Anesthesia E-ssential, May 30, 2013

Anesthesia E-ssential

May 30, 2013


Vital Signs

AANA Election Results Announced
The AANA is pleased to announce the results of the election for open positions on the FY2014 Board of Directors, Nominating Committee, and Resolutions Committee.
Open Positions on the FY 2014 Board of Directors
  • President-elect: Sharon P. Pearce, CRNA, MSN – North Carolina
  • Vice President: John F. Hanlon, Jr., CRNA, DNP – New Hampshire
  • Treasurer: Cheryl L. Nimmo, CRNA, MSHSA – Rhode Island
  • Director – Region 1: Dean T. Mazurek, CRNA, APN – New Jersey
  • Director – Region 4: Mark G. Odden, CRNA, BSN, MBA, ARNP – Iowa
  • Director – Region 5: Kathryn L. Jansky, CRNA, ARNP, MHS, USA, LTC(ret) – Washington
FY 2014 Nominating Committee
  • Region 1: Linda J. Kovitch, CRNA, MSN, RRT– Massachusetts
  • Region 2: Karin E. Lundgren, CRNA, MSN, NC, USN, CAPT(ret) – Virginia
  • Region 3: Lori R. Anderson, CRNA, MSN – Illinois
  • Region 4: Carole V. Doyscher, CRNA, MS, BSN – Minnesota
  • Region 5: James R. Stimpson, CRNA, DNP – Utah
  • Region 6: Joseph E. Lesser, CRNA, MSNA, ARNP – Ohio
  • Region 7: Steven R. Leach, CRNA, DNP – Texas
FY 2014 Resolutions Committee
  • Caroline S. Raskiewicz, CRNA, DNP, BSBA – Pennsylvania
  • Cheryl L. Schosky, CRNA, MSN – South Carolina
  • Adrienne G. Hartgerink, CRNA, DNP– Virginia
  • Debra A. Barber, CRNA, DNP – Kentucky
  • Garry J. Brydges, CRNA, DNP, MSN, ACNP-BC – Texas


The Pulse

  • Update From President Janice Izlar, CRNA, DNAP, on the Latest Meeting in the Ongoing Dialog Between AANA and NBCRNA Leadership
  • Important CE Change!
  • AANA to Again Award CE Credit for Life Support Courses
  • Annual Meeting Preconvention Workshops: Don't Miss this Opportunity!
  • Upper and Lower Extremity Block Workshop Coming this Fall
  • AANA Health & Wellness: AIR Saves Lives
  • Support Important Research: Make Your Donation to the AANA Foundation Today!
  • Attend the "State of the Science" at the 2013 Annual Meeting and Earn 2 CE Credits
  • AIUM Releases Guideline for the Use of Ultrasound to Guide Vascular Access Procedures

Call for Entries: Public Relations Recognition Awards


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
Update From President Janice Izlar, CRNA, DNAP, on the Latest Meeting in the Ongoing Dialog Between AANA and NBCRNA Leadership
May 18, 2013
As always, the discussion was robust and forthright. The meeting participants from both organizations are passionate representatives of our profession who are determined to achieve and sustain a strong working relationship on behalf of the nurse anesthesia profession.
The need for enhanced communication and avoidance of unmerited perceptions continues to be the focus of our discussions. While this may seem like a simple matter, in reality it is far from that given the importance of good communication as the starting point for building an effective relationship. Our recent meeting also addressed stumbling blocks to progress in the nuts and bolts of our business relationship and areas of mutual concern like the continued competency plan.
As your president, I thank you for your ongoing interest in the status of the relationship between the AANA and National Board of Certification and Recertification of Nurse Anesthetists (NBCRNA). During this year your AANA Board has done everything possible to extend the olive branch, heal old wounds, keep an open mind, promote transparency, and move our relationship with NBCRNA forward to allow both organizations to achieve common ground and establish common goals. The NBCRNA Board has aligned with the AANA Board by promoting their desire to establish a mutually beneficial relationship and breaking barriers from the past. We appreciate your patience as the leaders of both organizations strive to rebuild our relationship to benefit our profession and the patients we serve.
I will keep you informed.
Janice J. Izlar, CRNA, DNAP
Important CE Change!
The AANA will again award continuing education (CE) credit for life support courses taken on or after May 1, 2013. See the story below and review the American Nurses Credentialing Center (ANCC) memo for details.
AANA to Again Award CE Credit for Life Support Courses
Effective with programs taken on or after May 1, 2013, the AANA is pleased to announce that it will again award CE Credit for Life Support provider and/or renewal courses. Examples of acceptable content include ACLS, PALS, NRP, and other similar offerings. This change is in response to a revision by the American Nurses Credentialing Centers (ANCC). On May 1, 2013, the ANCC reversed their 2009 decision to restrict life support content for RN continuing education.This reversal means that once again, the AANA can prior approve and nonprior approve acceptable life support content. These credits as approved by the AANA will be acceptable toward recertification through the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). Requirements and conditions do apply in order for content to be eligible for credit. Updated application materials will be posted soon. In the interim, you may use the existing materials on the AANA CE webpage. If you have any questions or concerns, please contact us via
Annual Meeting Preconvention Workshops: Don't Miss this Opportunity!
New this year, TWO preconvention workshops are being offered in Las Vegas on Friday, Aug. 9, 2013, prior to the Annual Meeting.
  • Airway on Demand is an exciting and engaging opportunity presented by William Rosenblatt, MD, professor of Anesthesiology and Surgery at the Yale School of Medicine. Rosenblatt will cover such topics as aids to direct laryngoscopy, preparation for awake intubation, indirect vision-aided intubation, and extubation of the difficult airway. This course includes four hours of lecture followed by a two-hour hands-on session.
  • Introductory Fundamentals of Ultrasound Guidance for Anesthesia Providers Workshop will be presented by Jonathan Kline, CRNA, MSNA, director of Education for Twin Oaks Anesthesia. Practical information and pearls of wisdom for practice will be included. Topics include the foundations of ultrasound use, producing readable images, understanding and using the Doppler mode and intervention utilizing ultrasound imaging. Four hours of lecture will be followed by a two-hour hands-on session.
Space is limited, so register today!
Upper and Lower Extremity Block Workshop Coming this Fall
Mark your calendars and plan to attend the Upper and Lower Extremity Block Workshop Sept. 28-29, 2013, at the AANA Foundation Learning Center, Park Ridge, Ill.
This popular workshop will include discussion on anatomy, pharmacology, and techniques. Between the lectures attendees put what they have learned into practice in the “hands-on” sessions.
This popular program fills up quickly so register today!
AANA Health & Wellness: AIR Saves Lives
In 1983, members of AANA Peer Assistance formed Anesthetists in Recovery (AIR), a self-help support group for CRNAs and student nurse anesthetists in recovery or seeking recovery from substance abuse, addiction, and alcoholism. For more about the lifesaving work of this online community, see the Peer Assistance News article in the May 2013 AANA NewsBulletin. Each year during Annual Meeting an “open” AIR session is held–this year it will be Monday, Aug. 12, 2013 at 5 p.m.–all meeting attendees are invited to learn more or find needed support.

Support Important Research: Make Your Donation to the AANA Foundation Today!
The AANA Foundation continues to support important research with the help of individuals, state associations, and corporations. Evidence provides proof, and proof is power! Take a moment today to make your tax-deductible gift to AANA Foundation’s Proof is Power campaign through the Foundation’s secure donation page.
Donations of $100 or more made by June 15, 2013, will be included in the AANA Foundation Fiscal Year 2013 Annual Report and Recognition booklet. Thank you in advance for your contribution and support of nurse anesthesia through the AANA Foundation!
Attend the “State of the Science” at the 2013 Annual Meeting and Earn 2 CE Credits
Monday, Aug. 12, 3 p.m. to 5 p.m.
At the AANA Foundation’s “State of the Science” Oral Poster Session, 14 competitively-selected investigators will offer 15- to 20-minute presentations on their research. Topics include: 
  • Effects of QuikClot Combat Gauze on Hemorrhage Control
  • Implementation of a High-Fidelity Simulation in Protocol Using Malignant Hyperthermia
  • Nurse Anesthetists Intentions and Barriers to Pursuing Doctoral Faculty Membership
This continuing educational activity is supported by an independent educational grant from Merck. Visit to view the full list of presenters.


Professional Practice

AIUM Releases Guideline for the Use of Ultrasound to Guide Vascular Access Procedures
The American Institute of Ultrasound in Medicine (AIUM), in collaboration with AANA and other organizations whose members use ultrasound for guidance in vascular access procedures, has published the Practice Guideline for the Use of Ultrasound to Guide Vascular Access Procedures. The intent of this document is to highlight appropriate evidence while also providing practical, real-world expert consensus from clinicians with diverse backgrounds on the best use and techniques for incorporating ultrasound into vascular access procedures with the ultimate goal of improving the care of our patients.


PR, Publications, and eCommunications 

Call for Entries: AANA Public Relations Recognition Awards

Deadliine: July 15, 2013

The AANA Public Relations Committee is seeking entries for the 2013 Public Relations Recognition Awards. Visit the AANA website for more information about the awards criteria and guidelines and an electronic entry form.​

Terminal cancer patients whose pain is no longer treatable with oral or injected medications often are referred for intrathecal analgesia, which involves placing a catheter near the spinal cord to deliver strong opioids via drug pump. The process typically involves conducting a trial period of epidural anesthesia in the hospital first in order to set the initial dose of intrathecal pain relievers, but researchers set out in search of a shortcut that would allow them to skip this step and let cancer patients spend more of their final days at home instead of in the hospital. With a study base of 46 subjects, they used patients' age, type of pain, type of cancer, pain severity score, and last oral or injected drug dosage to develop equations for predicting initial intrathecal opioid dose without conducting an epidural trial. "This reduces time in the hospital for those with an already limited life expectancy and minimizes medical cost and potential complications," the researchers from Memorial Sloan Kettering Cancer Center wrote in the June issue of Anesthesia & Analgesia.
From "New Equations Could Shorten Hospitalization for Patients With Uncontrolled Pain, Say Researchers"
News-Medical (05/28/13)
New research out of the University of Michigan offers the strongest evidence to date that despite having distinct molecular targets, anesthetics inhibit frontal-parietal connectivity. The study results suggest that this disruption in communication could be a common mechanism by which loss of consciousness via anesthetics is achieved. Although researchers already were aware that sevoflurane and propofol impact this particular route of brain communication, it was unclear whether another anesthetic—ketamine, which affects different molecular targets than the other two—would function similarly. Investigators analyzed electroencephalogram (EEG) recordings from patients who received the three different anesthetics. They discovered that while the raw EEGs looked very different, all three drugs caused a very similar inhibition of the communication between the front and rear of the brain. The findings indicate that analysis of frontal-parietal connectivity could provide a universal metric for gauging depth of anesthesia, leading to the development of anesthesia monitors that would be able to provide accurate results for a variety of drugs. With the research showing the frontal-parietal communication needs to be inhibited for there to be a loss of consciousness, the implication is that having the connection intact is a prerequisite for consciousness—which supports the theory that consciousness is dependent on the transmission of information between cortical regions of the brain.
From "A Common Path to Unconsciousness"
The Scientist (05/22/13) Cossins, Dan
A study conducted at The Johns Hopkins Hospital (JHH) laid the foundation for researchers to update decades-old guidelines on the amount of blood ordered for surgical patients. According to a report in Anesthesiology, surgery has evolved and reduced blood loss over the years, but the guidelines have not been revised to reflect these improvements. As a result, both blood and money are being wasted as clinicians continue to prepare blood for procedures that rarely need transfusions. The JHH researchers scrutinized computerized anesthesia records—including blood use—for 53,000 surgeries performed on site from January 2010 through March 2012. After calculating how often blood transfusions were required and how much blood was transfused, they developed an algorithm to identify whether specific surgeries would possibly need blood, would very likely need blood, or probably would not need blood at all. The results indicated that liver transplants are most likely to require transfusions; while appendectomy, tonsillectomy, thyroidectomy, and gallbladder removal are among the procedures least likely to need them. Following the algorithm could save JHH more than $200,000 annually, the researchers estimate, because time and costs associated with ordering and preparing blood are no longer wasted on surgeries that do not need them. Additionally, patient safety is enhanced because fewer patients are getting blood that was previously set aside for a surgery but went unused and ultimately was returned to the supply. New research has indicated that blood stored more than three weeks begins to lose its ability to deliver oxygen-rich cells where needed most. While the new guidelines are specific to JHH, the researchers say they can be adapted by other hospitals. Those with computerized anesthesia records—about half of all U.S. hospitals—also can apply the new algorithm to develop their own specific guidelines.
From "Researchers Rewrite Obsolete Blood-Ordering Rules"
Medicalxpress (05/22/2013)
A study by researchers from the Clinic for Anesthesiology and Intensive Medicine and the Institute for Physiology at Germany's University of Duisburg-Essen is the first to examine regulation of hypoxia-inducible-factor-1 (HIF-1) in sepsis patients. Their results, published in the June issue of Anesthesiology, are the foundation for creating new therapeutic alternatives that will be able to target specific genetic areas that affect the incidence and severity of sepsis. Lead study author Simon Schafer, MD, said that for patients with sepsis, the "outcome seems to rest heavily on the body's response to the infection, which can range from uncontrolled immune system-driven inflammation to nearly shutting down of the immune system. This work suggests that HIF-1 is critical to that immune regulation." HIF-1 is a protein that binds to certain DNA sequences, allowing immune cells to function when oxygen is decreased or when bacterial infections occur. By enabling this process, cells are protected against an accumulation of acid in the blood and other conditions associated with a lack of oxygen. The team found that of 99 patients with sepsis, HIF-1 was decreased by 67 percent in white blood cells as early as 24 hours after the diagnosis, which was associated with increased severity of illness. It was found that in the short-term, administrating lipopolysaccharides to immune cells caused HIF-1 expression to increase; but when administered long term, both HIF-1 expression and HIF-1 protein were suppressed. Although the immune state of the septic patients met the clinical criteria for severe sepsis or septic shock, the results suggest their immune state had already shifted to an immunosuppressive pattern due to a decrease in HIF-1 expression.
From "Study Reveals Important Genetic Factors That Could Influence Survival in Sepsis Patients"
Newswise (05/22/13)
New research suggests that, in terms of preventing chronic or neuropathic pain following an anteroaxillary thoracotomy, epidural analgesic does not perform any better than systemic postoperative analgesia. To prove the theory, investigators analyzed results from 60 patients who underwent the procedure. All received a non-opioid intravenously following surgery, with 28 receiving a standardized oral analgesic protocol with controlled-release oxycodone and 32 receiving epidural analgesia with ropivicaine and sufentanil. Based on patients' responses to the painDETECT questionnaire one week after surgery and again six months later, the researchers determined that there was no statistical difference between the two groups—neither of which had neuropathic pain six months postoperatively.
From "Epidural Analgesia Is Not Superior to Systemic Postoperative Analgesia With Regard to Preventing Chronic or Neuropathic Pain After Thoracotomy"
7thSpace (05/13/13) Kampe, Sandra; Lohmer, Joachim; Weinreich, Gerhard; et al.
With anti-death penalty advocates lobbying drug makers to stop allowing their products to be used in executions, states are resorting to new laws that shield the identity of those manufacturers from the public. Advocacy campaigns already have left states with a shortage of lethal injection drugs such as sodium thiopental and pentobarbital. In response, Georgia implemented a new law this spring that classifies as a "confidential state secret" any information about "a person or entity that manufactures, supplies, compounds, or prescribes the drugs, medical suppliers or medical equipment" needed to carry out capital punishment sentences. Meanwhile, Arkansas, South Dakota, and Tennessee have amended their respective public records laws so that the identities of suppliers are shielded from disclosure.
From "4 States Pass Laws Hiding Names of Suppliers of Death Penalty Drugs"
AllGov (05/24/2013) Brinkerhoff, Noel
U.S. researchers have concluded that common pain relievers elevate blood pressure levels in men. The correlation was detected for non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen as well as for acetaminophen, which does not fall under the NSAID label. The team from Harvard Medical School and Brigham and Women's Hospital studied more than 16,000 male health professionals who did not suffer from hypertension at the start of the research. Over the course of the next four years, nearly 2,000 of the study participants had developed high blood pressure. Men who took acetaminophen for six or seven days per week were 34 percent more likely to develop the condition than those who did not use analgesics. The risk was 38 percent higher for men taking NSAIDs and 26 percent higher for aspirin. Taking at least 15 pills a week also was tied to a greater vulnerability to hypertension, compared to taking no pills at all. The researchers speculate that the analgesics block substances that normally would relax the blood vessels and, thus, lower blood pressure.
From "Researchers Uncover a Link Between Analgesics and High Blood Pressure"
News Fix (05/24/2013) Clarkson, April
According to a study published in the Spanish health scientific journal Gaceta Sanitaria, researchers say doctors are more inclined to prescribe pain-relieving medication to women than to men. They note that age, pain, and social class do not seem to influence the gender bias. Lead author Elisa Chilet-Rossell and her colleagues combined data from both the 2006 Spanish National Health Survey and the United Nations' Gender-related Development Index, then performed a statistical analysis to compare analgesic prescriptions among the social and economic inequalities between genders. The findings revealed a gender gap of 29 percent, and Chilet-Rossell said that "women suffer from pain more frequently than men, therefore it is logical that they are prescribed more analgesics." She also noted, however, that the gender gap results in "women [receiving] treatment for symptomatic pain more frequently than men, treatment which can be unspecific and blind to the causes of the pain," ultimately having a negative impact on women's health.
From "Women Are More Likely Than Men to Receive Pain Reliever Prescription"
Medical Daily (05/21/13) Caba, Justin
The KODIAC-04 and KODIAC-05 scientific trials found that naloxegol, an opioid receptor antagonist taken orally, relieved opioid-induced constipation. The studies, conducted at the University of Michigan, encompassed nearly 1,400 patients who had not been chronically constipated before starting opioid treatment for non-cancer pain. In KODIAC-04, 44.4 percent of patients receiving 25 mg daily of naloxegol and 40.8 percent of patients receiving 12.5 mg responded to the drug compared to just 29.3 percent of patients who took a placebo. The response rate in KODIAC-05 was similar for the 25 mg group, at 39.7 percent of patients versus 29.3 percent of the placebo group; however, the difference in response rates with the lower dose was negligible between the two sets of patients. The researchers report that serious complications were rare, and the naloxegol regimen did not appear to interfere with central opioid analgesia or trigger withdrawal.
From "Drug Eases Constipation From Opioids"
MedPage Today (05/23/13) Walsh, Nancy
A study by Boston researchers says the connection between asthma and early childhood use of acetaminophen or ibuprofen may be caused by respiratory infections that require the use of analgesics, and not the drugs themselves. The researchers used information from 1,139 mother-child pairs who were a part of Project Viva. The mothers completed questionnaires at several stages of pregnancy to determine acetaminophen and ibuprofen use. Acetaminophen users were divided into three categories, while ibuprofen users were grouped into two categories. According to the data, there was greater exposure to acetaminophen both prenatally and during the first 12 months of life compared to ibuprofen. The researchers then studied drug use and the occurrence of asthma, asthma like symptoms, bronchiolitis, pneumonia, bronchitis, croup, and other respiratory infections. They determined that while use of the drugs was linked to wheeze and asthma in unadjusted models, the connection between medication use in early childhood and asthma symptoms was substantially reduced after adjusting the results to account for respiratory infections. "These results suggest that respiratory infections in infancy, and not analgesic use, are the actual underlying risk factor for asthma and wheeze in children," said lead author Joanne Sordillo, instructor of medicine at Brigham and Women's Hospital in Boston.
From "Childhood Respiratory Infections Rather Than Analgesics Usage Linked to Risk for Asthma" (05/21/2013)
A study by Lisa Karamessinis at the University of Connecticut and colleagues found that the need for analgesics rapidly declined in children who had undergone a laparoscopic appendectomy, with almost all patients off pain medications within a week after discharge. The preliminary analysis involved 26 appendectomy patients for whom a mean of 14 tablets of oxycodone/acetaminophen, oxycodone, or hydrocodone/acetaminophen was prescribed. Patients used a mean of six pills based on a pill count and 5.1 pills based on diary report, according to the researchers. "We hope that this study will give us the opportunity to tighten up on drug prescribing for children undergoing this laparoscopic procedure," Karamessinis says. "We are continuing to recruit 100 patients." The participants, who were an average of about 13 years of age, completed 14-day home pain management diaries, and prescription opioid analgesics were dispensed with eCap technology. Roger Fillingim, president of the American Pain Society, says the study emphasizes the need to balance the curbing of postsurgical discomfort with the fear of prescription medicine diversion. The findings were presented at the annual meeting of the American Pain Society.
From "Kids May Be OK With Less Pain Medication"
MedPage Today (05/13/13) Susman, Ed
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