Anesthesia E-ssential

AANA Anesthesia E-ssential, April 11, 2019

Vital Signs

Join the Enhanced Recovery SIG Live From ASER

Join the Enhanced Recovery Shared Interest Group (SIG) panel live from the American Society for Enhanced Recovery (ASER) annual meeting on Thursday, April 25 at 5 p.m. CST for a presentation, discussion, and Q&A session regarding the latest enhanced recovery guidelines, CRNA experiences and leadership opportunities in implementation of enhanced recovery initiatives. Register for the webinar.
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Save the Date: AANA State Leadership Workshop, June 22-23, 2019, in Nashville

Save the date for the AANA State Leadership Workshop, "Taking the Show on the Road," June 22-23, 2019 in Nashville, Tenn.

These leadership workshops are designed for state leaders to effectively lead and govern state associations. Join your peer leaders for this interactive day and a half workshop and be inspired and engaged to:
  • Conduct an effective crucial conversation and learn how to influence change for positive outcomes.
  • Describe the applied skills in emotional intelligence and understand how this relates to your role as a state leader.
  • Develop strategies for improving association board governance.
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Healthcare Advocate Recognized for Commitment to Anesthesia by Professional Association

Stephen Smith, a Certified Registered Nurse Anesthetist (CRNA) and resident of Alpharetta, Ga., received the 2019 Daniel F. Vigness Federal Political Director of the Year Award from the American Association of Nurse Anesthetists (AANA) during the AANA’s Mid-Year Assembly held in Washington, D.C. Smith is the 18th recipient of the award. Learn more.
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Hot Topics

Coming This Week in Building Brydges

  • Inspirational CRNAs Advocating for our Future
  • “Evidence and Economics” working for you
  • A Successful Mid-Year Assembly: The Highlights
Stay tuned for the latest Building Brydges blog post, coming your way this Friday, April 12.
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Have a Question for the AANA Board of Directors Candidates?

The AANA Connect 2019 Board Candidate Forum is now available for members to interact with candidates for the AANA Board of Directors. The forum will remain open until May 8, 2019. After that date, members will be able to view the forum through the end of the voting cycle (May 21, 2019), but won't be able to post additional questions.

Go to Candidate Forum

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2018 MIPS Preliminary Feedback Information Now Available On QPP Website

The 2018 merit-based incentive payment system (MIPS) data submission period ended on April 2, 2019, and preliminary MIPS performance feedback data is now available through the Quality Payment Program (QPP) website. It does not include the Final Score, which will be available in July 2019.

CRNAs can view their preliminary feedback data using the Health Care Quality Improvement System (HCQIS) Access Roles and Profile (HARP) credentials that became effective January 2019. There is a QPP Access User Guide video to assist you if you need to sign up for a HARP account. Questions about MIPS performance feedback can be submitted to or by calling 1-866-288-8292. 
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Keep Track of Legislative and Regulatory Issues Affecting Your State or Region

With legislative and regulatory challenges increasing in frequency and intensity, it is important for you to understand how state legislation can affect your ability to practice. Visit State Government Affairs – Member Resources for information on important state healthcare policy issues affecting CRNAs, the State Update (published quarterly), and an interactive map highlighting the status of all state bills being tracked by the AANA, in your state and nationwide.
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April 27: Do Your Part for National Prescription Drug Take-Back Day

This year, National Prescription Drug Take-Back Day will be Saturday, April 27, 2019, from 10 a.m. - 2 p.m. This important date is a safe, convenient and responsible way to dispose of unused or expired prescription drugs.

Last year brought in more than 900,000 pounds of unused or expired prescription medication. This brings the total amount of prescription drugs collected by the Drug Enforcement Agency (DEA) since the fall of 2010 to 10,878,950 pounds.

To locate a collection site near you, go to the DEA's Take Back Day site.

For further information, visit the AANA website.
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How Much Do You Know About Your Employer-Provided Malpractice Insurance?

If you are covered by your employer’s malpractice insurance, it is important to know the parameters of your policy. For a list of questions to ask your employer, answers to frequently asked questions, and the benefits of having a supplemental policy, visit AANA Insurance Services’ Employed CRNA Toolkit.
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SRNAs: Apply for Student Representative to the Education Committee

The AANA Education Committee members include a student representative. The student representative facilitates the AANA Connect SRNA Community, contributes content to the AANA for SRNAs Facebook page, and writes the Student News column for the AANA NewsBulletin.

In addition, the student representative will participate in the efforts and mission of the Education Committee. The committee supports the professional development of nurse anesthesia didactic and clinical educators. Primary activities of the committee include planning the Assembly of Didactic and Clinical Educators (ADCE) meetings and the Student Session at Annual Congress. The committee also hosts the Student Luncheon and Anesthesia College Bowl at Annual Congress.

Students interested in education who wish to run for the position of Student Representative to the Education Committee can obtain an application from the AANA website under CE & Education > Education> Opportunities for Students. The application must be submitted by May 6, 2019 to The election will be held at Annual Congress.

Questions? Contact the Education department by e-mail or at 847-655-1161.
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PR Recognition Awards Deadline: Here Before You Know It!

Each year 15-20 entries are received from state associations, CRNAs or SRNAs, educational programs, businesses and others for the PR Recognition Awards competition coordinated by the AANA Communications Committee. Awards are presented in four categories:
  1. Best overall public relations effort for the past year, to be awarded to an individual, organization, or state association.
  2. Best promotional effort for National CRNA Week, to be awarded to an individual, organization, or state association.
  3. Best public relations effort by an individual, small group, organization or company not affiliated with a state association.
  4. Best use of “CRNAs: The Future of Anesthesia Care Today” campaign to promote the nurse anesthesia profession by an individual, organization, or state association.
All entries are judged by the committee onsite the day before the opening of the Annual Congress, and the winners are recognized during Opening Ceremonies. Detailed information about the competition, along with entry guidelines, can be found on the AANA website.

Winners will receive a plaque to commemorate their achievement, and their names will be added to a PR Awards exhibit on permanent display in the AANA Executive Office in Park Ridge, Ill.

Please note:

  • The deadline for entries is earlier than usual because this year’s Congress is taking place in August rather than September. The deadline is Friday, June 7. Late entries will not be considered.

For additional information or answers to questions about the PR Awards, please contact PR Department Administrative Associate Karen Sutkus at or 847-655-1140.

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April 2019 AANA Journal Highlights

The April 2019 AANA Journal features articles on:

Perioperative Considerations in Patients with Concussion
The authors engage in an evidence-based review of an important social and clinical topic: the concussed patient. Given the enormous press in the lay literature, especially with regards to sports-related concussion and long-term sequelae, this current paper will prove to be of great interest to AANA Journal readers. Seeking best evidence for caring for patients who have suffered concussion and who, in its aftermath, require anesthesia is a domain in need of illumination.

High-Fidelity Mannequin Simulation vs Virtual Simulation for Recognition of Critical Events by Student Registered Nurse Anesthetists
This article adds to our systematic understanding of the role of simulated experiences in the education and training of nurse anesthetists. Moving away from simple “perceptions of the subject” and into more quantitative analysis, this study provides more scientific analysis of the role of simulation and curricular enterprise, with some potential generalization beyond early training to ongoing continuing education of veteran providers.

To Block or Not to Block: Role of Ultrasonography in Guiding an Anesthetic Plan for a Patient with Charcot-Marie-Tooth Disease
Through a case study, the controversial management of the most common sensory/motor pathology that the CRNA is likely to be called upon to manage is discussed. The approach taken is carefully rationalized, and while some may have issues with the care rendered, the discussion is highly evidence-based and addresses important issues related to the care of such afflicted patients.

A Randomized Controlled Trial of Anesthesia Guided by Bispectral Index vs Standard Care: Effects on Cognition
The authors performed a randomized controlled trial (RCT) that is particularly relevant to contemporary practice: the effect of careful anesthesia dosing using quantitative instrumentation and its role in preventing short- and long-term postoperative cognitive dysfunction (POCD). The neurotoxic effects of anesthetics on the young and old brain are controversial, and this important study is a systematic effort to better define our role in modifying the genesis of POCD.

Cardiovascular Complications in Patients Undergoing Noncardiac Surgery: A Cardiac Closed Claims Thematic Analysis
The AANA’s closed claims analysis team led an effort that provides increasing insight into themes associated with nurse-anesthesia-based malpractice claims. Using a qualitative research process, five common themes were revealed that offer great insight into the genesis of these events, and consideration of how such events can become ‘never-events’ through targeted education and training.

A Primer to Pharmacogenetics of Postoperative Pain Management
The authors review the role that genetics play in the variable responses to drug and procedural interventions that we see virtually every day in the patients that we care for. In particular they examine the role of how genetics influence pain management, a topic all readers have a vested interest in.

Impact of Education on Professional Involvement for Student Registered Nurse Anesthetists’ Political Activism: Does Education Play a Role?
A survey of Pennsylvania training/education programs was performed to address questions regarding political activism and activism. This very unique study searched for educational program attributes and how those might influence the subsequent affect on students’ interest and behaviors regarding an increasingly important professional role.

Prevention and Treatment of Laryngospasm in the Pediatric Patient: A Literature Review
We’ve all been there, often with a mixture of growing anxiety and thoughtful composure. Here the authors discuss laryngospasm in the young patient, its causes, how we might best prevent it, and when it does occur, treatment approaches. All grounded in systematic review and emerging evidence-based decision making.

AANA Journal Course: Update for Nurse Anesthetists—Assessing Frailty and Its Implications on Anesthesia Care and Postoperative Outcomes in Surgical Patients
The author provides a valuable service to our profession with this CEU offering related to patient “frailty,” a quantifiable metric that is gaining increasing traction in the surgical, geriatric, and most recently, anesthesia literature. The role of frailty metrics in predicting short- and long-term outcome is presented in a state-of-the-art review.

AANA Journal ONLINE Content
And don’t miss four interesting and compelling Letters to the Editor, as well as the Education News that looks at an innovative “Pediatric Airway Rotator Program” that assessed the impact of a program that involved eight multidisciplinary groups as they obtained first-hand experience in pediatric airway management.

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NewsMaker: Retired Brig. Gen. William Bester Helps Recruit Veterans Into Nursing

In an interview with the Duluth News Tribune, retired Brig. Gen. William Bester, CRNA, talks about his efforts and the efforts of The College of St. Scholastica, Duluth, Minn., to recruit veterans into nursing, and to help veterans who are transitioning from military service into the civilian and academic environment.

"What I've been involved in with [The College of St.] Scholastica over the last four years is they received a pretty significant grant that focuses on trying to recruit veterans into the profession of nursing," says Bester. "The program pursues veterans who have some pretty good experience to try to consider nursing as a profession. We've built a model at Scholastica. We've hired a couple of veterans who are on the nursing faculty. Each year, this group of veterans is mentored and supported by the veteran faculty members and other faculty and staff members. And it provides a little special attention to these veterans and helps them transition from the military environment back to civilian environment, and then even more so to the college environment." Learn more
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NewsMaker: CRNA Creates Community Center for Special Needs Kids

Kate Bryan, CRNA, has a dream of building a community center ("Legacy Fields") that caters to everyone, including special needs children, according to the Northwest Florida Daily News. She has a two-phased plan for the community center. The first phase is to have a sensory studio and play station where children with all ability levels are welcome.

The second phase will be an expanded space for health, wellness and physical education training, in part to attract talented staff and to keep talent in the community. Learn more
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Meetings and Workshops

Now Open: Abstract Submission Process for 2020 Assembly of Didactic and Clinical Educators

You are invited to submit an abstract for consideration to present at the 2020 Assembly of Didactic and Clinical Educators(ADCE) on February 19-22, 2020, at the Chateau Elan Winery & Resort, Atlanta, Ga. The ADCE is the only forum that brings together all nurse anesthesia programs nationwide. Please visit the Call for Abstractspage on the AANA website for the Submission Guidelines and Content Questions.

The ADCE provides a variety of educational topics that will develop the maximum effectiveness of CRNAs in their roles as program administrators, didactic and clinical educators in diverse settings across the nation. Attended by hundreds of CRNAs, it is an excellent opportunity to present your best practices and research pertinent to education to your peers and nurse anesthesia students interested in becoming educators.

Build your reputation as an expert speaker while elevating your thought leadership. Get exposure to hundreds of top nurse anesthesia program decision-makers. All speakers are promoted in marketing materials that reach thousands of CRNAs and SRNAs leading up to the conference, and on the AANA website and AANA Meetings mobile app.

The ADCE goals are as follows:
  1. Provide an organized learning experience that augments the knowledge and skills of the CRNA in all educational settings.
  2. Serve as a forum to present best practices and research pertinent to nurse anesthesia didactic and clinical education.
  3. Facilitate interaction and networking between participants on a professional and social level.

Submission Deadlines and Notifications
  • Submission Deadline: April 16, 2019, at 11:59 p.m. CST.
  • Grading Deadline: May 20, 2019.
  • Notification Deadline: All presenters will be notified of their acceptance status no later than July 8, 2019.
Still have questions about the submission process after reviewing the website? Contact
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Foundation and Research

AANA Foundation
Apply Now: AANA Foundation’s Health Policy Program Award to attend George Mason University Health Policy Institute, June 3-6, 2019

Application Deadline: April 25, 2019

The AANA Foundation is supporting 3-5 qualified individuals to attend the George Mason Health Policy Institute program at George Mason University in Arlington, Va., on June 3-6, 2019. 

The program aims to educate CRNAs and SRNAs regarding leadership strategies to influence health policy that advances healthcare in the United States. Recipients of the Foundation’s Health Policy Program Award will be expected to be available to the AANA to provide expertise in their focused topic area through June 2021.

Up to $2,500 will be awarded for lodging, airfare, food, transportation and tuition in accordance with the AANA Foundation expense policy. Access the application on the AANA Foundation website and apply by April 25, 2019.
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AANA Foundation
Deadline Extended: State of the Science General and Oral Poster Session Applications

Deadline Extended: May 1, 2019

The deadline has been extended for the AANA Foundation’s ‘State of the Science’ General and Oral Poster Sessions which will take place at the AANA 2019 Annual Congress on August 9-13, 2019, in Chicago, Illinois. The poster application can be found on the Foundation website under Applications and Programs. Apply today!

If you have any questions, please contact the AANA Foundation at (847) 655-1170 or

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AANA Foundation
General Research Grant: Spring Application Now Open

Deadline: May 1, 2019

One of the goals of the AANA Foundation is to support new and seasoned investigators in nurse anesthesia through grants. Grant applicants must be submitted by AANA members who will use the funds for a research project and must discuss the research's relevance to the mission of the AANA Foundation. The mission of the AANA Foundation is to advance the science of anesthesia through education and research. The AANA Foundation sets a broad research agenda that includes the following areas:
  • Healthcare policy
  • Science of anesthesia
  • Education
  • Practice/Clinical
  • Leadership
More information and the grant application can be found on the Foundation website under Applications and Programs. Apply today!

If you have any questions, please contact the AANA Foundation at (847) 655-1170 or
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AANA Member Benefits

Motorcycle Safety: Being Seen by Other Drivers

Whether you’re a new driver or an old pro, motorcycle safety is something that should be practiced every time you get on your bike. But there’s a lot you can’t control out there – including other drivers. Here are some practical tips from Nationwide for staying visible and vigilant on the road.

April Motorcycle Safety
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Certified Registered Nurse Anesthetist: Memorial Health System, Springfield, Illinois

This position embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision and values. Our CRNAs administer general, regional, and MAC anesthesia to patients of all ages and any ASA status. The CRNAs work in a collaborative team environment with 50 CRNAs, 21 Anesthesiologists and 12 Anesthesia Techs to assist with room turnover and stocking. The CRNAs serve as Clinical Instructors for Southern Illinois University-Edwardsville (SIUE) and Millikin/Decatur Nurse Anesthesia programs. Due to our continued growth, Memorial Medical Center has multiple needs for Certified Registered Nurse Anesthetists. Positions are available full time in the Main OR or as a split 50/50 between Main OR and CVOR. Learn more.
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Certified Registered Nurse Anesthetist: Sanford Health Physician Recruiting Office, Fargo, North Dakota

Sanford Health Fargo Anesthesia Department is currently seeking Certified Registered Nurse Anesthetists (CRNAs) to join its current group of 21 anesthesiologists and 72 CRNAs. Department provides anesthesia for approximately 28,000 cases per year at two hospitals as well as a freestanding ASC. All specialties are represented, with the exception of heart or liver transplants. Department practice is the Anesthesia Care Team model. Family Birth Center epidural service is CRNA managed 24/7. Strong relationships within our department and with the surgical staff. SRNA clinical site for two nurse anesthesia programs. Excellent compensation, relocation allowance and benefits. Learn more.
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Nurse Anesthetist: WellSpan Health, York, Pennsylvania

WellSpan Health, an integrated health system serving central Pennsylvania and northern Maryland, has openings for six (6) full time and 4 part-time CRNAs to join Apple Hill Surgical Center in York. The organization is comprised of a multispecialty medical group of more than 1,500 physicians and advanced practice clinicians, a regional behavioral health organization, a home care organization, eight respected hospitals, more than 19,000 employees, and 170 patient care locations. Must be board certified. CRNAs with prior Ambulatory experience are encouraged to apply. Exciting opportunity to join an established surgical center. Case mix includes: GI, Plastics, Urology, General, ENT, Peds, Podiatry, Ortho and Ophthalmology. Enjoy a well-balanced lifestyle, excellent hours and schedule and no call. Competitive salary and outstanding benefits. Learn more.
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Instructional Academic Staff: University of Wisconsin-Oshkosh, Oshkosh, Wisconsin

Implement and facilitate teaching activities of the Nurse Anesthesia didactic, clinical, and simulation nursing curriculum that achieve program objectives. The Job Requirements include: Masters degree related to Nurse Anesthesia program of study with willingness to complete doctorate degree within mutually agreed upon time. PhD, DNP or DNAP degree preferred. Current certification as a Certified Registered Nurse Anesthetist. Unencumbered license as Registered Nurse in Wisconsin. Advanced practice nurse prescriber (APNP) in Wisconsin. Active, recent nurse anesthesia clinical practice preferred. Learn more.
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How Does Your Career Grow?

Are you looking to further your career? CRNA Careers is a valuable resource to help you both in your job search and with your career advancement. It's more than a job board. CRNA Careers is where those searching for fulfillment, opportunity, and challenges go to find helpful career tips, search for jobs, and upload anonymous resumes to be found by recruiters and employers.

Here's how to grow your career on CRNA Careers:

  • Seek and find the best jobs in your industry.
  • Set up job alerts to be notified when the jobs you're looking for are posted on the site.
  • Upload your anonymous resume and allow employers to contact you.
  • Access career resources and job searching tips and tools.

Growing your career requires regular care and cultivation. CRNA Careers has the tools to move your career toward your goals. Learn more today!


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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.

Cervical Nerve Root Block Effective on Cervical Herpes Zoster-Related Burden

Researchers evaluated the efficacy of ultrasound-guided cervical nerve root block (CRB) in the setting of acute cervical herpes zoster (HZ). They recruited 140 patients aged 50 years and older with cervical HZ and zoster-associated pain, all of whom received a week of oral antiviral therapy plus treatment with pregabalin and analgesics as necessary. One-half of the participants were then randomly assigned to CRB and the other half to placebo. The primary outcome was burden of illness scores at 30 days, which were better for patients in the active-treatment group not only at that interval but also at 30–90 days and at 90–180 days. Moreover, participants who underwent CRB were less likely to experience postherpetic neuralgia (PHN) at 90 days compared with 180 days, required less analgesic consumption, and reported a bigger improvement in their quality of life than placebo-takers. There were no serious adverse events. "We concluded that ultrasound-guided CRB combined with steroid as an early intervention during acute phase of HZ could effectively reduce the burden of illness due to acute HZ associated pain in the cervical dermatome region, and might be a feasible preventive strategy to reduce the incidence of PHN," the researchers noted. The findings appear in Pain Practice.

From "Cervical Nerve Root Block Effective on Cervical Herpes Zoster-Related Burden"
Clinical Pain Advisor (04/08/19) May, Brandon

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OR Air Contamination Standards Needed to Control SSI Risk

Microbial aerosol particulates already present in the operating room (OR) or introduced when the doors are opened elevate the risk for surgical site infections, according to new research. The 18-month study, led by Charles E. Edmiston Jr., PhD, an emeritus professor of surgery at the Medical College of Wisconsin, analyzed in situ air samples from dozens of separate surgical procedures. Coagulase-negative staphylococci were found in 86 percent of air samples and Staphylococcus aureus was recovered from 64 percent of air samples. "Nasopharyngeal shedding from the person participating in the operation was identified as the source of many of these airborne contaminants—failure of the traditional surgical mask to prevent microbial implants, especially in procedures lasting longer than 90 minutes," Edmiston explained. However, he added, technology is available that can clean the air to substantially reduce the risk for contamination and infection of surgical wounds. Existing engineering standards measure particle size to determine the effectiveness of a hospital's air circulation system, according to Edmiston, but he argues that measuring viable particulates instead of total particulates is more useful. He is urging the United States to take its cue from Europe, where proposed standards would allow no more than 50 CFU/m3 of aerosol microbial contamination in general ORs and less than 10 CFU/m3 for orthopedic, cardiac, and transplant ORs.

From "OR Air Contamination Standards Needed to Control SSI Risk"
Anesthesiology News (04/05/19) Rosenthal, Tom

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Chloroprocaine Is Associated with Faster Recovery and Earlier Patient Discharge From Ambulatory Knee Arthroscopy

A Dutch study compared chloroprocaine and prilocaine for spinal anesthesia in patients undergoing ambulatory knee arthroscopy. After randomly allocating study participants to one approach or the other, researchers discovered several benefits of preservative-free, plain 2-chloroprocaine 1%. Compared with hyperbaric prilocaine 2%, the agent was associated with a 15-minute faster progression to complete recovery from motor blockade. Chloroprocaine also achieved onset of sensory block twice as quickly as prilocaine and reached full regression of sensory block in 120 minutes compared with 165 minutes with prilocaine. Additionally, patients who underwent the procedure with spinal chloroprocaine were discharged home a full hour sooner than patients who received spinal prilocaine. "The results confirm earlier observations that both short-acting spinal anesthetics chloroprocaine and prilocaine result in adequate anesthesia with quick recovery of sensory and motor functions for knee arthroscopy in the ambulatory setting," the researchers reported. Chloroprocaine may be a better option, however, because speedier recovery improves patient flow—which is both clinically and economically advantageous to patients and institutions alike. Researchers plan to present the findings at the 44th Annual Regional Anesthesiology and Acute Pain Medicine Meeting in Las Vegas, Nev., on April 11.

From "Chloroprocaine Is Associated with Faster Recovery and Earlier Patient Discharge From Ambulatory Knee Arthroscopy"
Newswise (04/02/19)

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Intraoperative Methadone in Same-Day Ambulatory Surgery

Intraoperative methadone lowers opioid demand and curbs postoperative pain during same-day ambulatory surgery, report researchers from Washington University in St. Louis. The team assembled a study population of 60 participants scheduled for major inpatient surgery, randomly assigning 40 to receive a single intravenous dose of methadone intraoperatively. The remaining 20 patients received usual care: repeat doses of short-acting opioids, such as fentanyl and hydromorphone, administered as necessary. The main outcome was in-hospital consumption of opioids, which was reduced with an intraoperative dose of methadone as compared to the conventional practice of providing short-duration opioids on an as-needed basis. According to home diaries kept by patients for 30 days post-surgery, meanwhile, the methadone recipients experienced less pain at rest and used fewer opioids than the patients in the control group. Investigators also determined that the benefits of I.V. methadone were most effective with a single 0.15 mg/kg ideal body weight dose.

From "Intraoperative Methadone in Same-Day Ambulatory Surgery"
Anesthesia & Analgesia (04/19) Vol. 128, No. 4, P. 802 Komen, Helga; Brunt, L. Michael; Deych, Elena; et al.

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Randomized Clinical Trial of Liposomal Bupivacaine Transverse Abdominis Plane Block Versus Intrathecal Analgesia in Colorectal

Research indicates that transverse abdominis plane (TAP) block can be substituted for neuraxial analgesia in many abdominal operations, with colorectal surgery being a notable exception. In pursuit of more evidence to support this application, researchers performed a multisite study and analyzed results from 200 participants undergoing elective small bowel or colorectal resection. Roughly half were randomized to liposomal bupivacaine TAP block, with the others assigned to single-injection intrathecal (IT) opioid administration with hydromorphone. Patients were evaluated at 4, 8, 16, 24, and 48 hours following surgery; and the primary endpoints were mean pain scores and morphine milligram equivalents (MMEs) administered within 48 hours of surgery. Patients in the TAP treatment arm had a 1.6-point greater mean pain score than the IT group at 4 hours postoperatively, a difference that persisted for 16 hours. The TAP group also received more MMEs within the first 24 postoperative hours than the IT group, but consumption levels were about the same at 24 and 48 hours. While IT opioid administration delivered better postoperative pain relief than TAP block immediately after colorectal surgery, both techniques generated low pain scores and are viable elements for multimodal postoperative analgesic strategies.

From "Randomized Clinical Trial of Liposomal Bupivacaine Transverse Abdominis Plane Block Versus Intrathecal Analgesia in Colorectal"
British Journal of Anaesthesia (03/19) Colibaseanu, D.T.; Osagiedge, O.; Marchea, A.; et al.

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Nitrous Oxide Occupational Exposure in Conscious Sedation Procedures in Dental Ambulatories

Italian researchers examined the potential occupational health risks of nitrous oxide, which is commonly used for conscious sedation but could be dangerous to medical staff at certain environmental concentrations. The setting for their pilot study was the dental ambulatories at Bambino Gesù Children's Hospital in Rome. Investigators analyzed gas concentrations during outpatient sessions where young patients received conservative care or had teeth pulled. The mean environmental concentration of nitrous oxide during the sessions was 24.7 ppm, and an association was drawn between dentists' and dental assistants' exposure to the gas and concentrations of it in their urine. The environmental concentration values yielded from the study are below the reference value of 50 ppm cited in regulations in force on nitrous oxide concentration. Still, the researchers conclude, their findings can inform future technical standards and system requirements for dental ambulatories, which must differentiate from guidance on gas concentrations in surgical theatres.

From "Nitrous Oxide Occupational Exposure in Conscious Sedation Procedures in Dental Ambulatories"
BMC Anesthesiology (03/27/19) Vol. 19, No. 42 Zaffina, S.; Lembo, M.; Gilardi, F.; et al.

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Boys Rescued From Thai Cave Were Sedated with Ketamine

Ketamine was a critical element of the mission to rescue a youth soccer team from a cave in Thailand last year, according to new details reported in the New England Journal of Medicine. A letter written by an Australian anesthesia provider and three Thai medics who participated in the daring mission revealed that divers dosed the 12 boys with the powerful anesthetic to avoid panic as they were guided out of Tham Luang cave. The drug was also selected for its anti-shivering properties, which was important given the threat of hypothermia. The boys were also wrapped in blankets to fight off hypothermia, and they donned full-face masks supplying oxygen and wetsuits. Australia's Richard Harris, one of world's two cave-diving anesthesiologists, feared the plan would fail. "I expected the first two kids to drown and then we'd have to do something different," he told National Geographic. "I put their odds of survival at zero."

From "Boys Rescued From Thai Cave Were Sedated with Ketamine"
CNN (04/04/19) Hunt, Katie

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News summaries © copyright 2019 SmithBucklin

Anesthesia E-ssential is an executive summary of noteworthy articles of interest to nurse anesthetists. It is distributed weekly to AANA members.

Anesthesia E-ssential is for informational purposes, and its contents should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

If you are interested in advertising in Anesthesia E-ssential contact HealthCom Media at 215-489-7000.

For more information on AANA and Anesthesia E-ssential, contact:

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Park Ridge, IL 60068
Phone: (855) 526-2262 (toll-free)/(847) 692-7050
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Attn: Cathy Hodson
E–ssential Editor
April 11, 2019
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