Anesthesia Essential, November 30, 2012

Anesthesia E-ssential

November 30, 2012 

Vital Signs

New Tools Help Clinicians Ensure That Every Injection is Safe 
The Centers for Disease Control and Prevention and the Safe Injection Practices Coalition have released a suite of new materials to make it easier for healthcare providers to learn about and follow safe injection practices. Of special interest to AANA members: A Digital Press Kit includes a podcast conducted by AANA President Janice Izlar, CRNA, DNAP. Visit the special page on the AANA website for links to the new materials, and visit http://blogs.cdc.gov/safehealthcare/ for further information.

 

The Pulse

 
  • AANA Journal is now an App!
  • Nurse Anesthetists Week Promotional Materials Available Now
  • Business of Anesthesia Workshop Coming in January
  • Update on the 2013 Elections
  • Volunteers Wanted: Introducing the AANA State Reimbursement Director (SRD) Program
  • Delegate on the Education Committee: Candidates Sought
  • Nominations Sought for Federal Political Director of the Year
  • Fungal Meningitis Outbreak Information: Keep Current
 
  • Opening for COA CRNA Educator Member
  • Opening for COA CRNA Practitioner Member
 
 

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
AANA Journal is now an App!
The AANA Journal is available as an app, and issues are free to download! Click here  to download for iPad; here for iPhone; here for Android on Google; and here for Android on Amazon. Take the Journal with you wherever you go!
 
Nurse Anesthetists Week Promotional Materials Available Now
CRNAs all across the country are gearing up for the 14th annual National Nurse Anesthetists Week, to be celebrated Jan. 20-26, 2013. Promotional items, including posters, buttons, ink pens, table tents, and the ever-popular Nurse Anesthetists Week logo merchandise, including T-shirts and mugs, are available now for purchase at www.aana.com/nnaw beginning in November. Please note: Ordering is now online-only. Phone, fax, or mail orders will not be accepted.?
 
Business of Anesthesia Conference Coming in January
Make plans now to attend the Business of Anesthesia Conference on Jan. 26, 2013 at the beautiful Waldorf Astoria Hotel and golf resort in Naples, Fla. This highly successful program was originally presented prior to the 2012 Mid-Year Assembly. Past participants had this to say:
  • "Excellent, best money ever spent at an AANA meeting"
  • "Excellent content"
  • "Great speakers"
Come and learn about your economic worth as an anesthesia provider! Practical information will be presented on the nuts and bolts of billing, coding, and reimbursement options. Sessions will also explore the financial impact of various practice models on nurse anesthesia economics. Content on compliance and RAC audits, contract negotiation and legal issues will be presented Don’t miss this outstanding program; registration is limited so make your plans to attend and REGISTER TODAY!
 
Update on the 2013 Elections
This is a reminder that nominations for members for elected office and consent forms from nominees are due in the AANA office by Dec. 1, 2012. Each state association may submit one nominee for president-elect, vice president, and treasurer. In addition, state associations may submit one nominee for regional director for their region. This year, nominees for Directors of Regions 1, 4 and 5 are due on the ballot. Finally, state associations may submit one name each for the AANA Nominating Committee and the Resolutions Committee to represent their region. Also new for this year, the membership approved a proposed amendment to the Standing Rules that allows members to self-nominate, or to nominate another member as long as the nominee meets the qualifications for office found in the AANA Bylaws and Standing Rules.
 
For information regarding the electoral process, please visit http://www.aana.com/myaana/AANABusiness/electioncenter/Pages/default.aspx (member login and password required).
 
Delegate on the Education Committee Candidates Sought
Applications Due January 31, 2013
 
The AANA Education Committee is seeking candidates who are interested in serving on the committee as a delegate. The deadline for receiving completed candidate packets is Jan. 31, 2013. Click here for further information.
 
Vounteers Wanted: Introducing the AANA State Reimbursement Director (SRD) Program: Position Description for the SRD
In September, your AANA Board of Directors approved the development of a State Reimbursement Director (SRD) Progra m. The goal of this program is to establish representation from all 50 state nurse anesthesia associations for effective reimbursement advocacy in each state. With the AANA’s Federal Political Director (FPD) Program as a template, the SRD will be the point person for reimbursement knowledge and advocacy in each individual state. Like the FPD who works with Key Contact CRNAs, the SRD in each state will most likely coordinate the monitoring and advocacy work of the program through a team of involved and engaged individuals. For further information about the objectives, position requirements, and how to volunteer, click here.
 
Nominations Sought for Federal Political Director of the Year
Nominations Due: January 15, 2013
 
Nominations are sought for the Federal Political Director of the Year Award. A nominee must be a CRNA who has served as an FPD and has been active in the federal political process by their visible involvement in political campaigns, development of a close working relationship with federal officials, leading successful grassroots efforts in response to AANA requests, CRNA-PAC fundraising efforts, and recruitment of CRNAs to participate in political campaigns. Visit www.aana.com/awards for further information and a nomination form.

 
 

 
 
Fungal Meningitis Outbreak Information: Keep Current 
The Centers for Disease Control and Prevention (CDC), in collaboration with the Food and Drug Administration (FDA), state public health departments, and state boards of pharmacy, is investigating the outbreak which has been identified as fungal meningitis. The outbreak does not appear to have been caused by improper infection control practices by healthcare providers who administered the medication.The AANA has compiled resources about the outbreak and other pertinent information regarding infection control practices that are essential to our patients’ safety. To stay informed, visit http://www.aana.com/resources2/professionalpractice/Pages/Outbreak-Information.aspx
 
 

 
 
Opening for COA CRNA Educator Member
Deadline: March 15, 2013
The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is seeking nominations for a CRNA Educator Member. Candidates must be available to attend three-day COA meetings, typically held in January, May, and October. The term of office is for three years, fall 2013 through fall 2016. The individual then would be eligible to be considered for reelection.
 
Candidates must meet the following requirements:
  • 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 such things as:
    Attendance at the Assembly of School Faculty.
    Attendance at local, state and national meetings of the AANA.
    Election or appointment to a position in the AANA.
 
To apply, submit the following by March 15, 2013, to Barbara Farkas, Senior Accreditation and
Education Specialist: bfarkas@coa.us.com
  • Letter of Intent to Serve
  • Current Curriculum Vitae (résumé)
  • Letter of Recommendation
  • Biographical Form—available on the COA’s website at home.coa.us.com
Only complete applications will be considered.
 
Note: Correction to November NewsBulletin Announcement
The announcement on page 21 for the "Opening for COA Educator Member" incorrectly stated that candidates "must have no significant association with a school of anesthesia." We apologize for the editorial error.
 
 
Opening for COA CRNA Practitioner Member
Deadline: March 15, 2013
The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is seeking nominations for a CRNA Practitioner Member. Candidates must be available to attend three-day COA meetings, typically held in January, May, and October. The term of office is for three years, fall 2013 through fall 2016. The individual then would be eligible to be considered for reelection.
 
Candidates interested in the CRNA Practitioner Director position 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 a CRNA practitioner.
  • Is actively involved in the profession, as evidenced by such things as:
    i. Attendance at national assemblies.
    ii. Attendance at local, state, and national meetings of the AANA
    iii. Previous election or appointment to a position in the AANA.
To apply, submit the following by March 15, 2013, to: Barbara Farkas, Senior Accreditation and Education Specialist bfarkas@coa.us.com
  • Letter of Intent to Serve
  • Current Curriculum Vitae (resume)
  • Letter of Recommendation
  • Biographical Form – available on the COA’s website at home.coa.us.com

Only complete applications will be considered.
 
 
 

 
 

 
 
 
Personality Predicts Placebo Effect
In a discovery that could improve the accuracy of clinical studies, researchers report that people who embody certain personality traits are more likely to experience pain relief from a placebo. Building on their earlier finding that drew a correlation between placebo analgesia and activity in the part of the brain involving rewards and pleasure, the University of Michigan team evaluated 47 healthy volunteers. The investigators assessed the personality characteristics of the test subjects, who also were subjected to a standard pain challenge while lying in a positron emission topography (PET) scanner. The results—based on activation of endogenous opioid receptors in the brain as recorded by the PET scan, volunteers' own pain assessments, and placebo-induced changes in the stress hormone cortisol—indicated that individuals who are straightforward, resilient, and altruistic are more receptive to the placebo effect as opposed to those who are angry and hostile. Moreover, they also presented lower cortisol levels and greater activation of opioid receptors in brain regions associated with reward—the reward in this case being pain relief. Lead researcher Jon-Kar Zubieta believes that identifying such study participants also will help to more effectively prove a drug's true effect. "Many trials fail not because the compound doesn't work, but because placebos are also effective, which creates noise," he says. The study is published in Neuropsychopharmacology.
 
From "Personality Predicts Placebo Effect"
The Scientist (11/16/12) Cossins, Dan
 
 

Scientists Probe Strategies to Curb Hospital-Acquired Infections
A recent study tested whether an ultraviolet light emitting robot could disinfect hospital rooms after patients had been discharged. In the 28 rooms where patients infected with vancomycin-resistant enterococci or Acinetobacter stayed, there was a more than 90 percent reduction in colony-forming units than before UV treatment. Of the 17 UV-treated rooms that housed patients infected with Clostridium difficile, zero yielded cultures of the organism. Duke University's Deverick J. Anderson noted that the machines cost about $100,000 and that the UV disinfection process adds 20 minutes to 45 minutes to the time it takes to clean a hospital room. However, a typical hospital-acquired infection costs $30,000 to $50,000, so "you don't have to prevent that many to make [UV disinfection] cost-effective," he said. A separate study of 43 hospitals led by Susan Huang of the University of California tested ways to handle ICU patients who carried methicillin-resistant Staphylococcus aureus (MRSA). Some hospitals were instructed to continue with screening and isolation, others were assigned to screen patients for MRSA and do targeted decolonization (applying mupirocin in the nose and bathing the patient in chlorhexidine daily), and a third group of hospitals was assigned to decolonize all ICU patients without screening. The team found that universal decolonization was most effective at reducing MRSA infections in the ICU, with a 37 percent reduction in the risk of MRSA colonization and a 44 percent reduction in bloodstream infections. There were few adverse events among patients who received the chlorhexidine baths, the most common of which were mild rashes that resolved after discontinuing the baths. The investigators believe that using chlorhexidine and mupirocin in this manner involves little risk, said Huang, although clinicians will need to monitor whether the wide use of such techniques could foster resistance to these agents.
 
From "Scientists Probe Strategies to Curb Hospital-Acquired Infections"
Journal of the American Medical Association (11/28/12) Vol. 308, No. 20, P. 2069 Kuehn, Bridget M.
 
HH Story 2 Reference
 

Corps Seeks Smaller Portable Anesthesia Machine
The Marine Corps Systems Command says it is searching for a compact "field ruggedized and modernized" anesthesia machine that weighs less than 10 pounds and could fit in a person's hand, according to a request for information from the defense industry. The system would replace existing heavy and bulky draw-over vaporizers (DOVs), which are no longer approved for use by the U.S. Food and Drug Administration and are restricted to training purposes. Officials at MARSYSCOM and the Naval Medical and Health research centers want to find out what kinds of devices companies have on the market. DOV equipment used in field hospitals can weigh as much as 200 pounds, and "typically have to operate with dedicated ventilators and support equipment," Marine officials say. "The only unit cleared for marketing in the United States went out of production ... in about 2007," says Shoshona Pilip-Florea, a Navy Bureau of Medicine and Surgery spokeswoman. "Since then, the DoD has been going to extraordinary efforts to keep the existing units serviceable." The Marine Corps plans to seek FDA approval for a replacement system, and it could potentially be adopted by all the services, she says.
 
From "Corps Seeks Smaller Portable Anesthesia Machine"
Marine Corps Times (11/18/12) Fuentes, Gidget
 

Anesthetic Choice May Not Be Critical in Noncardiac Surgery
A multi-center study led by Swiss researcher Giovanna Lurati Buse found no evidence that choice of general anesthetic impacts the risk for myocardial infarction following noncardiac surgery. Buse and colleagues at University Hospital Basel monitored 385 patients, all of whom presented a risk for cardiovascular complications. In the randomized trial, subjects were given either propofol or sevoflurane; and a like number—40.3 percent and 40.8 percent, respectively—experienced myocardial ischemia within 48 hours of their procedure. Postoperative delirium occurred at a similar rate—14.4 percent for propofol and 11.4 percent for sevoflurane—and the incidence of major cardiac trauma in the 12 months after surgery was not statistically significant between the two groups, at 8.5 percent and 7.6 percent, respectively. The findings, published in Circulation, contradict existing preliminary evidence of lower risk for negative ischemic outcomes when patients at cardiovascular risk are administered volatile anesthetics when having noncardiac surgery. That position is supported by American College of Cardiology/American Heart Association guidelines.
 
From "Anesthetic Choice May Not Be Critical in Noncardiac Surgery"
News-Medical.net (11/14/2012) McDermid, Eleanor
 
 
Memory Loss, Thinking Problems After Surgery the Subject of UF Research
A new study hopes to narrow down which patients are most at risk of cognitive dysfunction—a loss of memory and thinking abilities—following surgery. The condition has long been observed in older adults, about 40 percent of whom are challenged immediately after a procedure by changes in their memory, in their ability to do more than one task at a time and in their ability to absorb new information. Some suffer these problems for months. While the cause is unknown, experts suspect the length and type of surgery, as well as the type and dose of anesthesia given, may play a role. To get a better idea, University of Florida assistant professor Catherine Price and her team will utilize brain imaging to identify biomarkers associated with cognitive decline. They are embarking on a five-year study of 80 patients at least 60 years of age who are undergoing total knee replacement. The research will entail pre- and postoperative administration of MRI scans and cognitive testing, to be compared against 80 subjects who share similar age, education, and health traits but who are not having surgery. "We believe the current study is going to give us useful information about patient risk factors and surgery variables that we can then apply toward intervention programs," Price says. "We will eventually be able to identify patients who need extra monitoring or certain anesthetic or surgical procedures, based on pre-surgery brain and cognitive status. This will promote an ideal postoperative recovery even for the most at-risk individuals."
 
From "Memory Loss, Thinking Problems After Surgery the Subject of UF Research"
HealthCanal.com (11/13/12)
 
 
CDC, Others Look at Antibiotic Resistance
Twenty-six organizations, including the American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC), have issued a consensus statement that calls attention to antibiotic resistance, an issue involved in "Get Smart About Antibiotics Week." The statement represents a commitment to address this growing problem, noting that healthcare personnel, patients, policymakers, researchers, and pharmaceutical companies all share responsibility. "We must remind ourselves that antibiotics are a shared resource, and every individual should consider how each prescription or use of antibiotics impacts the overall effectiveness of the antibiotic arsenal," said Dr. Arjun Srinivasan, associate director for healthcare-associated infection prevention programs for the CDC. "How we use and protect these precious drugs must fundamentally change." New data from the Center for Disease Dynamics, Economics, & Policy's Extending the Cure project show that the average number of prescriptions per 1,000 people declined by 17 percent from 1999 to 2010.
 
From "CDC, Others Look at Antibiotic Resistance"
MedPage Today (11/13/12) Neale, Todd
 
 

Decision Tree-Based Learning to Predict Patient Controlled Analgesia Consumption and Readjustment
Recent research conducted at National Chiao Tung University in Taiwan on patient-controlled analgesia (PCA) illustrates the feasibility of using data mining to help anesthesia providers predict analgesic requirements and PCA readjustment. Each of the 1,099 patients in the study was described by 280 attributes, emphasizing attributes related to PCA. Using decision tree-based learning algorithms based on initial PCA medication use, researchers estimated analgesic use and PCA control readjustment. Total analgesic consumption (continuous dose and PCA dose) achieved prediction accuracy of 80.9 percent and PCA analgesic requirement (PCA dose only) reached 73.1 percent. The researchers also employed a nearest neighbor-based data cleaning method to address the class-imbalance problem in forecasting PCA setting readjustment, which improved the performance of all learning methods in this study. In predicting use of analgesics, decision tree-based learning proved more accurate than other models such as Artificial Neural Network, Support Vector Machine, Random Forest, Rotation Forest, and Naive Bayesian. Pain management that is well-handled enables patients to regain mobility more quickly and to be hospitalized for a shorter period and at a lower cost.
 
From "Decision Tree-Based Learning to Predict Patient Controlled Analgesia Consumption and Readjustment"
7thSpace (11/14/12) Hu, Yuh-Jyh; Ku, Tien-Hsiung; Jan, Rong-Hong; et al.
 
 

Human Models Could Be Way Forward for Assessing Analgesic Efficacy
Researchers from Goethe University say human experimental pain models could potentially be used to gauge the clinical efficacy of analgesics in phase I clinical studies. They noted that finding novel analgesics is challenging, as pain cannot be measured directly in animal models and human trials. Furthermore, the human body detects painful stimuli in several ways, and each mechanism responds to a different type of analgesic. In a review of available literature that was published in the British Journal of Pharmacology, the researchers found that human experimental pain models were better able to predict the efficacy of an analgesic than believed previously. The overall prediction of analgesic efficacy or drug failure was also found to closely correlated with experimental and clinical settings. "Not using these pain models in drug development seems to be unjustified—in fact they should be used routinely in drug development programs," remarked one of the authors, Bruno Oertel. But the researchers also said the correct selection of a model requires more detailed information about which model predicts which clinical pain condition. They hypothesized that if an analgesic drug were effective in an experimental pain model and in a clinical setting, the model might be predictive for a particular pain clinical setting and should be preferred for testing analgesics targeted at that particular pain condition.
 
From "Human Models Could Be Way Forward for Assessing Analgesic Efficacy"
News-Medical.net (11/13/2012) Mahendra, Piriya
 
 
MD Trainees Wary of Ordering Opioids for Chronic Pain
A new study indicates that many physicians-in-training are reluctant to prescribe opioid analgesics for long-term pain management. The study, led by the University of Mississippi Medical Center's Ike I. Eriator, was presented at the 2012 annual meeting of the American Pain Society. The study researchers asked 93 trainees and 16 medical students about their pain treatment practices, of whom 45 percent said they treated chronic pain on a regular basis. Twenty-one percent of the respondents said they felt comfortable treating chronic pain, while 34 percent said it depended on the situation. But 81 percent reported feeling uncomfortable prescribing long-term narcotics for chronic pain patients. The most common concern with prescribing long-term narcotics was the risk for chemical dependency or addiction (37 percent), followed by escalating opioid doses and legal considerations. Eriator said the study results could help revise pain management training to focus more on areas where residents may require more knowledge. "At an anesthesiology meeting several years ago, we presented data that showed residents' knowledge of acute pain treatment varied across specialties," he said. "For instance, orthopedic residents were more likely to attribute increasing requests for medication to the development of tolerance, while family medicine residents would attribute it to addiction," he observed.
 
From "MD Trainees Wary of Ordering Opioids for Chronic Pain"
Anesthesiology News (11/01/12) Vol. 38, No. 11 Hawkins-Simons, Dana
 
 
 
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