Anesthesia E-ssential May 30, 2014

 
Anesthesia E-ssential

May 30, 2014

 

Vital Signs

AANA Election Results Announced
The AANA is pleased to announce the results of the election for open positions on the FY2015 Board of Directors, Nominating Committee, and Resolutions Committee.
 
Open Positions on the FY 2015 Board of Directors
  • Juan F. Quintana, CRNA, DNP, MHS, President-elect
  • Cheryl L. Nimmo, CRNA, DNP, MSHSA, Vice President
  • Bruce A. Weiner, CRNA, MS, Treasurer
  • Debra A. Barber, CRNA, DNP, MS, Director – Region 2
  • Randall D. Moore II, CRNA, MSN, MAJ, USAR, Director – Region 3
  • Linda J. Goetz, CRNA, MHS, Director – Region 6
  • Garry J. Brydges, CRNA, DNP, MSN, ACNP-BC, Director – Region 7
 
AANA Board of Directors FY 2015
  • Sharon P. Pearce, CRNA, MSN, President
  • Juan F. Quintana, CRNA, DNP, MHS, President-elect
  • Cheryl L. Nimmo, CRNA, DNP, MSHSA, Vice President
  • Bruce A. Weiner, CRNA, MS, Treasurer
  • Dean T. Mazurek, CRNA, APN, Director – Region 1
  • Debra A. Barber, CRNA, DNP, MS, Director – Region 2
  • Randall D. Moore II, CRNA, MSN, MAJ, USAR, Director – Region 3
  • Mark G. Odden, CRNA, BSN, MBA, ARNP, Director – Region 4
  • Kathryn L. Jansky, CRNA, ARNP, MHS, USA, LTC (ret.), Director – Region 5
  • Linda J. Goetz, CRNA, MHS, Director – Region 6
  • Garry J. Brydges, CRNA, DNP, MSN, ACNP-BC, Director – Region 7
 
FY 2015 Nominating Committee
  • Laura L. Ardizzone, CRNA, DNP, Region 1
  • Terry L. Sweatt, CRNA, MSN, Region 2
  • Michael C. MacMillan, CRNA, BS, Region 3
  • Marcia A. Kluck, CRNA, MNA, BSN, Region 4
  • David A. Andrews, CRNA, MHS, Region 5
  • Caroline S. Raskiewicz, CRNA, DNP, BSBA, Region 6
  • Rosann M. Spiegel, CRNA, DNAP, JD, ARNP, Region 7
 
FY 2015 Resolutions Committee
  • Laura P. Santibanez, CRNA, MSN
  • Michael J. Ruebusch, CRNA, MSN
  • Jay G. Thomas, CRNA, MS, MPA
  • Dennis J. McKenna, CRNA, MHS
  • Bernadette M. Henrichs, CRNA, PhD, CCRN
To access the report from the election services coordinator, visit http://www.aana.com/electioncenter. (Member login and password required.)
 
 

 

The Pulse

 
  • Board of Directors Approves New Clinical Practice Guidelines
  • How to Make a Research Request to the AANA Archives-Library
  • CRNA Profiles Bring Nurse Anesthesia History to Life
  • AANA Seeks Senior Director, Education and Professional Development
  • Archives-Library Student Center Now Available
  • Additional Member Discounts on AANALearn through July 31, 2014
  • Friends for Life Deadline – June 15, 2014
  • Support the AANA Foundation: Shop AmazonSmile to Donate 0.5% of Eligible Purchases
  • Purchase Your Tickets Today for Fundraising Events at Annual Congress – Talent Show and Golf Tournament
  • AANA Research Announcement: Register for Free Webinar – Evaluative Methods for Quality Improvement Interventions
 
  • Save the Date: Lobbyist Track at the Fall Leadership Academy
 
  • Meet Your Educational Needs
  • Want to Learn from the Best? Register for the 2014 Nurse Anesthesia Annual Congress
  • Look at your Career Differently - Business of Anesthesia Conference
  • Save the Date for the AANA’s Fall Leadership Academy
  • Save $50 by registering today for the Upper and Lower Extremity Nerve Block Workshop
 
Federal Government Affairs
  • Before a June 10 Deadline, AANA Member Action Needed Now to Protect and Advance Private Coverage of CRNA Services
  • AANA-Backed Veterans Healthcare Language, Military CRNA Incentive Special Pays, Advance on Capitol Hill
  • Medicare Proposes 2015 Inpatient Hospital Payments
  • NIH Announces the Launch of Federal Pain Research Database
  • Congress Hears from CRNA-PAC -- Will CRNA-PAC Hear from You?
  • State Associations are Using New Advocacy Tools -- How about Yours?
  • FEC REQUIRED LEGAL DISCLAIMER FOR CRNA-PAC
 
 

Healthcare Headlines

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

 
 
Inside the Association
 
Board of Directors Approves New Clinical Practice Guidelines
The AANA Board of Directors approved three clinical practice guidelines during its April 2014 meeting. The new “Guidelines for Critical Incident Stress Management” (CISM) outlines the team response to a critical incident and intervention strategies to support patients and healthcare providers with resources for CISM program development; the “Safe Injection Guidelines for Needle and Syringe Use” underscores the importance of correct drug preparation and administration; and the “Guidelines Regarding the Role of the CRNA in Mass Casualty Incident and Preparedness” details the role the CRNA serves as a member of the response and management team. All practice related documents and resources are available on the AANA Professional Practice Documents webpage.
 
 
How to Make a Research Request to the AANA Archives-Library
If you have ever had a question about the history of nurse anesthesia but didn’t know where or how to address it, don’t worry! You can ask the archivist. Check out our How to Make a Research Request page for more information on the process. Here, you will learn how to format a request, when and where to submit it, and what you can expect in return. The mission of the AANA Archives encompasses much more than collecting and preserving; we’re also here to make that information available to researchers like you.
 

CRNA Profiles Bring Nurse Anesthesia History to Life
The AANA Archives maintains a collection of profiles on influential CRNAs. Col. Ruth P. Satterfield, first nurse ever appointed Consultant to the Army Surgeon General, and Helen P. Vos, respected educator and AANA past president, were added to our collection this month. In honor of Memorial Day, check out the CRNA Profiles page for more information on these incredible nurse anesthetists and others who served our country, including Mildred Clark and Sophie Winton.

 ​ 
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. Read more here for further information about the position, required qualifications, and how to apply.

  
Archives-Library Student Center Now Available
Are you a student working on a paper? Are you hoping to donate the dissertation or thesis you spent so much time and energy completing? The newly added Student Center page provides a great starting point for a conversation with the archivist. Check back as we continue to add new sections to this site. 
 
 
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.
 
 

  
 
AANA Foundation Friends for Life Deadline is June 15, 2014
The Friends for Life submission deadline for recognition at this year’s Annual Congress in Orlando, Fla., is 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 ncarmichael@aana.com.  
 
 
Support the AANA Foundation: Shop AmazonSmile to Donate 0.5% of Eligible Purchases
AmazonSmile is a simple way to support the AANA Foundation every time you shop, at no cost to you. AmazonSmile is a website operated by Amazon that offers the same wide selection of products and exact same low prices as Amazon.com; the difference is that the Amazon Smile Foundation will donate 0.5 percent of the price of eligible purchases to the AANA Foundation. To shop at AmazonSmile, go to smile.amazon.com. To go directly to the AmazonSmile webpage supporting the AANA Foundation, click here. Please log on and shop today! Millions of products are marked “Eligible for AmazonSmile donation” on their product detail pages. Thank you in advance for participating in this easy way to support the AANA Foundation.
 
 
Purchase Your Tickets Today for Fundraising Events at Annual Congress – Talent Show and Golf Tournament
The AANA Foundation is hosting two fabulous events that you won’t want to miss, so be sure to purchase your tickets when you register for the AANA 2014 Nurse Anesthesia Annual Congress.
 
Orlando – The Stars Come Out Again
This fabulous and fun event will take place on Sunday, Sept. 14, 2014, and will feature talented CRNAs and SRNAs competing for fabulous prizes. There will also be dancing, dinner, drinks, and a DJ. Sponsorships are available and include tickets and recognition. Visit the Orlando – The Stars Come Out Again webpage to learn more.
 
17th Annual Golf Tournament at Hawk’s Landing Golf Club
Plan to tee off at 1:30 p.m. at Hawk’s Landing Golf Club, 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. Click here to visit the golf tournament webpage for more details including information on club rental, sponsorships, contests, and photos from past Foundation golf tournaments. If you have any questions, please contact Luanne Irvin, AANA Foundation Development Officer, at (847) 655-1173 or lirvin@aana.com.
 
 
AANA Research Announcement:
Register for Free Webinar – Evaluative Methods for Quality Improvement Interventions
On July 1, 2014, a webinar hosted by the EDM Forum will build on an Agency for Healthcare Research and Quality (AHRQ)-funded special supplement in Academic Pediatrics to explore specific methods. Increasingly, health services researchers and providers have been called upon to evaluate the effectiveness of quality improvement (QI) activities that address gaps in quality and safety. State-of-the-art evaluation methods include careful articulation and analysis of the conditions under which such interventions and innovations are effective. It is important to understand how key contextual variables such as leadership, teamwork, culture, and resources contribute to the differences in outcomes observed across sites. Go to the AcademyHealth website to learn more about this webinar titled The Keys to Evaluative Methods for Quality Improvement Interventions: Understanding and Analyzing Context. The webinar will be held on Tuesday, July 1, 2014, from 3to 4:30 p.m. EDT. Registration is free.

 

 

 
 
 
Save the Date: Lobbyist Track at the Fall Leadership Academy
Nov. 7-9, 2014, in Rosemont, Ill
New this year, the Fall Leadership Academy will feature a Lobbyist Track in conjunction with the Government Relations (GR) Track. The goal of this track is to enhance opportunities for education and networking for state associations’ lobbyists and to educate them about issues specific to CRNAs and help advance the practice of nurse anesthesia at the state level. For more information, please contact Anna Polyak, RN, JD, senior director, State Government Affairs at apolyak@aana.com.
 
 

 
 
Meet Your Educational Needs
AANA has meetings and workshops designed to meet your educational needs. Click here to find out more.
 
 
Want to Learn from the Best? Register for the 2014 Nurse Anesthesia Annual Congress
The AANA Nurse Anesthesia Annual Congress brings together thought leaders in the fields of quality, patient safety, and satisfaction. The Affordable Care Act has brought a rapidly changing environment to healthcare. Join your CRNA colleagues in Orlando as we discuss our patients’ best outcomes through evidence-based practice and quality improvement programs. Register today.
 
 
Look at your Career Differently - Business of Anesthesia Conference
Join your colleagues on July 12 in Chicago for the AANA Business of Anesthesia Conference. The AANA’s Business of Anesthesia Conference in the heart of downtown Chicago, and will provide you with the knowledge you need to effectively address may of the business challenges that face an anesthesia practice. Save $50. Register today.
 
 
Save the Date for the AANA’s Fall Leadership Academy
Mark your calendars for AANA’s Fall Leadership Academy, to be held 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 the AANA’s offices, is designed to expand your skills and expertise in using upper and lower extremity nerve block anesthesia. Register today for this hands-on workshop.
 
 
 

 

Federal Government Affairs

 
Before a June 10 Deadline, AANA Member Action Needed Now to Protect and Advance Private Coverage of CRNA Services
AANA members have the opportunity today to make their voices heard with the Medicare agency in favor of equitable recognition and coverage of CRNA services by private health plans. The deadline for Medicare to hear from the public on this issue is June 10, 2014.
 
The Centers for Medicare & Medicaid Services (CMS) is seeking public comments on a request for information (RFI) regarding implementation of the AANA-backed provider nondiscrimination law. This critical law, passed in 2010 and taking effect this year, prohibits health plans from discriminating against qualified licensed healthcare professionals solely on the basis of their licensure, such as CRNAs. The help of AANA members is needed to ensure that this important provision has its intended effect of promoting fair market competition that helps patients obtain the quality healthcare that they need and deserve.
 
Health plans have latitude to determine the quantity, type, and geographic location of healthcare professionals they need to ensure availability of healthcare benefits to their enrollees. However, when health plans organize their healthcare delivery in such a way that they discriminate against whole classes of qualified licensed healthcare professionals by licensure—for example, by prohibiting reimbursement for anesthesia and pain management services provided by CRNAs—patient access to care is impaired, consumer choice suffers, and healthcare costs climb for lack of competition.
 
The most important thing you can do to help ensure fair implementation of this important law is to take a few minutes to learn more, and then to submit a comment in your own words to CMS. By clicking on this link, https://www.crna-pac.com/washingtonpolicyissues.aspx, entering your AANA member login and password, and clicking “Provider Nondiscrimination,” you can learn more about this issue and its impact on nurse anesthetists, and join the AANA in submitting a comment in your own words to CMS.

 
AANA-Backed Veterans Healthcare Language, Military CRNA Incentive Special Pays, Advance on Capitol Hill
Provisions that the AANA has promoted on Capitol Hill to support the Veterans Health Administration (VHA) process for recognizing CRNAs and other advanced practice registered nurses (APRNs) to their full practice authority, and to extend the incentive special pay (ISP) program for military CRNAs, made progress in Congress just before Memorial Day.
 
The VHA advisory report language backed by the AANA is included with the Military Construction, Veterans Affairs and Related Agencies Appropriations legislation for FY 2015 unanimously adopted by the Senate Appropriations Committee on May 22. Identical to a parallel House measure, the Senate provision 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.” The bill (not yet numbered) is expected to be considered in the full Senate this summer.
 
The ISP program that helps our U.S. Armed Forces recruit and retain CRNAs is extended one more year, to Dec. 31, 2015, with the AANA’s support, as part of a major FY 2015 defense authorization bill (H.R. 4435) that the U.S. House passed on May 22. The next step is for the Senate to consider similar legislation.
 
 
Medicare Proposes 2015 Inpatient Hospital Payments
The Medicare agency proposed updating inpatient hospital payments for 2015, in a 1,688-page release dated April 30. Though this facility payment proposal does not directly affect CRNA reimbursement, the AANA is reviewing it for possible CRNA impacts.
 
The agency proposes increasing inpatient hospital payments 1.3 percent, adjusting the hospital value-based purchasing (VBP) program so that maximum reductions for failing to meet quality measurement targets may reach 1.5 percent of participating hospitals’ base payments, and increasing penalties for hospitals failing to meet the goals of the Hospital Acquired-Condition Reduction Program. Of specific interest to CRNAs, the proposal includes discussion about a procedure requiring anesthesia (the left-atrial appendage procedure) and a device involved in procedures requiring anesthesia (the Argus II Retinal Prosthesis System). Comments are due to CMS by June 30, 2014. 
 
 
 
NIH Announces the Launch of Federal Pain Research Database
On May 27, the National Institutes of Health (NIH) announced the launch of a multi-agency pain research database to provide information on the latest data and research on pain supported by the federal government. The database is of interest to CRNAs who are researchers and those involved in pain management practice. More than 1,200 research projects in the database are categorized as either Tier 1, which are basic, translational, or clinical research projects, or Tier 2, which include grants related to 29 scientific topic areas related to pain, such as biobehavioral and psychosocial mechanisms, chronic overlapping conditions, and neurobiological mechanisms. Tier 2 categories are also organized into nine research themes: pain mechanisms, basic to clinical, disparities, training and education, tools and instruments, risk factors and causes, surveillance and human trials, overlapping conditions, and use of services, treatments, and interventions. According to a statement by NIH, the purpose of the database is to “ensure that federal research efforts are not redundant and to identify opportunities to collaborate and share resources across agencies.” 
 
Access the research database at http://paindatabase.nih.gov, and read the NIH statement at http://www.nih.gov/news/health/may2014/ninds-27.htm.
 
 
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 month communicating with members of Congress, will the CRNA-PAC hear from you now? To learn more about how CRNA-PAC supports the practice and profession of nurse anesthesia, or to make a contribution, click www.crna-pac.org (requires AANA member login and password). And to see your 2013 CRNA-PAC Annual Report … just click here.

  
State Associations are Using New Advocacy Tools – How about Yours?
More than 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.
 
 
The following is an FEC required legal notification for CRNA-PAC: Gifts to political action committees are not tax deductible. Contributions to CRNA-PAC are for political purposes. All contributions to CRNA-PAC are voluntary. You may refuse to contribute without reprisal. The guidelines are merely suggestions. You are free to contribute more or less than the guidelines suggest and the association will not favor or disadvantage you by reason of the amount contributed or the decision not to contribute. Federal law requires CRNA-PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. Each contributor must be a US Citizen.
 

  
 

 
 
 
A Randomized Clinical Trial Comparing the Effectiveness of Ultrasound Guidance Versus Nerve Stimulation for Lateral Popliteal-Sciatic Nerve Blocks
Previous research has indicated that ultrasound guidance, used in place of nerve stimulation, can shorten procedural time for peripheral nerve blocks; however, these studies have been limited to mostly non-obese patients. To determine whether the findings could be reproduced in the obese population, investigators recruited 24 people with a body mass index greater than 30 kg/m2 who were scheduled for foot/ankle surgery. Each was randomly assigned to receive a lateral popliteal-sciatic nerve block with either ultrasound guidance or nerve stimulation, with procedural time serving as the primary outcome. The results indicated a mean procedural time of 206 seconds under the ultrasound approach, compared to 577 seconds with nerve stimulation. In terms of secondary outcomes, the ultrasound cohort required fewer needle redirections, needed less opioid medication, and had a higher level of satisfaction with their nerve blocks. The researchers concluded that ultrasound guidance offers obese patients similar block characteristics to nerve stimulation while reducing procedural time and procedural-related pain.
 
From "A Randomized Clinical Trial Comparing the Effectiveness of Ultrasound Guidance Versus Nerve Stimulation for Lateral Popliteal-Sciatic Nerve Blocks"
Journal of Ultrasound in Medicine (06/01/14) Vol. 33, No. 6, P. 1057 Lam, Nicholas; Petersen, Timothy; Gerstein, Neal; et al.
 
 
 
Effect of Using a Safety Checklist on Patient Complications After Surgery: A Systematic Review and Meta-Analysis
Recent findings indicate there is a correlation between checklist use in surgery and fewer postoperative complications. To examine the impact of surgical checklists on complication rates, researchers conducted a meta-analysis of seven studies involving more than 37,000 patients. The researchers found that the use of checklists in surgery in comparison with standard practice led to a reduction in any complication, wound infection, and blood loss. There were, however, no significant reductions observed in mortality, pneumonia, or unplanned return to operating room.
 
From "Effect of Using a Safety Checklist on Patient Complications After Surgery: A Systematic Review and Meta-Analysis"
Anesthesiology (06/14) Vol. 120, No. 6, P. 1380 Gillespie, Brigid M.; Chaboyer, Wendy; Thalib, Lukman; et al.
 
 
 
Precision-Guided Epidurals and Better Blood Monitors
By using optical coherence tomography (OCT)—an imaging technique that is similar to ultrasound but has better resolution—in tandem with other tools, researchers say clinicians can improve care for laboring mothers and enhance blood monitoring. Investigators at the University of Maryland have paired an OCT device with an epidural needle so that anesthesia providers can see tissue from the perspective of the tip of the needle. Instead of relying on anatomical landmarks, the approach could help providers to deliver spinal anesthetic with less pain and fewer problems. "An OCT forward-imaging probe can provide [anesthesia providers] with real-time visualization of the microarchitecture of tissues and important landmarks, and thus could significantly improve the accuracy and the safety of the needle-based procedure," summarized researcher Yu Chen. At the University of California, Davis, meanwhile, investigators have demonstrated how OCT can measure blood flow and blood oxygenation in vessels without using contrast agents. Researcher Shau Poh Chong explains that while traditional pulse oximetry uses transmitted light to gauge oxygen saturation, the system developed at UC Davis uses broadband visible light. Although the use of reflected light for this purpose has been challenged in the past because of modeling errors caused by light scattering, the team has developed new methods to reduce such errors.
 
From "Precision-Guided Epidurals and Better Blood Monitors"
Medicalxpress (05/27/2014)
 
 
 
Antibody That Blocks Pain and Itching Discovered
Through animal testing, researchers at Duke University say they have discovered an antibody that prevents both pain and itching. The antibody targets voltage-sensitive sodium channels that control the flow of sodium ions in the neuron's cell membrane to block these sensations. In the "closed" position, for example, the sodium channel Nav1.7 disables the ability to sense pain. In tests on mice with inflammatory and neuropathic pain, the antibody's ability to stabilize the closed state reduced pain sensation without the lab subjects showing any indication of physical dependence or enhanced tolerance toward the antibody. Lead researcher Seok-Yong Lee said the team hopes to advance the findings to clinical trials, with a goal of developing "a safer treatment for pain and itch as an alternative to opioids, which often cause addiction and other detrimental side effects." The study results were published online in Cell.
 
From "Antibody That Blocks Pain and Itching Discovered"
Science World Report (05/26/14) Matilda, Benita
 
 
 
During Childbirth, Serious Anesthesia Complications Are 'Very Rare'
New research published in Anesthesiology suggests that serious complications from epidural, spinal, or general anesthesia given during labor are rare, occurring in just one in every 3,000 births. Serious complications associated with these procedures include high neuraxial block, respiratory arrest, and unrecognized spinal catheter. Led by Dr. Robert D'Angelo of Wake Forest University in North Carolina, the study is the first multi-center investigation of its kind to examine rates of serious complications linked to anesthesia. The team used data from more than 257,000 deliveries where epidural, spinal, or general anesthesia was administered during childbirth. A total of 157 complications were reported in the data used, and only 85 of those were linked to anesthesia. D'Angelo confirmed the team's discovery that "serious complications such as bleeding, infection, paralysis and maternal death were extremely rare." However, he stressed that it is vital for anesthesia providers to pay close attention to patients and be prepared to diagnose and treat any complication that arises. Although the team sought to determine the risk factors associated with these complications, it was unable to do so because the incidence of serious complications was so rare. However, the researchers noted that the findings can be used to guide conversations about complications with patients and also will be used to develop a national obstetric anesthesia complication registry.
 
From "During Childbirth, Serious Anesthesia Complications Are 'Very Rare'"
Medical News Today (05/20/14) Ellis, Marie
 
 
 
Propofol Preferable for Sedation During Joint Surgery
Findings from a retrospective study suggest that dexmedetomidine's role in regional anesthesia may be limited. During recent shortages of the drug propofol, providers performing regional anesthesia at Virginia Mason Medical Center in Seattle instead began using dexmedetomidine during total joint replacement surgeries. Researchers later examined the electronic medical records of 126 consecutive elective surgery patients treated between Dec. 15, 2012, and Jan. 31, 2013, and after adjusting for other factors, found that patients who received dexmedetomidine for spinal anesthesia were four times more likely than propofol recipients to experience bradycardia. In addition, the episodes of bradycardia—or heart rate below 60 beats per minute in the postanesthesia care unit (PACU)—experienced by this group of patients tended to be longer and more severe than those experienced by the other patient group. Dexmedetomidine administration was also associated with a longer stay in the PACU, resulting in higher costs associated with the use of the drug. In addition, as the branded form of dexmedetomidine is the only version currently available, it is also a more expensive option at base cost—although generic versions are expected later this year.
 
From "Propofol Preferable for Sedation During Joint Surgery"
Anesthesiology News (05/01/14) Vol. 40, No. 5 Wild, David
 
 
 
Pain Prevalence, Intensity, Assessment and Management in a Hospitalized Pediatric Population
Although researchers and healthcare providers have been working to improve pain management in infants and children, pain remains common in hospitalized children. Patient populations at higher risk of increased pain include females, Caucasians, and individuals who have undergone surgery. Identifying such patients, and the obstacles to analgesic management, may be a focus for targeted interventions and further research. Researchers sought to identify the prevalence and demographics of pain and pain management in hospitalized children. They examined patient demographics, location of pain, pain intensity, pain assessment documentation, analgesic use, side effects of analgesic therapy, and patient/family satisfaction in a random sample of 200 patients aged seven days to 21 years admitted to the Johns Hopkins Children's Center from October 2007 to November 2008. Female gender, age of five years or younger, and Caucasian race were all associated with higher mean pain scores. According to the authors, obstacles to optimal analgesic management include lack of documented physician pain assessment, a high prevalence of "as needed" analgesic dosing, frequent opioid-induced side effects, and patient/family dissatisfaction with pain management.
 
From "Pain Prevalence, Intensity, Assessment and Management in a Hospitalized Pediatric Population"
Medscape (05/14/14) Kozlowski, Lori J.; Kost-byerly, Sabine; Colantuoni, Elizabeth; et al.
 
 
 
Nerve Damage After Hip Surgery May Not Be Providers' Fault
An article published in Mayo Clinic Proceedings suggests that while nerve damage following hip surgery is often attributed to the actions of anesthesia providers or surgeons, in some cases it actually may be caused by inflammatory neuropathy. Researchers used nerve biopsy in a study of patients who developed limb pain and weakness following hip surgery to show that, despite having no documented or direct traction injury, all of the patients presented signs of inflammatory neuropathies. Mayo neurologist Nathan Staff, MD, PhD, said physicians need to be aware of certain signs that could suggest that patients experiencing such damage may have suffered an inflammatory issue. Red flags include anatomical distribution that differs from the expected distribution, neuropathy that develops over time, neuropathy that progresses, and severe pain. Staff added that being able to identify patients who have experienced inflammatory neuropathy—in contrast to those who suffered damage from mechanical factors such as patient positioning—can allow physicians to implement better and faster treatment, which can help relieve pain and result in better outcomes.
 
From "Nerve Damage After Hip Surgery May Not Be Providers' Fault"
Outpatient Surgery (05/19/14) Burger, Jim
 
 
 
Could Cone Snail Venom Treat Neuropathic Pain in Humans?
The findings of a study by Australian researchers suggest that venom produced by marine cone snails to immobilize their prey could potentially treat pain in mammals. The naturally occurring toxin has analgesic properties that could lead to the development of synthetic versions of Vc1.1—which works to block pain—that could be used to prevent certain types of neuropathic pain from occurring in humans. Neuropathic pain is often associated with changes in the transmission of signals between neurons, which is controlled by several types of voltage-gated calcium channels (VGCCs). Previous research has demonstrated that Vc1.1 acts against neuropathic pain in mice; and, now, the Australian investigators have discovered that it also works through GABA type B receptors to inhibit N-type channels. The researchers found that Vc1.1 works through these receptors to inhibit a class of neuronal VGCCs that have been implicated in pain signaling but that are not well-understood. Despite the potential for a new anesthetic, researchers do have some concern that targeting these channels to combat neuropathic pain could trigger unwanted side effects.
 
From "Could Cone Snail Venom Treat Neuropathic Pain in Humans?"
Science World Report (05/15/14) Lees, Kathleen
 
 
 
Opioids Questioned as Spine Surgery Outcome Marker
Findings from a new study presented at the North American Spine Society's 2013 annual meeting show that patients who took opioids prior to elective spine surgery were more likely to use them after surgery than those who were opiod-naive. Principal investigator Marjorie Wang, MD, and colleagues at the Medical College of Wisconsin conducted the study of adults undergoing elective cervical spine surgery for degenerative changes. Of the study participants, 75 used opioids preoperatively while 97 did not. After surgery, the two groups demonstrated similar improvements in their scores on the Neck Disability Index (NDI) and the Short Form-36 (SF-36) Physical Functioning and Bodily Pain scales. While a logistic regression analysis determined that surgical characteristics were not significant predictors of opioid use 12 months after surgery, any preoperative opioid use was found to be a significant predictor. Other significant predictors of opioid use at 12 months following the surgery included preoperative tobacco use, any preoperative comorbidity, symptoms lasting for more than nine months prior to surgery, and lower preoperative SF-36 Physical Functioning scores.
 
From "Opioids Questioned as Spine Surgery Outcome Marker"
Pain Medicine News (05/01/2014) Vol. 12, No. 5 Frei, Rosemary
  
 
 
Will Hospitals Be Ready To Get Smart?
A study led by Bassam Kadry, MD, clinical assistant professor of anesthesiology, perioperative and pain medicine at Stanford University, suggested that a smart alert technology could be developed that could revolutionize patient management when coupled with mobile medical monitoring techniques. The researchers found that a single metric—whether patients had used an opioid analgesia before admission for total knee arthroplasty—was a strong indicator that the patient would need additional postoperative pain management and would be likely to have an extended stay in the hospital. This single metric, they said, proves that selected data points can be used to identify patients who are more likely to require additional interventions. Kadry said he envisioned using these data points to develop algorithms could deliver smart alerts to physicians warning them of potential problems even before they present clinically. One of the first steps to establishing such a system is to define the data points that can flag patients who are likely to require interventions, Kadry said, saying that these "must be be 'vital'—valid, important, timely, actionable and low-cost." However, prior to implementing such systems, hospitals must be using devices that can collect and integrate the necessary medical data. Since most monitors currently used in hospitals do not accomplish this, a different device must be introduced to meet this requirement. Mobile health, or "m-health" devices, could be ideal for this use, as they are specifically designed to store and share data on multiple medical parameters across many different platforms. Kadry commented that changes in healthcare payment structure will drive hospitals to streamline their services and take steps to minimize complications, which would drive the adoption of such patient management technology.
 
From "Will Hospitals Be Ready To Get Smart?"
Anesthesiology News (05/01/14) Vol. 40, No. 5 Savoie, Keely
 
 
 
Under the Knife: Where Infections Fly Under the Radar
Advances in anesthesia and laparascopy have increased the popularity of ambulatory care centers among Americans seeking a range of services, including eye operations and biopsies. More than 5,000 outpatient surgical centers now operate nationwide. Operations conducted at these facilities have generally positive results because patients approved for surgeries outside hospitals tend to be healthier than most. With any surgery there is a risk for infection, but—unlike hospitals—outpatient surgery centers are not required to track health care-associated infections. Beth Bell, director of the National Center for Emerging and Zoonotic Infectious Diseases, raised the issue before Congress last fall, noting the growing number of procedures ambulatory surgery centers are handling. "These days there are a lot more—and more complicated—surgeries that are taking place in ambulatory surgery centers, and so this sort of clean break between the hospital and the ambulatory surgery center is perhaps not as clean as it once was," she said. "We don't have very good estimates about [infections in] ambulatory surgery centers."
 
From "Under the Knife: Where Infections Fly Under the Radar"
Scientific American (05/19/14) Maron, Dina Fine
 
 
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