Anesthesia E-ssential November 27, 2013

 
Anesthesia E-ssential

November 27, 2013

 

Vital Signs

New Speakers/Hot Topics: Apply Now for 2014 AANA Nurse Anesthesia Annual Congress Speaking Opportunity
The AANA Program Committee invites all CRNAs to apply for an opportunity to be a new speaker in a concurrent session on Saturday, Sept. 13, 2014, in Orlando, Fla.
 
The Nurse Anesthesia Annual Congress  provides this opportunity for novice speakers to present evidence-based topics to an audience and receive feedback from experienced faculty members. Six individuals selected by the Program Committee will have the opportunity to present their topic in front of both a panel of expert speakers and a live audience. Following their lecture, each speaker will meet with the panel of experts to receive constructive feedback.
 
For further information and an application, send an email to jhogan@aana.com. The deadline for application is Monday, Dec. 16, 2013—take advantage of this opportunity now!
 
 

 

The Pulse

 
  • Register Now for the Assembly of School Faculty
  • Consider Serving with the National Quality Forum
  • Nominations for 2014 Elections Due Dec. 1
  • Save the Date for the Upper and Lower Extremity Nerve Block Workshop
  • Disaster Resources
  • Proof is Power: Telemarketing Update
  • Last Call for Applications: NBCRNA Doctoral Fellowship Opportunity
 
  • Open Positions on the COA
 
Professional Practice
  • AAAHC Institute for Quality Improvement Releases Patient Safety Toolkits
  • Joint Commission FAQ: Laundering of Surgical Scrubs and Other Surgical Attire
 
  • New Member Spotlight Story Added
  • Don't Wait to Order Your Nurse Anesthetists Week Materials
 
State Government Affairs
  • AANA SGA Division to Host Webinar for State Association Attorney and Lobbyists
  • Questions Arise About the Minnesota Board of Nursing's Ability to Discipline Nurses
 
  • Somnia Anesthesia: Certified Registered Nurse Anesthetist, Hazleton, PA
  • Somnia Anesthesia: Clinical Practice, Indiana
  • CRNA Opportunities – EmCare Anesthesia Services
  • CRNA Career Center
 

Healthcare Headlines

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

 
 
Inside the Association
 
Register Now for the Assembly of School Faculty
The 2014 Assembly of School Faculty will be held Feb. 18-20 in San Diego, Calif., and will be the premier meeting for nurse anesthesia program administrators and program faculty. While this year's meeting will run midweek (Tuesday – Thursday this year only), the agenda will continue to tackle the issues faced by nurse anesthesia educators, educational programs and student registered nurse anesthetists, including:  How will changes in healthcare policy affect education? What are the barriers to evaluating clinical performance? What effect do recent regulatory changes have on accreditation and certification?

The 2014 John Garde Memorial Lecturer is Virginia Trotter Betts, RN, JD, MSN, FAAN. Trotter Betts will address The Impact of Healthcare Policy Change on Advance Practice Nursing and the Nation – What Educators Need to Know.  
 
Your colleagues have said this about ASF:
 
"The Assembly of School Faculty has always been my favorite national conference. It gathers together practically everyone active in CRNA education.  I have learned so much over the years from my peers! I always come home with a list of to-do’s and ideas to make my program better." — Michael P. Dosch, CRNA, PhD, MS, Chair, University of Detroit Mercy Graduate Program of Nurse Anesthesiology
 
"If you want to know the latest in nurse anesthesia education, the Assembly of School Faculty has always been the place to be." — Nancy Bruton Maree, CRNA, MS, Program Administrator, Raleigh School of Nurse Anesthesia, University of North Carolina at Greensboro
 
The educational requirements for nurse anesthetists are ever-changing and that change will define the future of the profession. Join your colleagues and make sure you are in the know by registering today for the 2014 Assembly of School Faculty at http://www.aana.com/meetings/aanaassembliesRegister now and receive $50 off your registration!
 
 
Consider Serving with the National Quality Forum
Do you have expertise in quality initiatives and performance measurement? Consider getting involved with the National Quality Forum. The AANA is looking for CRNAs who are interested in potentially working on NQF projects. Interested CRNAs should visit the AANA website at http://www.aana.com/NQFNominations to view specific projects currently accepting nominations. Links are provided to information regarding the project scope, expertise preferred, time commitment, and documentation required. Questions regarding this process can be directed to practice@aana.com.
 
 
Nominations for 2014 Elections Due Dec. 1
Nominations for members for elected office and consent forms from nominees are due in the AANA office by Dec. 1, 2013. Each state association may submit one nominee for president-elect, vice president, and treasurer. In addition, state associations may submit one nominee for a director of their region. In 2014, directors from Regions 2, 3, 6, and 7 are eligible for election. Finally, state associations may submit one name of a member from their region for the AANA Nominating Committee and for the Resolutions Committee. Also, members may self-nominate or nominate another member as long as the nominee meets the qualifications for office found in the AANA Bylaws and Standing Rules. Click here for further information.

  
Save the Date for the Upper and Lower Extremity Nerve Block Workshop
The Upper and Lower Extremity Nerve Block Workshop is March 8-9, 2014, in Park Ridge, Ill. This workshop is being held at the AANA National Headquarters and is designed for CRNAs interested in developing their skills and knowledge of peripheral nerve blocks. The program includes anatomy, pharmacology, and ultrasound techniques, and also includes case studies and hands-on demonstrations, return demonstration, and skill validation. Register today.
 
 
 

  
 
Proof is Power: Telemarketing Update
The AANA Foundation will soon Kick off its 2014 Proof is Power Telemarketing campaign. On the strength of tax-deductible gifts, the Foundation will continue advancing and supporting nurse anesthesia through research and education. When you receive a call for your tax-deductible donation, please be a part of our success and donate generously. We need YOUR help to fund future studies and distribute scholarships, fellowships, and grants needed to secure the future of our profession. To learn more about the Foundation’s Proof is Power campaign or to make your tax-deductible gift today, please click here.
Thank you for your continued support of the CRNA profession!
 
 
Last Call for Applications: NBCRNA Doctoral Fellowship Opportunity
The deadline for the AANA Foundation’s $10,000 doctoral fellowship sponsored by National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) is Saturday, Nov. 30, 2013. The project/research must address the value of certification or recertification in the advancement of patient safety through enhancing provider quality.
 
The overall goal of the fellowship program is to:
  • Cultivate the development of leaders in research within nurse anesthesia
  • Encourage CRNAs to pursue a program of research
  • Equip CRNAs with the skills to be leaders in research
  • Recognize exceptional academic ability and leadership
  • Establish a network of talented researchers
  • Support a strong research commitment
  • Funding is to be used to support an academic course of study and/or a target research project
Please click here to access the application. If you have any questions, contact the AANA Foundation at (847) 655-1170.
 
 

 
 
Open Positions on the COA
The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is seeking nominations for three director positions. Candidates must be available to attend three-day COA meetings, typically held in January, May, and October. The term of office is three years, beginning fall 2014 through fall 2017. Individuals then would be eligible to be considered for reelection for an additional three-year term.
 
Healthcare Administrator Director
Candidates for healthcare administrator must meet the following criteria:
  • Holds one or more graduate degrees from an institution or institutions of higher education accredited by a nationally recognized accrediting agency.
  • Shows evidence of current involvement in a healthcare administration setting and direct interaction with a program of nurse anesthesia.
Public Director
Candidates for public director must meet the following criteria:
  • Holds one or more graduate degrees from an institution or institutions of higher education accredited by a nationally recognized accrediting agency.
  • Is able to represent the consumer's perspective and to act as an advocate for the public's interest within the context of Council activities.
  • Demonstrates active involvement in his/her chosen profession and/or community service.
  • Demonstrates no close association with any healthcare field.
  • Demonstrates no direct professional relationship with any of the schools or programs that the Council on Accreditation reviews.
CRNA Educator Director
Candidates for CRNA educator director must meet the following criteria:
  • Holds one or more graduate degrees from an institution or institutions of higher education accredited by a nationally recognized accrediting agency.
  • Has certification or recertification as a nurse anesthetist.
  • Has current experience as an educator and/or administrator in a nurse anesthesia education program.
  • Successfully completed the accreditation process through self-evaluation and onsite review.
  • Is actively involved in the profession, as evidenced by the following:
    i. Attendance at the Assembly of School Faculty.
    ii. Attendance at local, state, and national meetings of the AANA.
    iii. Election or appointment to a position in the AANA.
To apply, email the following by March 14, 2014, to Barbara Farkas, Senior Accreditation and Education Specialist, at bfarkas@coa.us.com. Please use the subject line COA Director Application. Only complete applications will be considered. Elections will be held at the COA’s May 2014 meeting.
  • Letter of Intent to Serve
  • Current Curriculum Vitae (resume)
  • Letter of Recommendation
  • Biographical Form – available on the COA’s website at http://home.coa.us.com
 
 
 
AAAHC Institute for Quality Improvement Releases Patient Safety Toolkits
The AAAHC Institute for Quality Improvement has developed patient safety toolkits, which are available for download. Each toolkit includes a brief overview of evidence-based information on important ambulatory safety issues with references and patient assessment tools to aid in clinical decision making and patient management.
 
Download and view the toolkits below:
 
Joint Commission FAQ: Laundering of Surgical Scrubs and Other Surgical Attire
The Joint Commission recently released an FAQ discussing whether employers are required to commercially launder surgical scrubs and other surgical attire. The FAQ states, “For surgical scrubs or other surgical attire not visibly contaminated, organizations can choose between home laundering (acceptable per CDC/HICPAC) or a healthcare-accredited laundry facility (recommended per AORN). For all visibly contaminated clothing, the employer must be responsible for laundering per OSHA standards. Your organization should develop a policy addressing how it will manage this process and what guidelines it is following, which will drive our survey process.” Read the entire FAQ for Ambulatory Health Care, Critical Access Hospitals, Office-Based Surgery, and Hospitals
 

 
 
New Member Spotlight Story Added
Capt. Richard Crocker, CRNA, ANC, USA, is profiled in the latest Member Spotlight story. While serving in the U.S. Army in Afghanistan, Crocker decided to write down, illustrate, and publish the bedtime story he had been telling his children the last 10 years. He partnered with the charity Feed My Starving Children and has donated all proceeds of the book to the organization, raising close to $300. To read the entire story, click here
 
 
Don't Wait to Order Your Nurse Anesthetists Week Materials
Jan. 19-25, 2014, will be here before you know it. Plan to promote your profession and join in the fun by ordering your National Nurse Anesthetists Week promotional materials now. Ordering deadline: Jan. 14, 2014. 
 
 
 

 
 
AANA SGA Division to Host Webinar for State Association Attorneys and Lobbyists
State legislatures will reconvene in January 2014 for a new legislative session. On Dec. 10 at 2 p.m. CST, the AANA State Government Affairs Division will host a webinar updating state association attorneys and lobbyists regarding legislative and regulatory issues that could affect CRNAs. While this webinar is directed at state association attorneys and lobbyists, state association leaders and any interested AANA member is welcome to attend. For more information, see our SGA webinar page (member login and password required). 
 
 
Questions arise about the Minnesota Board of Nursing’s Ability to Discipline Nurses
A recent Minneapolis Star-Tribune article was highly critical of the Minnesota Board of Nursing, claiming that it allowed nurses to keep practicing after stealing drugs from patients, practicing while impaired or generally neglecting patients. The Board defended its disciplinary practices, noting that it frequently removes nurses’ licenses if needed. The Board also asked the state for additional investigative abilities and other statutory changes, pointing out that its ability to discipline nurses is limited by state laws and by inconsistent reporting of problems by employers and state agencies. The Minnesota Nurses Association, the state’s largest nursing union, responded to the article by stating that “illicit behavior by nurses … is undoubtedly devastating to patients and families” but that “statistics prove these circumstances represent less than 1 percent of the millions of patient-nurse engagements occurring every year in a variety of healthcare settings in our state.”
 
 
 

 
 
NEW! Featured Career Opportunities
​ 
Certified Registered Nurse Anesthetist - Somnia Anesthesia

Hazleton, PA

Somnia Anesthesia is seeking an experienced CRNA to join its team at Hazleton General Hospital, a growing community hospital close to the scenic Pocono Mountains and within driving distance of Philadelphia and New York City. Read more about this position.
 
 
CRNA - Somnia Anesthesia

Central, IN

Somnia Anesthesia is actively seeking to hire a CRNA for Fayette Regional Health System, a community hospital in eastern central Indiana. Read more about this position.
 
 
CRNA Opportunities – EmCare Anesthesia Services

Multiple Opportunities Exist Nationwide

Multiple Opportunities Exist Nationwide. EmCare Anesthesia Services supports hundreds of hospitals and surgery centers from coast-to-coast. Search all available opportunities at www.EmCare.comRead more about these opportunities.
 
Visit the CRNA Career Center
 

 
 
 
Specialty Pharmacies Fill Execution Drug Shortage, Raising Concerns
Shut off from access to the drugs previously used to carry out capital punishment sentences, states are resorting to fatal drug cocktails concocted by compounding pharmacies. The trend is drawing even more scrutiny to the compounding industry, which came under fire after a bout of meningitis that killed dozens of people last year was traced back to a facility in Massachusetts. Now, critics are focused on state corrections departments that are patronizing compounding pharmacies as manufacturers have stopped production of some lethal injection drugs and others have prohibited their use for executions. The latest example comes from Missouri, which previously used a three-drug combination before supply issues forced it to switch to a single-drug protocol using propofol, which is manufactured overseas. When the European Union threatened to limit export of that anesthetic—which would have caused myriad problems at hospitals across the United States—Gov. Jay Nixon authorized the use of pentobarbital instead. The state ordered the drug from a compounding pharmacy and used it to put convicted murderer Joseph Paul Franklin to death with no complications. Although the pharmacies must be licensed, they do not require accreditation; and detractors complain that the products may be unsafe and could constitute cruel and unusual treatment of condemned prisoners. A bill now on the president's desk would give the U.S. Food and Drug Administration the authority to inspect and close the biggest compounding pharmacies in the country.
 
From "Specialty Pharmacies Fill Execution Drug Shortage, Raising Concerns"
NBC News (11/20/13) McClam, Erin
 
 
 
Propofol Dosing by Weight May Shortchange Obese Patients
When inducing anesthesia in patients with morbid obesity, Canadian researchers find that it is better to base propofol dosage on bispectral index values (BIS) rather than on lean body weight (LBW). Waleed Riad Soliman, MD, PhD, of the Department of Anesthesia at Toronto Western Hospital, who led the study comparing the two calculation methods, said that clinical observations have suggested that patients undergoing bariatric surgery and dosed using the LBW guidelines "were not adequately anesthetized and developed tachycardia and hypertension in response to intubation." Sixty bariatric surgery patients with a body mass index of at least 40 kg/m squared were randomized to receive propofol induction based on LBW or according to BIS values. The LBW group received a precalculated fixed dose of 2.6 mg/kg LBW, an approach recommended in 2011. Propofol induction was halted in the other group when BIS declined to 50. According to Soliman, 60 percent of those in the LBW group required addition propofol to achieve deep sedation compared to just 3.3 percent of patients in the BIS group, although total induction doses did not differ significantly and there were no differences in heart rate during intubation.
 
From "Propofol Dosing by Weight May Shortchange Obese Patients"
Anesthesiology News (11/01/13) Vol. 39, No. 11 Wild, David
 

Postoperative Pain Increased With Sequential Surgery
Sensitivity to pain worsens after the second surgery for patients who have bilateral total knee arthroscopy (TKA), according to researchers in South Korea. In a study of 30 people who had a second knee operated on within a week of undergoing surgery on the first, subjects reported a spike in pain levels following the second procedure. They also needed more opiate analgesic in the first 24 hours and more rescue analgesics in the first 48 hours following the first procedure than they did during the same intervals after the second round of surgery. The differences in pain presented even though preoperative pain levels were similar for both joints and the same TKA protocol was followed for both operations. The researchers speculate that hyperalgesia occurs in the second knee as a result of pain-induced neuroplasticity caused by persistent nociceptive inputs from the first knee, which alter sensory processing and sensitive subcortical structures. "Therapeutic approaches to reduce such hyperalgesia induced by sequential surgical procedures deserve further study," they write in Pain, "given the detrimental impact of unrelieved postoperative pain and considering the potential contribution to the study of hyperalgesia mechanisms."
From "Postoperative Pain Increased With Sequential Surgery"
MedWire News (11/18/13) Lyford, Joanna
 

Study Finds Widespread Use of Opioid Medications in Nonsurgical Hospital Patients
Research led by Boston's Beth Israel Deaconess Medical Center has uncovered heavy use of prescription opioids, both before and after a hospital stay, for who patients who did not even have surgery. The study examined 1.14 million nonsurgical admissions nationwide over a one-year period, finding that more than half of the patients were given narcotic pain drugs while hospitalized. Not only were they administered high doses, elevating the risk for adverse events, the findings additionally indicate that more than a quarter of patients receiving opioids were written prescriptions on the day they were released—increasing the likelihood of the patient accidentally overdosing or experiencing another kind of complication. Hospitals that more freely prescribe narcotic painkillers have a higher risk for serious opioid-related problems, according to the research results. The analysis revealed that the highest incidence of opioid prescribing for nonsurgical patients is in the western United States, with the lowest rate of occurrence in the Northeast. "Looking ahead," lead author Shoshana Herzig, MD, MPH, writes in The Journal of Hospital Medicine, "a better understanding of the predictors of opioid-related adverse events in hospitalized patients might enable institutions to take steps to make these medications safer during hospital use."
 
From "Study Finds Widespread Use of Opioid Medications in Nonsurgical Hospital Patients"
e! Science News (11/14/2013)
 
 
 
New Sedative May Be Helpful for Colonoscopy
A study published in the November issue of Anesthesia & Analgesia lauds a new sedative called remimazolan as a promising new alternative for patients undergoing colonoscopy and other brief procedures. According to lead researcher Dr. Mark Worthington of Johns Hopkins Hospital, "Remimazolam has the attributes of a sedative drug, with success rate comparable with recent studies of other drugs." Designed to work faster and more predictably, with a shorter recovery time than currently available sedatives, remimazolam achieved adequate sedation in less than one minute following administration for most of the volunteers in the study. Afterward, each patient "rapidly recovered to fully alert" in a median time of under 10 minutes. Only a few of the study subjects experienced less-than adequate sedation or minor adverse events. No serious or unexpected adverse events were documented. Researchers subsequently found that flumazenil could be used to reverse the sedative effect of remimazolam, with patients regaining full alertness within 60 seconds of receiving an injection of flumazenil.
 
From "New Sedative May Be Helpful for Colonoscopy"
EndoNurse (11/14/13)
 
 
 
Walk This Way: Adductor Block After TKA Aids Ambulation
While earlier study has shown that adductor canal blocks effectively provide analgesia following knee replacement surgery, new research indicates that this approach also improves ambulation after total knee arthroplasty (TKA). In a study of 45 patients, 21 of whom received femoral nerve blocks and 24 of whom received adductor canal blocks following TKA, patients in the adductor group were able to walk a median 24 meters—nearly four times farther than patients in the femoral group, who were able to walk only a median of six meters. Femoral nerve blocks can contribute to weakness in the quadricep muscles that can interfere with the physical therapy process and cause patient falls. The adductor canal, in turn, can be blocked with little motor activity, making it a more distal site to insert a perineural catheter. Doing so may avoid fatiguing the quadriceps while still providing pain adequate pain relief. According to Asokumar Buvanendran, MD, director of orthopedic anesthesia and anesthesiology professor at Rush University Medical Center, the findings add to the growing body of evidence supporting the use of adductor canal blocks for TKA.
 
From "Walk This Way: Adductor Block After TKA Aids Ambulation"
Anesthesiology News (11/01/13) Vol. 39, No. 11 O'Rourke, Kate
 
 
 
U.S. Hospitals Adopt Child-Friendly Tactics to Minimize Pain, Trauma
Children's hospitals are utilizing numerous technologies and techniques to reduce the pain, discomfort, and distress their youngest patients experience during their treatment. Such efforts are more important than ever, with the National Association of Children's Hospitals and Related Institutions putting the number of "medically complicated" children in the U.S. at 3 million and rising by 5 percent a year. According to the National Child Traumatic Stress Network, 80 percent of pediatric patients and their families report some traumatic stress following injury, hospitalization, or a painful medical treatment. Mission Children's Hospital in Asheville, N.C., is counteracting this in part with a new digital video system that allows children to watch a movie using a pair of goggles they wear during MRIs, which reduces the number of children that have to be sedated during such procedures. Mission child-life specialist also uses medical play techniques to put children at ease by play acting medical scenarios with dolls and toys. Cardon Children's Medical Center in Mesa, Ariz., creates "safety zones" for children away from areas where potentially stressful or painful procedures are carried out. Cardon also makes use of medical play as well as a device called the J-Tip, which uses pressurized gas to deliver numbing medication before an IV needle is inserted into a vein, making the process pain-free.
 
From "U.S. Hospitals Adopt Child-Friendly Tactics to Minimize Pain, Trauma"
Wall Street Journal (11/11/13) Landro, Laura
 
 
 
Postoperative Pain May Increase Risk of Cognitive Impairment
An animal study from the Massachusetts General Hospital (MGH), published in the Journal of Neuroscience, examined a possible mechanism for pain-induced cognitive impairment and suggested ways to target potential preventative measures. According to Zhongcong Xie, MD, PhD, director of the Geriatric Anesthesia Research Unit at MGH, the study findings suggested that pain was a perioperative factor that could contribute to the risk that a surgical patient would develop cognitive dysfunction. Other factors include anesthesia, sleep disturbance, and the surgery itself. Experiments were conducted on mice that had small incisions made on one of their paws while under general anesthesia. They were later tested for sensitivity, learning, and memory. Inadequate pain treatment was suggested by the findings as a possible cause of "postoperative cognitive dysfunction through a synapse-associated mechanism." Xie noted that treatments targeting CDK5 activity and inflammation could help ease this issue and provide improved pain control, saying, "We hope this research will promote more studies into the underlying mechanism of postoperative cognitive dysfunction—specifically whether aged animals have greater postoperative impairments—findings of which should ultimately improve outcomes for surgical patients."
 
From "Postoperative Pain May Increase Risk of Cognitive Impairment"
Science World Report (11/06/13) Lees, Kathleen
 
 
 
Bumps in the Road to Developing Long-Lasting, Single-Injection Nerve Blocks
Preliminary research shows promise in the use of a single injection of liposomal bupivacaine to deliver a long-lasting nerve block. Although the study led by Dr. Brian Ilfeld of the University of California San Diego showed that a single injection of a liposomal bupivacaine preparation with the brand name Exparel was able to produce a femoral nerve block lasting longer than 24 hours in volunteers, the study results were confusing. According to the November issue of Anesthesia & Analgesia, the results presented variable responses and an "inverse relationship" between dose and response. The preparation used in the study was designed to release local anesthetic over a period of 96 hours following the initial injection; and while not approved for performing peripheral nerve blocks, Exparel is indicated for use in managing incision pain after surgery. The results show significant, lasting responses for both sensory and peripheral nerve blacks, though there was an inverse relationship as lower doses of Exparel produced greater responses, which the researchers called "biologically implausible" and attributed to the "limited sample size and the subjective nature of the measurement instruments." Despite this, the study adds to the body of evidence that supports the use of liposomal bupivacaine to provide longer-lasting nerve blocks. The researchers stressed that larger trials will be needed before recommending the drug for routine clinical use in performing nerve blocks.
 
From "Bumps in the Road to Developing Long-Lasting, Single-Injection Nerve Blocks"
Science Daily (10/28/2013)
 
 
 
Propofol's Effect on the Sciatic Nerve: Harmful or Protective?
Propofol injections promote cell regeneration following injury to the sciatic nerve, according to new findings published in Neural Regeneration Research. In lab tests, investigators discovered that injecting the anesthetic into the injured sciatic nerve of mice had the effect of markedly curtailing the number of apoptic cells in L4-6 segments of the spinal cord, curbing nerve conduction block, and alleviating nerve myelin defects. The researchers concluded that propofol works by blocking damage cause by proinflammatory cytokines and by protecting the central nervous system.
 
From "Propofol's Effect on the Sciatic Nerve: Harmful or Protective?"
Phys.Org (10/31/13)
 
 

Intranasal Topical Local Anesthetic and Decongestant for Flexible Nasendoscopy in Children: A Randomized, Double-blind, Placebo-Controlled Trial
For children undergoing flexible nasendoscopy, there is no statistically significant difference in discomfort whether they received a decongestant nasal spray, a decongestant with topical local anesthetic (TLA), or a saline placebo spray, new research shows. The study looked at 69 children, ages three to 12 years, who underwent flexible nasendoscopy after receiving a nasal spray. The study's primary outcome measure was the child-reported Wong-Baker Faces Pain (WBFP) scale. Results showed that the mean child-rated WBFP scale scores were 2.4, 1.8, and 2.2 for the placebo, decongestant, and decongestant with TLA groups, respectively. These findings were statistically nonsignificant. Researchers found no correlation between the outcomes and participants' age or sex. Though the findings were not statistically significant, decongestant was still associated with the least discomfort according to child, caregiver, and observer-rated pain scale scores; it also had the lowest rating for difficulty of procedure.
 
From "Intranasal Topical Local Anesthetic and Decongestant for Flexible Nasendoscopy in Children: A Randomized, Double-blind, Placebo-Controlled Trial"
JAMA Otolaryngology–Head & Neck Surgery (10/24/2013) Chadha, Neil K.; Lam, Gilbert O. A.; Ludemann, Jeffrey P.; et al.
 
 
   
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