Anesthesia E-ssential May 15, 2014

Anesthesia E-ssential

May 15, 2014


Vital Signs

House Approves Veterans Appropriations with Language Affirming VHA Process for Proposing to Recognize Full Practice Authority of CRNAs and Other APRNs
Veterans Health Administration (VHA) appropriations legislation was approved by the House on a 416-1 vote April 28, including advisory report language that affirms the VHA’s process for proposing to recognize full practice authority for CRNAs and other APRNs providing care for America’s veterans.
The report (H. Rept. 113-416) accompanying the bill (H.R. 4486) includes language that states, “The Committee understands that the VHA Nursing Handbook is currently under review. The Committee encourages the VHA to seek input from internal VA program offices and external professional stakeholders, prior to possible regulatory action and submission to the Under Secretary for Health for final approval. The Committee believes all possible outreach efforts should be used to communicate the proposed changes, to gather public comment, and to collaborate with Congress, stakeholders, VA nursing staff, and external organizations. Finally, the Committee requests that the VHA ensure that any changes to handbooks within the VHA do not conflict with other handbooks already in place within the VHA.”
VHA recognition of CRNAs as full-practice providers does not conflict with the VHA anesthesia handbook (VHA-1123). The AANA and the Association of Veterans Affairs Nurse Anesthetists (AVANA) worked to ensure that the report language supported the agency’s ongoing process for considering nursing handbook updates.  Senate consideration of the FY 2015 Military Construction, Veterans Affairs and Related Agencies legislation begins in subcommittee later this spring.


The Pulse

  • Be Sure to Vote in the AANA 2014 Election!
  • AANA Seeks Senior Director, Education and Professional Development
  • Be a Part of Nurse Anesthetists Delegation to South Africa
  • Additional Discounts for AANALearn
  • Kentucky Anesthesiologist Assistant Bill Fails
  • Minnesota S.B. 511 Passes House
  • FDA Posts Anesthesia-Related Drug and Device Recalls and an Update on the Saline Shortage
  • AANA Past President Janice Izlar Seated on AAAASF Board of Directors and Standards Committee
  • AAASF Welcomes New CEO, COO
  • Meet Your Educational Needs
  • Enjoy a Weekend in Chicago at the AANA’s Business of Anesthesia Conference
  • Orlando has Something for Everyone, Including AANA’s 2014 Nurse Anesthesia Annual Congress
  • Mark your Calendars for the AANA’s Fall Leadership Academy
  • Save $50 by Registering Today for the Upper and Lower Extremity Nerve Block Workshop
AANA Foundation and Research News
  • Friends for Life Dealine -- June 15, 2014
  • AANA Foundation to Host 17th Annual Golf Tournament at Hawk's Landing Golf Club in Orlando, Fla.
  • Orlando -- The Stars Come Out Again -- Pruchase Your Ticket(s) Today
  • Medicare Issues 2015 Hospital Payment Proposed Rule
  • Up-scheduling Products Containing Hydrocodone May Impair Patient Access to Care, AANA and Coalition Tell DEA
  • AANA Urges Senate to Confirm Burwell as HHS Secretary
  • Congress Hears from CRNA-PAC – Will CRNA-PAC Hear from You?
  • State Associations are Using New Advocacy Tools – How About Yours?
  • Amendments

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
Be Sure to Vote in the AANA 2014 Election!
Voting Ends May 20
Have you voted yet? The AANA 2014 election will continue until May 20, 2014, 12 noon CDT. Active AANA members received their ballot materials, including their election passcode and voting instructions, electronically or in the mail from Survey & Ballot Systems (SBS), the AANA's election coordinator. The email with the voting credentials originated from Please make sure this email did not end up in your spam or junk mail folder.
To access the AANA election site visit and enter your member number and the election passcode provided to you by SBS.
If you do not have your election login information, click on the "Email  my login information" link on the login page, enter the email address on file with AANA, and your election login information will be emailed to you. SBS can be reached by phone at (952) 974-2339 (Monday through Friday, 8 a.m. to 5 p.m. CDT) or by email at
IMPORTANT NOTE:If you requested an electronic ballot, SBS has suggested that you add the following email address to your contact list as an approved sender:
AANA Seeks Senior Director, Education and Professional Development
The AANA is seeking candidates for the position of Senior Director, Education and Professional Development. This position provides strategic leadership and guidance to the Education and Professional Development Division, reports directly to the AANA’s Executive Director, and serves as a member of the senior management team.
The Senior Director, Education and Professional Development supervises a staff of nine professionals in the Educational Programming, Professional Development and Continuing Education departments.  The Senior Director is responsible for advancing nurse anesthesia education, developing a robust continuum of professional development opportunities for members and supervising a high quality Continuing Education approval process.
The ideal candidate for this position will provide the following qualifications: A doctorate in a healthcare-related field and a Certified Registered Nurse Anesthetist designation are required; at least five years of progressive experience in the nurse anesthesia education profession, including project management, budget management and developing, evaluating and managing educational programs; experience in professional development and continuing professional education is required; and a team-focused leader with a strong management ability to develop and empower a high-performing staff that produces quality results in a timely manner.
This search is being led by Dan Nevez, Consultant, and assisted by Daniel Fissinger. To be considered for this opportunity, please send a resume and cover letter to:
Daniel Fissinger
Associate Consultant, Executive Search
(312) 506-0062 direct

One East Wacker Drive, Suite 2100
Chicago, IL 60601
Be a Part of Nurse Anesthetists Delegation to South Africa
AANA Past-President Debbie Malina, CRNA, DNSc, MBA, ARNP is leading a delegation to visit South Africa in October 2014 to discuss the evolution of nurses and anesthesia in South Africa. Professionals Abroad, a division of Academic Travel Abroad (ATA), is organizing the delegation. Read Malina's letter to all CRNAs and view the trip itinerary to find out more information on how you can be a part of this great opportunity. If you have questions regarding the delegation, contact the Program Representative at Professionals Abroad, at (877) 298-9677. 
Additional Member Discounts on AANALearn through July, 31, 2014
AANA’s online continuing education resource, AANALearn, is featuring the entire Clinical Topics catalog at an additional 30 percent discount for AANA Members now through July 31:
Click here for more information.

Kentucky Anesthesiologist Assistant Bill Fails
Kentucky Senate Bill 94, which proposed a direct path for licensure of anesthesiologist assistants, has failed. Currently, certified physician assistants who have graduated from an anesthesiologist assistant program can practice as anesthesiologist assistants in Kentucky; however, anesthesiologist assistants do not have a direct path to licensure. Kentucky’s legislature has adjourned, and S.B. 94 has died without making it to a hearing. Thanks to the aggressive lobbying of the Kentucky Association of Nurse Anesthetists, anesthesiologist assistant bills have been defeated in Kentucky in 2012, 2013, and 2014. 
Minnesota S.B. 511 Passes House
Foundation Story 2 TexThe Minnesota legislature passed a bill removing barriers to independent practice for advanced practice nurses, including CRNAs. Minnesota S.B. 511 implements various aspects of the APRN consensus model by amending the definition of CRNA practice to include, among other things, independent prescriptive authority; ordering, performing, supervising, and interpreting diagnostic studies; and ability to perform nonsurgical therapies for acute and chronic pain symptoms upon referral and in collaboration with a physician. The full language of the bill can be found at

FDA Posts Anesthesia-Related Drug and Device Recalls and an Update on the Saline Shortage
Numerous drug and device recalls that apply to anesthesia practice have recently been initiated:
The FDA is exercising its discretion in allowing Baxter Healthcare Corp. to temporarily distribute normal saline in the U.S. from its Spain manufacturing facility. Previously, the FDA allowed Fresenius Kabi USA, LLC, to temporarily distribute normal saline in the U.S. from its Norway manufacturing facility. See the FDA’s website for more information regarding the saline shortage. 
A list of drug shortages and drug and device recalls is available on the AANA website under Resources > Professional Practice > FDA.
AANA Past President Janice Izlar Seated on AAAASF Board of Directors and Standards Committee
The AANA is delighted to announce that Janice Izlar, CRNA, DNAP, has been seated as the AANA’s representative on the Board of Directors of the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) and will also serve on AAAASF’s Standards Committee. Izlar succeeds Jennifer Quicci, CRNA, MS, who represented the AANA with dedication for more than three years on the AAAASF board. 
AAAASF Welcomes New CEO, COO
The American Association for Accreditation of Ambulatory Surgery Facilities has recently announced two new members of its executive staff: James Pavletich, MHA, CAE, will serve as the new Chief Executive Officer, while Theresa Griffin-Rossi, CAE, will become the new Chief Operating Officer. Both appointments took effect May 1, 2014. Their bios can be found on AAAASF’s website.

Meet Your Educational Needs
AANA has meetings and workshops designed to meet your educational needs. Click here to find out more.
Enjoy a Weekend in Chicago at the AANA’s Business of Anesthesia Conference
As a CRNA you know that knowledge is the key to your career. More importantly, with the changes that are occurring in healthcare, your future and your career are based on understanding not only the medical aspects of the profession but understanding your economic value as well. Join your colleagues on July 12 in Chicago for the AANA Business of Anesthesia Conference. Register today.
Orlando has Something for Everyone, Including AANA’s 2014 Nurse Anesthesia Annual Congress
AANA’s largest practice-focused meeting is scheduled for Sept. 13-16 in Orlando. The program will highlight new research, emerging technology, specialty practice, practice and business management, personal wellness, and other topics important to your unique practice. Up to 28 CE credits will be available. Register today.
Mark your Calendars for the AANA’s Fall Leadership Academy
Expand and refine your leadership skills by attending the AANA’s Fall Leadership Academy. The meeting is Nov. 7-9 in Rosemont, Ill. Registration opens in July.
Save $50 by Registering Today for the Upper and Lower Extremity Nerve Block Workshop
AANA’s Upper and Lower Extremity Nerve Block Workshop, Aug. 2-4 at AANA’s headquarters in Park Ridge, Ill., is designed to expand your skills and expertise in using upper and lower extremity nerve block anesthesia. Register today for this hands-on workshop.


AANA Foundation and Research News

Friends for Life Deadline -- June 15, 2014
Friends for Life help support the future of the nurse anesthesia profession through meaningful, lasting gifts. Contributions through Friends for Life help fund and sustain programs that further research and education in anesthesia.
Friends for Life receive a medallion at the AANA Annual Congress Opening Ceremonies, an engraved plaque in the AANA Park Ridge office, and an invitation to the Annual Awards and Recognition Event.
The minimum gift commitment to join Friends for Life is $25,000. Members may fulfill this commitment through a cash gift, but there are many other ways to meet the commitment through planned gifts. Some of the most popular planned gift options for becoming a Friend for Life include:
  • A gift (bequest) in the will for a specific amount or a percentage of the total estate
  • Gift of personal property or real estate
  • Including the Foundation as a beneficiary on a retirement plan or a whole life insurance policy
For further information, please contact Nat Carmichael at (847) 655-1175 or The Friends for Life submission deadline for recognition at this year’s Annual Congress in Orlando, Fla., is June 15, 2014.
AANA Foundation to Host 17th Annual Golf Tournament at Hawk’s Landing Golf Club in Orlando, Fla.
The AANA Foundation will host its 17th Annual Golf Tournament on Friday, Sept. 12, 2014, at Hawk’s Landing Golf Club, with tee off at 1:30 p.m. Hawk’s Landing is an 18-hole championship golf course conveniently located on the lush grounds of the Orlando World Center Marriott Resort where the AANA 2014 Nurse Anesthesia Annual Congress will be held. The golf course spans over 220 acres of lush grounds—the perfect setting for challenging golf and a scenic blend of native Florida wildlife and tropical vegetation.
Click here to visit the AANA Foundation 17th Annual Golf Tournament webpage for more details including information on club rental, sponsorship, contests, and photos from past AANA Foundation golf tournaments. 
The golf registration fee is $250. To register, click here to be directed to the AANA Annual Congress Registration Page.
Please plan to participate in this fun event and experience Hawk’s Landing with CRNAs and SRNAs from across the country while benefiting the AANA Foundation and its mission to advance the science of anesthesia through education and research.
If you have any questions, please contact Luanne Irvin, AANA Foundation Development Officer, at (847) 655-1173 or
Orlando – The Stars Come Out Again
Purchase Your Ticket(s) Today
Plan to attend a fabulous and fun event on Sunday, Sept. 14, 2014. Orlando – The Stars Come Out Again will feature 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.
Register Today – Be sure to purchase your ticket(s) for the event when you register for the AANA 2014 Nurse Anesthesia Annual Congress.
Sponsorships Available – Sponsorships includes tickets and recognition; please visit the Orlando – The Stars Come Out Again webpage to learn more.
Questions? Contact Luanne Irvin at the AANA Foundation at (847) 655-1173 or

Medicare Issues 2015 Hospital Payment Proposed Rule
The Medicare agency’s April 30 proposal for 2015 hospital payments recommends continuing to tie Medicare hospital payment incentives to achieving certain quality measures. It also recommends adjustments to some of those measures.
Of interest to CRNAs are the following proposals from the Centers for Medicare & Medicaid Services (CMS):
  • CMS is removing some of the Surgical Care Improvement Project (SCIP) measures from the hospital value-based purchasing program because they have become meaningless due to very high performance levels.
  • Partly due to the removal of these SCIP process-of-care measures, CMS is proposing to decrease the weight of the clinical process of care under the hospital value-based purchasing program.
  • CMS is proposing to include as part of the hospital value-based purchasing program a measure on elective deliveries prior to 39 completed weeks gestation.
  • CMS is scheduled to transition to ICD-10-CM/PCS on Oct. 1, 2015, instead of October 2014 due to passage of the Protecting Access to Medicare Act of 2014, Pub. L. 113-93, enacted on April 1. After Oct. 1, 2015, CMS will only accept hospital quality measure data coded in ICD-10-CM/PCS.
  • CMS is proposing that CAHs affected by recent OMB redesignation from rural to urban be given two years from the date the redesignation becomes effective to reclassify as rural and thereby retain their CAH status.
The Medicare agency’s Hospital Inpatient Prospective Payment System Proposed Rule is under review by AANA and subject to comment by June 30. Read the rule in the Federal Register
Up-scheduling Products Containing Hydrocodone May Impair Patient Access to Care, AANA and Coalition Tell DEA
Up-scheduling hydrocodone-containing products (HCPs) from Schedule III to Schedule II, the same schedule where pure hydrocodone is listed, may impair patient access to needed pain care and may not be an effective strategy for reducing harmful diversion and misuse of these pharmaceuticals, stated AANA in a coalition letter signed on April 28 by over a dozen healthcare professional organizations.
“While diversion, misuse, and abuse of opioids have reached appalling levels in many parts of the United States and have left many communities reeling from the effects and searching for a legitimate solution, reclassifying all HCPs as Schedule II controlled substances will irrefutably have serious health consequences for patients across the country,” stated the letter in response to a proposal by the Drug Enforcement Administration. “Overall, reclassification would severely limit patient access to effective pain treatment for legitimate needs by putting into place new restrictions and would, in some cases, completely eliminate the ability of some types of providers to deliver these treatments to patients when and where they need care and during a critical time in the healing process.”
AANA Urges Senate to Confirm Burwell as HHS Secretary
Citing her public and private sector management and financial experience, the AANA urged the U.S. Senate to confirm the president’s nominee, Sylvia Mathews Burwell, as Secretary of the U.S. Department of Health and Human Services, succeeding Kathleen Sebelius.
“We believe that the president and the country are best served by a Secretary of HHS possessing the full powers of the office, which oversees so many healthcare delivery, health research and healthcare workforce development initiatives critical to the American people and the American economy,” states the letter signed by AANA President Dennis Bless, CRNA, MS. “For this position, the president has nominated Ms. Burwell, an individual with superlative private and public sector credentials, and a proven manager that has demonstrated her ability to lead, forge strong relationships, and deliver excellent results in both the public and private sectors.”
AANA was present at the Senate Health, Education, Labor and Pensions Committee for its one confirmation hearing for Burwell May 8.
Congress Hears from CRNA-PAC – Will CRNA-PAC Hear from You?
Congress hears from the CRNA-PAC almost every day, as CRNAs around the country and members of the AANA’s team in Washington attend political events supporting CRNA-friendly legislators as well as the campaigns of federal lawmakers influential to CRNA reimbursement and practice. Governed by CRNAs and focused solely on the interests of the nurse anesthesia profession and its patients, the CRNA-PAC supports involvement in the campaigns of Republican and Democratic legislators and candidates alike.
While the ASA was in Washington, D.C., last week communicating with members of Congress, will the CRNA-PAC hear from you this week? To learn more about how CRNA-PAC supports the practice and profession of nurse anesthesia, or to make a contribution, click (requires AANA member login and password).
State Associations are Using New Advocacy Tools – How About Yours?
Some 20 state associations of nurse anesthetists have transitioned to real-time online access to Legislator District Matching Service (LDMS) data for their states, and four have signed up for the AANA’s online grassroots action tool for connecting CRNAs and student registered nurse anesthetists with their state legislators. More are coming aboard, and that’s good news for AANA members interested in strengthening their professional voice in their state capitals.
For state associations of nurse anesthetists seeking to urge their members to contact their state legislators, these new tools being made available by the AANA make that process much easier.
Congressman Surrenders to FBI
Rep. Michael Grimm (R-NY) surrendered to the FBI April 28, which charged him with federal mail fraud and tax fraud. The second-term lawmaker, a Marine, and former FBI agent, pled not guilty and was released on $400,000 bail, according to news reports. The lawmaker is known to CRNAs as the co-author of the 2014 “Grimm-Kirkpatrick letter” that raised concerns about the Veterans Health Administration recognizing CRNAs and other APRNs to their full practice authority. Read more about his case at
Joyce Wins Primary
AANA’s 2014 National Health Leadership Award winner, Rep. David Joyce (R-OH), won his primary election May 6 in Ohio’s 14th Congressional District, thanks in part to the support of CRNA-PAC and AANA members involved in his campaign. This year is an election year, and your participation in a House or Senate campaign on behalf of CRNAs can make the difference—and can be a lot of fun! For more information, contact your state’s FPD, or email the AANA Washington office at
Inspector General Says Medicare Could Save Billions
The HHS Office of Inspector General says Medicare could save billions of dollars if it paid for outpatient hospital services at the lower rate provided to ambulatory surgery centers. Only facility fees were examined in the report, not Part B CRNA and physician services fees. The report, released earlier in April, is available at
Make Sure You Are Up to Date on CRNA Reimbursement Issues
Make sure you are up to date on CRNA reimbursement issues by obtaining version 2.1 of the AANA’s “Issues Briefs on Reimbursement and Nurse Anesthesia,” available only for AANA members at (requires AANA member login and password).
Local Paper Honors Griffin
Andrew Griffin, CRNA, PhD, the winner of the AANA’s Daniel D. Vigness Federal Political Award for 2014, was honored in his local community newspaper, and you can read the article at
See your 2013 CRNA-PAC Annual Report … just click here.

Assistant Director/Clinical Director Nurse Anesthesia - Newman University
Wichita, KS
Newman University Nursing is searching for a full-time faculty position as Assistant Director/Clinical Director of the Masters in Nurse Anesthesia Program.

CRNAs - Infinity HealthCare
Milwaukee, WI
Infinity HealthCare is actively recruiting CRNAs to join our growing physician- and employee-owned group practice in the Milwaukee area.
Visit the CRNA Career Center

Acupuncture Plus Electricity Helps in Endoscopy
Researchers in Hong Kong have found that using electroacupuncture analgesia alleviates pain and anxiety in patients undergoing endoscopic ultrasound—a prolonged procedure that normally requires sedation. A total of 32 patients were given electroacupuncture analgesia, while another 32 patients were administered phony electroacupuncture. Those who actually received the electroacupuncture needed 0.22 mg/kg of propofol on average, but the sham group required 0.71 mg/kg. In addition, only two electroacupuncture patients resorted to patient-controlled analgesia; but 10 of the patients receiving the sham procedure did so. Pain scores were lower in the electroacupuncture group (2.1) compared to the sham cohort (6.2). "Our findings were exceptional," summarized lead researcher Anthony Teoh, MD, of the Chinese University/Prince of Wales Hospital. "Those who were given electroacupuncture used less sedation; they were happier with the procedure; they said they were more likely to return for another examination. With electroacupuncture, the patients don't need as much drug, and in some cases they don't need any drugs. They require less recovery time as well."
From "Acupuncture Plus Electricity Helps in Endoscopy"
MedPage Today (05/09/14) Susman, Ed
Recycling a Patient's Lost Blood During Surgery Better Than Using Banked Blood
Researchers at Johns Hopkins have determined that it is better to use fresh red blood cells during heart surgery than to transfuse a patient with blood bank supplies. The study involved 32 patients—12 who received only their own recycled red blood cells, 10 who received their own blood plus five or more units of stored blood, and 10 who received their own blood and five or fewer units of banked blood. The investigators observed increasing red cell damage the more units of banked blood a patient received. To the contrary, collecting blood lost during the operation, recycling it, and giving it back to patients produced cells better equipped to deliver oxygen where needed. The results add to an existing body of research suggesting that recycling fresh blood cuts down on hospital-acquired infections, adverse transfusion-related reactions, hospital stays, and risk of death. "If banked blood, which is stored for up to six weeks, is now shown to be of a lower quality, it makes more sense to use recycled blood that has only been outside the body for one or two hours," remarked study leader Steven Frank, MD, Johns Hopkins associate anesthesiology professor. "It's always been the case that patients feel better about getting their own blood, and recycling is also more cost-effective." The findings are published in the June issue of Anesthesia & Analgesia.
From "Recycling a Patient's Lost Blood During Surgery Better Than Using Banked Blood"
RedOrbit (05/09/14)
POISE-2 Disappoints on Prevention of Post-Op Heart Attacks
Researchers behind the POISE (PeriOperative ISchemic Evaluation) trial that was reported recently in the New England Journal of Medicine conclude that perioperative administration of either aspirin or clonidine does not lower the risk of myocardial infarction (MI) for patients undergoing noncardiac surgery. The POISE-1 study showed that while perioperative administration of beta-blockers successfully prevented heart attacks, it also caused more strokes, resulting in higher total mortality. POISE-2 followed up with the question of whether administering low-dose clonidine or aspirin would successfully prevent heart attacks without increasing strokes. Within 30 days of surgery, there was no statistically significant difference in the number of patients given clonidine or placebo who died or had a heart attack; and similar results were recorded for the secondary outcome of stroke. The findings among patients given aspirin mirrored the results seen in the clonidine cohort. Daniel Sessler, MD, who helped conduct the trial, said he does not believe that prevention of postoperative MIs is an unattainable goal for clinicians. He said researchers will tackle the matter again with the POISE-3 trial, which is still in the design phase.
From "POISE-2 Disappoints on Prevention of Post-Op Heart Attacks"
Anesthesiology News (05/01/14) Vol. 40, No. 5 Marcus, Adam
Acupuncture Helping Reduce Use of Pain Killers in Army
The Army's assistant surgeon general, Brigadier Gen. Norvell Coots, told Congress last month that acupuncture and other kinds of alternative medicine are helping to curtail the use of opioids for treating soldiers' pain. Testifying at a Senate committee, he said the Army has been incorporating yoga, meditation, biofeedback, massage, and other practices since the Army-led Pain Management Task Force released recommendations in 2010. Partially thanks to the addition of those disciplines, Coots reported that the share of all service members prescribed at least one type of opioid dropped to 24 percent in 2013 from 26 percent two years earlier. "It is a small difference, but I think it still represents a big cultural change and a move ahead," he stated, noting that military patients are no exception to what the Centers for Disease Control have labeled an "epidemic" of prescription drug abuse. In addition to alternative medicine, the Army is combating the problem by adding clinical pharmacists that identify patients who are at risk because they take multiple medications. As result, Coots said, overall costs drop, fewer adverse drug-related events occur, hospital admissions go down, and patient outcomes improve.
From "Acupuncture Helping Reduce Use of Pain Killers in Army"
Fort Campbell Courier (KY) (05/08/14) Sheftick, Gary
New Tool May Better Predict Surgery Risks for Seniors
The population is graying, leading to more surgeries and driving interest in new ways to gauge the risks for older patients who undergo operations. Researchers in South Korea have developed a screening tool for this purpose that they believe may be more effective than the American Society of Anesthesiologists (ASA) test that currently is the standard. The multidimensional frailty score (MFS) model predicted negative outcomes following surgery by considering the results of the comprehensive geriatric assessment—a preoperative survey designed to flag frail patients who may not tolerate the trauma of surgery as well as healthier older people—along with the Charlson Comorbidity index, which classifies other medical issues that could elevate the risk for death. In addition, the MFS factored in other patient traits and laboratory variables, dementia, risk of delirium, malnutrition, short mid-arm circumference, dependence in activities of daily living, and dependence in instrumental activities of daily living. The model better predicted problems, such as longer hospital stay or need for discharge to a nursing home, than the ASA tool, the study determined. According to the researchers, who published their findings in JAMA Surgery, "This model may support surgical treatments for fit older patients at low risk of complications, and it may also provide an impetus for better management of geriatric patients with a high risk of adverse outcomes after surgery."
From "New Tool May Better Predict Surgery Risks for Seniors"
DailyRx (05/07/14) Maleki, Nancy
Postop Opioid Use Tied to NSCLC Recurrence
A retrospective study of patients treated for early-stage non-small cell lung cancer (NSCLC) found that those who experienced disease recurrence five years after surgery had received a significantly higher dose of opioids postoperatively. Dermot Maher, MD, and colleagues from Cedars-Sinai Medical Center in Los Angeles noted that patients whose cancer recurred had received a mean dose of 232 mg of opioids in the 96 hours following their surgeries. By comparison, patients who did not experience NSCLC recurrence within five years had received a mean dose of 124 mg of opioids during that same postoperative time period. Maher explained that painkillers often inhibit the action of naturally occurring killer cells that find and destroy any cancer cells that might have escaped the surgery, adding that this inhibition period typically lasts for four days. Because the researchers were aware of this and the fact "that opioid-sparing anesthetic techniques can reduce the recurrence rate of certain cancer," they studied opioid use in NSCLC patients during the 96-hour period following surgery. All of the confounding variables were the same for patients in the study, save treatment of breakthrough pain, providing a clean analysis. The researchers noted that while the study suggested a link between recurrence and opioid administration postoperatively, "future prospective randomized controlled trials are needed to [properly] establish [a] causatory link." The findings have been accepted for publication in the British Journal of Anaesthesia.
From "Postop Opioid Use Tied to NSCLC Recurrence"
MedPage Today (05/04/14) Susman, Ed
Patients' Eye Color a Clue to Pain Tolerance
According to a pilot study conducted by researchers at the University of Pittsburgh School of Medicine, Caucasian women with blue or green eyes demonstrate higher tolerance for pain than Caucasian women with brown or hazel eyes. Inna Belfer, MD, presented the results at the annual scientific meeting of the American Pain Society, although the lead author was Cindy Teng, BA, a medical student at the university. The study attempted to keep the population as homogeneous as possible, so 58 pregnant Caucasian women were recruited from the University of Pittsburgh Magee Women's Hospital. Investigators discovered that those with darker eyes reported higher reductions in pain after being administered epidural analgesia, prompting Teng to suggest that they felt the relief more strongly because they had a higher sensitivity to pain. However, the pain reduction figures were not statistically significant, she said. Belfer commented that hair color difference previously has been linked to anesthesia resistance and that eye color has been linked with behavior and possibly with neural transmission. She noted that while the research is too early to suggest why eye color and pain tolerance may be linked, she suspects that there may be genetic component. Belfer added that further research into "pain phenotypes and more readily identifiable features like eye color could enhance clinical care and treatment effectiveness."
From "Patients' Eye Color a Clue to Pain Tolerance"
MedPage Today (05/02/14) Susman, Ed
'Facing' Pain: Proactive Approach Gets Pain Reduction Results

An initiative at California's Cedars-Sinai Medical Center shows that better pain management can be achieved by taking a proactive rather than responsive approach. The new protocol entailed encouraging collaboration between patients and providers, letting patients define their own treatment goals and expectations, embracing nonpharmacologic treatments, and balancing pain management with physical functioning. In one change, Cedars-Sinai added behavior-specific statements to a widely used visual analog pain scale. "The new scale reminds patients and staff that pain is not a solitary thing, that it is tied to functioning," explained Kapil Anand, MD, who helped lead the project. "The more a patient is medicated, the less mobility they tend to have, which can mean more falls and longer hospital stays, for example." The medical center also adopted bedside "patient care boards" that Anand said offers "a sense of where [the patient's] pain is at, and that helps [providers] set reasonable expectations for pain management together with the patient." Another new component is a menu of other options, such as spiritual services and music therapy, that are available. "The comfort guide lets patients know that we believe managing their pain is about more than just drug treatment," Anand noted. To gauge patient satisfaction, about 1,000 patients treated before and 1,000 treated after the program was adopted in May 2012 were surveyed. The results indicated that the share of patients who felt "hospital staff always did everything they could to help with my pain" increased from 77 percent before the intervention to 82 percent one year after it was put in place. Additionally, the number of patients reporting that their "pain was always controlled" rose to 66 percent from 62 percent.
From "'Facing' Pain: Proactive Approach Gets Pain Reduction Results"
Pain Medicine News (05/01/2014) Vol. 12, No. 5 Wild, David
Hypothermia During Surgery Affects Even Warmed Patients
Research out of the Cleveland Clinic in Ohio found that despite the use of forced-air warming, patients undergoing non-cardiac surgery commonly experience hypothermia. Additionally, the study found that patients who experienced core temperatures below 35°C had more transfusion needs and longer hospital stays. The investigators used data on 58,814 patients who underwent non-cardiac inpatient surgery at the institution between April 1, 2005, and Feb. 15, 2013, who met three criteria: their anesthesia lasted at least one hour, their core temperature was measured in the esophagus, and forced-air warming was used. Instead of assessing the final intraoperative temperatures to determine hypothermia occurrence, a time-weighted measurement of core temperature was used. The study found that about a third of patients had a core temperature of 36°C or lower for at least one hour; 8 percent were below that threshold for more than three hours; and 5 percent had temperatures at or below 35°C for at least one hour. Lead study author Daniel Sessler, MD, said that "almost 10 percent of patients were distinctly hypothermic and remained near 35°C at the end of surgery. This is a degree of hypothermia that has been shown to cause major complications." He recommended combating the problem by actively warming patients prior to surgery or by increasing the efficacy of intraoperative warming systems.
From "Hypothermia During Surgery Affects Even Warmed Patients"
Anesthesiology News (05/01/14) Vol. 40, No. 5 Vlessides, Michael
Surgeries at Ambulatory Centers Are Quicker and Cheaper Than at Hospitals
Demand for outpatient surgery has spiked over the past 30 years—largely due to advances in anesthesia and laparoscopy—and research now suggests that performing operations at ambulatory centers is actually more efficient and less expensive than doing them in a hospital setting. University of Louisville health economist Elizabeth Munnich and her University of Minnesota counterpart, Stephen Parente, analyzed federal data for 52,000 surgical visits at more than 400 facilities over a four-year period. Their findings, published in the May issue of Health Affairs, indicated that patients at ambulatory centers spent 25 percent less time undergoing outpatient surgery than hospital patients did. Additionally, Munnich and Parente calculated that patient costs were as much as $1,000 lower than at hospitals, with a comparable level of care. They projected that the number of outpatient surgeries in hospitals alone will continue to expand by 8 percent to 16 percent annually through 2021.
From "Surgeries at Ambulatory Centers Are Quicker and Cheaper Than at Hospitals"
Louisville Business First (05/06/14) Mann, David A.
Intraoperative Wound Anesthetic Cut Chronic Pain After Hip Replacement
New U.K. research indicates that local anesthetic infiltration during total hip replacement surgery can alleviate chronic pain at 12 months following the procedures. Vikki Wylde, PhD, reports that use of in-patient analgesia and length of hospitalization did not differ between those randomly assigned to standard care alone—meaning spinal anesthesia, with or without general anesthesia—and those who had local anesthetic added to the standard care. However, the double-blind study did find that neuropathic pain was significantly reduced at 12 months for those who received the local anesthetic infiltration. At the end of the postoperative year, 8.6 percent of the patients who received standard care reported severe pain compared to just 1.4 percent of those who had local anesthetic injected directly into the wound before closure. According to Wylde, the study "suggests that local anesthetic infiltration is unlikely to change long-term pain outcomes for the majority of patients, but potentially can improve pain relief for a small number of patients who may otherwise go on to develop severe long-term pain after surgery."
From "Intraoperative Wound Anesthetic Cut Chronic Pain After Hip Replacement"
Family Practice News (04/28/2014) Wendling, Patrice
Engineering Seniors Attempt to Normalize Infant Blood Pressure Values
Two students from the Penn School of Engineering and Applied Science at the University of Pennsylvania have designed a program that creates graphs measuring the blood pressure of an infant under anesthesia for a lobectomy or pyloric senosis. The students established a baseline graph of blood pressure levels against factors such as age, height, weight, and medications taken that affect blood pressure and wrote a code allowing doctors to use real-time information to create a graph measuring the infant's blood pressure. For their program, seniors Deepthi Shashidhar and Mingzhe Lin used data on patients aged 30 to 364 days from the Children's Hospital of Philadelphia's Anesthesia Information Management System. "I'm surprised that something like this doesn't already exist," Shashidhar said. "It's a critical thing to know what a child's blood pressure is during surgery and what's critical or not."
From "Engineering Seniors Attempt to Normalize Infant Blood Pressure Values"
Daily Pennsylvanian (04/08/14) Getsos, Alex
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