like to recognize their research endeavors, send the completed application to foundation@aana.com. Upon receipt, the application will be presented to the AANA Foundation Board of Trustees. Once the application is approved, a certificate will be sent back to the Program Director for presentation to the student. Thank you.
 
Register Now for AANA Foundation Events at the Annual Meeting
If you’re planning to attend the Annual Meeting in San Francisco and are looking to have a great time, experience local flavor, and support a great cause, register today for the following events…
  • Saturday, Aug. 4: California Hornblower Dinner and Dance Cruise on San Francisco Bay
  • Tuesday, Aug. 7: 15th Annual Golf Tournament at San Francisco’s Presidio Golf Course – register by June 15, 2012, to receive the early bird registration fee of $215.
To register, use the AANA Annual Meeting Registration Form. Click here to be directed to the Registration Form on the AANA website.  Print the form and be sure to complete section 5 – Ticketed Social Events to register for the AANA Foundation Fundraiser and/or the AANA Foundation Golf Outing. Mail, fax or email the form to AANA, 222 S. Prospect Ave, Park Ridge, IL 60068.
 
A portion of your registration fee for these events is tax-deductible and will support nurse anesthesia education and research. 


 

News from COA

COA Composition: CRNA Practitioner
The composition of the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) represents the communities of interest for the nurse anesthesia profession. Composition represented includes: five (5) CRNA educators, two (2) CRNA practitioners, one (1) health care administrator representative, one (1) university representative, two (2) public directors, and one (1) student representative.
 
Two COA directors are CRNA practitioners who are actively involved in clinical practice. The term for the CRNA practitioner is three years, at which time the candidate is eligible for reelection for one additional term. Currently, Maria Garcia-Otero, CRNA, PhD, is one of the COA’s CRNA practitioners. Maria has been a practicing CRNA for over 30 years both in the didactic and clinical environments.  She is actively involved in the nurse anesthesia profession by presenting at state meetings. She also serves as chair of the Selection and Evaluation Committee for the COA. To obtain additional information about the CRNA practitioner and her insights on how the COA brings value to the nurse anesthesia profession, please visit the COA’s website and select the biography titled “From the Practitioner’s Viewpoint.” 
 

  

Federal Government Affairs

AANA Attends Nurse Organizations Briefing on Health Reform Implementation
On the eve of National Nurses Week, AANA Executive Director Wanda Wilson, CRNA, PhD, participated in an April 30 meeting of nursing organizations with senior Administration officials in Washington and discussed implementation of the Affordable Care Act and other federal initiatives important to CRNAs.
 
Together with senior representatives of some 30 nursing groups, Wilson visited with Health and Human Services Secretary Kathleen Sebelius, Centers for Medicare & Medicaid Services Acting Administrator Marilyn Tavenner, RN, BSN, MHA, FACHE, and Health Resources and Services Administrator Mary Wakefield, RN, PhD, FAAN.
 
“In the interest of strengthening patient access to high-quality healthcare, we stressed the importance of lowering federal policy barriers to the use of CRNAs and other APRNs as the Institute of Medicine has recommended,” said Wilson. Among other regulatory and policy issues discussed were that the Graduate Nursing Education demonstration project application deadline closes shortly, that CMS’s initial proposal to eliminate outdated regulatory burdens in hospitals (to which AANA and CRNAs provided comments) will soon be the subject of a final rule, and that the agency’s “Million Hearts” campaign intends to prevent a million heart attacks and strokes over the next five years.

Health Resources and Services Administrator Mary Wakefield, RN, PhD, FAAN (left), visited with AANA Executive Director Wanda Wilson, CRNA, PhD, MSN, in Washington, D.C., April 30.
 
AARP, AANA and 44 Nurse Groups Commend Federal Trade Commission for Supporting Patient Access and Choice in Healthcare
The AANA joined the AARP and 44 nursing organizations in a May 8 letter to the Federal Trade Commission (FTC), commending the FTC’s recent actions in support of patient access to quality healthcare, and in favor of consumer choice and competition that helps lower healthcare costs.
 
“By responding to state-based requests to evaluate regulatory and legislative proposals that risk patient access to quality healthcare, the FTC is fulfilling its duty to promote market competition and its benefits. Ensuring competition in healthcare is more important than ever as the U.S. spends twice as much on healthcare services as our industrialized competitors, without enjoying twice the beneficial outcomes.” said the letter to FTC Chairman Jon Leibowitz.

 
National Election Update for CRNAs
AANA member Lee Bias, CRNA, contending for the Republican nomination in West Virginia’s Third District, came in second to an incumbent state representative, who meets incumbent Rep. Nick Joe Rahall (D-WV) this fall.

 
FEC REQUIRED LEGAL DISCLAIMER FOR CRNA-PAC
Gifts to political action committees are not tax deductible. Contributions to CRNA-PAC are for political purposes. All contributions to CRNA-PAC are voluntary. You may refuse to contribute without reprisal. The guidelines are merely suggestions. You are free to contribute more or less than the guidelines suggest and the association will not favor or disadvantage you by reason of the amount contributed or the decision not to contribute. Federal law requires CRNA-PAC to use our best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. I am a US Citizen.


  

Jobs



 
 
Why Nurses Need More Authority
Estimates say there will be nearly 30,000 fewer primary care physicians than needed in the United States by 2015, and the number could swell to almost 66,000 by 2025. Although a pliable solution to the shortage is readily available—broadening the scope of what advanced practice registered nurses (APRNs) are permitted to do—physician groups are opposed to giving these providers more responsibilities, even though doing so would neither compromise quality of care nor affect primary care doctor income. Such is the case in Colorado, where former Gov. Bill Ritter in 2010 empowered Certified Registered Nurse Anesthetists to provide anesthesia and pain management care in rural and critical-access hospitals plagued by a lack of anesthesia doctors. Although the impartial Institute of Medicine of the National Academy of Sciences released a report that same year concluding that APRNs "should be able to practice to the full extent of their education and training," medical and anesthesiologist organizations in Colorado sued to roll back Ritter's decision. Nearly three dozen other states still block nurse practitioners from performing a full range of practice; but the Federal Trade Commission has gotten involved, finding cause for anti-competitive practices in a few states as well as some evidence that the restrictions are not necessarily in patients' best interests. It also may not be the most prudent move, fiscally speaking. Research shows that widening the scope of practiced for nurses not only can free up doctors for more complex tasks but also save money. According to RAND, using nurse practitioners to their full capacity in Massachusetts, for example, would generate as much as $8.4 billion in savings over the course of a decade.
 
From "Why Nurses Need More Authority"
The Atlantic (05/07/12) Rowe, John W.
Return to Headlines
 
Neuraxial Opioid Therapy Benefits a Subset of Pediatric Sickle Cell Patients 
Researchers at Emory University believe they have identified an alternative treatment for managing pain in young sickle cell patients. Children and teens with the disease often do not respond well to a regimen of increasingly higher doses of intravenous opioids, which can present adverse side effects. However, in a study of eight pediatric patients admitted to the hospital with severe pain episodes, epidural analgesia proved to be an effective course of treatment. "Neuraxial opioids, with or without local anesthetics and clonidine, were felt to be helpful," according to lead researcher Dr. Claudia Venable, an assistant professor of anesthesiology at Emory. "Patients experienced improved analgesia, with fewer side effects, and we got them off their peripheral morphine very quickly." She also noted that functional skills were improved, and the children were able to take advantage of ancillary services such as physical therapy and psychologist visits. Moreover, hospital stays were shortened; and there were fewer hospital admissions in the six months after epidural placement. The research team developed an algorithm, recommending an epidural for patients for who there is concern after 48 hours on peripheral opioids, that they would like to see used in clinical decision making. They suggest follow-up research that includes measurements of functional abilities.
 
From "Neuraxial Opioid Therapy Benefits a Subset of Pediatric Sickle Cell Patients"
Pain Medicine News (05/01/2012) Helwick, Caroline
 
Too Fat for Anesthesia? Suction Cups Hold Up Patients' Guts During
Surgery
Bioengineering students at Rice University in Houston have designed a device that helps lift the weight off of the stomachs of obese patients during surgery, allowing them to breathe easier. The R-Aides device was created at the request of Dr. Mehdi Razavi, a heart surgeon who specializes in implanting pacemakers and performs heart catheterizations. Razavi said he often uses "conscious sedation" during procedures; however, during one surgery on an obese man, he realized that the man was snoring and having difficulty breathing because his abdominal fat was pushing against his lungs. Razavi approached the students for help, and they eventually came up with a device that uses suction cups. The cups, hooked to a horizontal beam over the abdomen, are attached to the skin and a vacuum pump. Activating the pump enables the cups to raise the abdomen slightly, moving the fat out of the way.
 
From "Too Fat for Anesthesia? Suction Cups Hold Up Patients' Guts During Surgery"
MSNBC (05/11/12) Alexander, Brian
 
Local Anesthesia May Be Enough for TAVI
According to a feasibility study, local anesthesia alone may suffice during transcatheter aortic valve implantation (TAVI). General anesthesia has been used since the first TAVI was performed 10 years ago, because the large size in the sheaths used in the procedure required doctors to access the femoral artery surgically. Today, with sheath sizes significantly smaller, local anesthesia is adequate and offers a number of benefits: less need for inotropes; ability to easily monitor neurological status during the procedure; ability to assess pain during dilator and sheath placement; and shorter hospital stays, including time in the intensive care unit. In the feasibility study, Helene Eltchaninoff, MD, and fellow researchers at the University of Rouen in France looked at 151 patients booked for transfemoral aortic valve replacement with only local anesthesia and fluoroscopic guidance between May 2006 and January 2011. Local anesthesia included lidocaine 2 percent injected into the skin, subcutis, and around the femoral artery, with additional doses administered as needed. Patients also received conscious sedation via intravenous midazolam 1 mg and nalbuphine 5 mg at the beginning of the procedure. The researchers found that just 3.3 percent of patients in the high-surgical-risk case series required conversion to general anesthesia. Moreover, those undergoing general anesthesia needed it because of complications with the valve procedure—not because of problems with the IV sedation.
 
From "Local Anesthesia May Be Enough for TAVI"
MedPage Today (05/09/12) Phend, Crystal
 
Hemoglobin Desaturation After Propofol/Remifentanil-Induced Apnea
Building on previous research that revealed ventilation problems tied to anesthesia induction with thiopental and succinylcholine, investigators at Gosford Hospital in New South Wales, Australia, tested the procedure with two different agents. The earlier study found that the succinylcholine in many cases caused prolonged apnea, which in turn led to hemoglobin desaturation due to muscle relaxation. In hopes of avoiding that scenario, the researchers replaced the thiopental and succinylcholine with propofol and remifentanil for tracheal intubation. They gave 12 healthy volunteers 2 mg/kg of propofol and 2 mcg/kg of remifentanil, while another 12 subjects received 2 mg/kg of propofol and 1.5 mcg/kg of remifentanil. Of the two dozen participants, desaturation occurred in four volunteers in the higher-dose remifentanil group and in one volunteer in the lower-dose group. The Gosford team concluded that propofol coupled with 2 mg/kg of remifentanil effectively achieves acceptable intubating conditions but produces apnea that carries a substantial risk of desaturation. Propofol with 1.5 mcg/kg of remifentanil, meanwhile, does not reliably achieve acceptable intubating conditions nor does it necessarily prevent desaturation.
 
From "Hemoglobin Desaturation After Propofol/Remifentanil-Induced Apnea"
Anesthesia & Analgesia (05/12) Stefanutto, Tiscia Bernadette; Feiner, John; Kromback, Jens; et al.
 
Cancelled Surgeries Costing Hospitals Millions
New research reveals that patients who either do not show up or cancel on the day of their surgery are costing hospitals millions of dollars annually. However, the researchers, from Tulane University Medical Center, note that patients who go in for a preoperative visit with an anesthesia provider are much more likely to keep their surgical appointments. In 2009, 6.7 percent of 4,876 scheduled elective outpatient surgeries at the medical center were cancelled, which cost the hospital almost $1 million. "People need to recognize that there is a cost to cancelled surgeries that is not insignificant," says Dr. Sabrina Bent, clinical associate professor of anesthesiology and director of research at the Tulane University Department of Anesthesia. Bent notes that more than 30 percent of the patients in the study did not show up at the time of the surgery for reasons including lack of transportation, confusion over the time of the appointment, and forgetting time of procedure. A small number of cancellations were due to issues at the hospital itself, such as a shortage of beds or equipment. However, the researchers note that patients who did not have a preoperative clinic visit with an anesthesia provider were more likely to cancel than those who did—nearly 11 percent vs. fewer than 4 percent of surgeries that first had a clinic visit. The authors therefore advise hospitals to make sure that all patients receive a preoperative visit to ensure that they are medically ready for surgery and that they receive the correct preoperative instructions for the day of the surgery. "That is a major factor that should be achievable," Bent says.
 
From "Cancelled Surgeries Costing Hospitals Millions"
Anesthesiology News (05/01/12) McCook, Alison
 
Topical Anesthesia Versus Regional Anesthesia for Cataract Surgery: A Meta-Analysis of Randomized Controlled Trials
Researchers in China conducted a meta-analysis of previously published randomized controlled trials (RCTs) of cataract surgery under topical anesthesia (TA) and regional anesthesia, including retrobulbar anesthesia (RBA) and peribulbar anesthesia (PBA). The team used the Cochrane Collaboration method to identify appropriate RCTs for use in the analysis and looked for any possible differences in the clinical outcomes. The primary outcome parameters assessed were intra- and post-operative pain scores, intraoperative difficulties and inadvertent ocular movement, the need to administer additional anesthesia during the procedure, and patient preference. The researchers found that while TA did not provide the same level of pain relief during cataract surgery as did RBA/PBA, it did achieve similar surgical outcomes, reduced injection-related complications, and eased patients' fear of injection. The researchers concluded that TA was not a appropriate option for those patients with a higher initial blood pressure or higher perception of pain.
 
From "Topical Anesthesia Versus Regional Anesthesia for Cataract Surgery: A Meta-Analysis of Randomized Controlled Trials"
Ophthalmology (04/12) Vol. 119, No. 4, P. 659 Zhao, Li-Quan; Zhu, Huang; Zhao, Pei-Quan; et al.
 
Anesthesiologists Take on Central Role In Stroke Care
Dramatic technological advances for treating strokes are driving facilities that specialize in this kind of care, like Montefiore Medical Center’s Stern Stroke Center in New York City, to change their protocols in order to support the latest therapies. For example, Montefiore—which specializes in intra-arterial stroke treatment—has fostered a teamwork approach in which neuroanesthesiologists are fully integrated into patient care, meeting regularly with vascular neurologists, neuro-interventional radiologists, and neurosurgeons. The anesthesia provider is a vital member of the stroke team, as its vascular neurologists notes: "Having a neuroanesthesiologist is mission critical. They understand the need to keep blood pressure up, help decide whether to intubate a patient or not, and provide a tremendous amount of direct management of vascular control above and beyond just keeping the patient sedated." As Montefiore and other facilities adopt mechanical thrombectomy for clot removal and other new procedures, some experts have made a case for wider availability and use of general anesthesia in response to technical advances in treating endovascular stroke.
 
From "Anesthesiologists Take on Central Role In Stroke Care"
Anesthesiology News (05/01/12) Vol. 38, No. 5 Hanawald, Jennifer
 
A Survey of Anesthesiologists' Views of Operating Room Recycling
While operating rooms are big producer of hospital waste, little is known about how doctors view waste recycling. Researchers polled anesthesiology specialists in Australia, New Zealand, and England, with the goal of determining what percentage consider recycling operating room waste to be important and identifying barriers that providers say are preventing such recycling efforts. The Web-based survey found that 93 percent of respondents would like to increase recycling of operating room waste and would commit their time to doing so. Forty-nine percent of study participants said the greatest barrier to such recycling efforts were inadequate facilities, while 17 percent said negative staff attitudes should top the list.
 
From "A Survey of Anesthesiologists' Views of Operating Room Recycling"
Anesthesia & Analgesia (05/12) McGain, Forbes; White, Stuart; Mossenson, Simone; et al.
 
Transfused Blood Often Used in Patients Who Don't Need It 
Researchers led by Johns Hopkins associate anesthesiology professor Steven Frank, MD, have concluded that blood transfusions are performed far more often than necessary during surgery. "Over the past five years, studies have supported giving less blood than we used to," he explained, "and our research shows that practitioners have not caught up." Frank and his team reviewed the electronic anesthesia records of more than 48,000 patients who had surgery at Johns Hopkins Hospital from February 2010 to August 2011, identifying 2,981 who were given blood transfusions. Certain procedures, including adult cardiac surgery and transplants, were more likely to involve transfusions that others; and there also was broad variation among surgeons and anesthesia providers—who typically decide together whether or not to go forward with a transfusion—in terms of how quickly they ordered them compared with their peers. The data was collected and evaluated using anesthesia information management systems, which are in use at between 15 percent and 50 percent of large institutions. "By evaluating transfusion practices in this fashion, appropriate feedback can be given to providers to potentially improve the utilization of blood components, with a primary goal of reducing unwarranted transfusion," the study authors wrote in the April issue of Anesthesiology.
 
From "Transfused Blood Often Used in Patients Who Don't Need It"
Medscape (04/30/12) Broder, Joanna
 
Innovative Infusion Pump Allows for Texas Children's Patients to Be Treated in an Outpatient Setting
Texas Children's Hospital West Campus has started using an innovative, electronic pump to help modulate pain for patients who have undergone orthopedic day surgeries, including any joint surgery of the shoulder, elbow, or knee. In the past, most children remained in the hospital after surgery and were given pain medications intravenously, with a pump or through an injection. The ambIT Pain Pump system lets anesthesia providers more directly target where medication is needed, and the take-home system operates on its own and has safety measures in place to ensure it cannot be tampered with. The ambIT Pain Pump system consists of a portable, compact infusion pump that delivers numbing medication to control a patient's pain. The anesthesia provider places the catheter and pump prior to surgery to control pain in the perioperative period. The pump reduces the need for oral narcotics, which can have side effects including nausea, vomiting, and constipation. "Regional anesthesia is the forefront in the evolution of perioperative pain control and I feel, with ultrasound guidance, it will soon become the new standard of care," said Dr. Chris Glover of Texas Children's Hospital. "With this device, we can have a more sustained and localized control of a patient's pain compared to intravenous medications."
 
From "Innovative Infusion Pump Allows for Texas Children's Patients to Be Treated in an Outpatient Setting"
Your Houston News (04/29/12)
 
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