AANA Anesthesia E-ssential
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Vital Signs

Now Open: AANA Connect Community for Candidates for the AANA Board of Directors

The AANA Connect Community for Candidates for the AANA Board of Directors became available on April 4, 2016, after candidates were introduced at the Mid-Year Assembly. All AANA members are able to interact with Board candidates during the voting cycle. The Candidate Forum is your place to interact with candidates and ask questions. The Forum will be available until the voting cut-off date of May 17, 2016. To participate:

  1. Join the community
  2. Find the candidate to whom you'd like to ask a question
  3. Click "Reply to Discussion" next to thread
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CPC Facts

CPC Exam Spoiler Alert: It is between 8 and 17 years away

The myth is that the CPC Exam will start “soon” and that CRNAs don’t feel ready for it. But did you know that although the CPC Program launches August 1 of this year, the first exam that certificants will take is not required to be completed until 2024 or 2025? That’s at least eight years from now, depending on the certificant’s initial year of certification (odd/even). Did you also know that your performance on that exam will not affect certification? The purpose of that first CPC Exam is to help each CRNA evaluate their strengths, as well as any areas they may want to strengthen. The second exam, the Passing Standard Exam, will not need to be taken until either 2032 or 2033, again, depending on the certificant’s original year of certification (odd/even). That's 16-to-17 years away.

For more information about the NBCRNA's Continued Professional Certification (CPC) Program, which will launch on Aug. 1, 2016, go to the cpc-facts.aana.com and NBCRNA websites.

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Hot Topics

#AANA2016 Registration Now Open!

Registration is now open for the 83rd AANA Annual Congress, September 9-13, 2016, in Washington, D.C. Look for the Preliminary

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NEW! 2016 PQRS Webinar Archive Available on myAANA Research

If you missed the live program titled “2016 PQRS Essentials for CRNAs” that took place on Thursday, April 14, 2016, and was presented by SCG Health expert Jennifer Searfoss, you can now view or download the meeting materials oln Quality Resources by logging on to myAANA.

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Dwayne Self Named Federal Political Director of the Year

Congratulations go to Dwayne Self, CRNA, of Canton, Miss., who received the 2016 Daniel F. Vigness Federal Political Director of the Year Award from the AANA during the Mid-Year Assembly held in Washington, D.C. Self is the 15th recipient of the award. The Daniel D. Vigness Federal Political Director of the Year Award was established in 2001 by the AANA Board of Directors to acknowledge the CRNA who makes the greatest strides in advancing the AANA’s federal healthcare agenda through grassroots political activities as a Federal Political Director. A nurse anesthetist for more than 30 years, Self is well known to local, state, and federal legislators for his political involvement. His efforts have helped make the Mississippi Association of Nurse Anesthetists a well-known healthcare organization in the state capital of Jackson. Most notably, he is credited with leadership that prevented provider discrimination in reimbursement, and with passing regulations which would have critically restricted the practice of Advanced Practice Registered Nurses in Mississippi. Of note, two different governors appointed the Mississippi native to the Mississippi Board of Nursing in 2003, 2004, and 2007.

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CMS Call on “2016 PQRS Reporting: Avoiding 2018 Negative Payment Adjustments”

Centers for Medicare & Medicaid Services (CMS) will be hosting a live educational call on April 21 from 3 to 4:30 p.m. ET. The speakers will provide an overview of the 2016 PQRS and related resources and cover guidance and instructions on how individual eligible professionals and PQRS group practices can get started, satisfactorily report/participate, and avoid the 2018 PQRS negative payment adjustment. A question-and-answer session will follow the presentation.

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2016 PQRS Group Practice Reporting Option (GPRO) Registration Is Now Open

Group practices defined as 2 or more eligible professionals (EPs) who have reassigned their billing rights to a single Taxpayer Identification Number (TIN) can register to participate in the 2016 PQRS GPRO via the CMS Physician Value-PQRS Registration System by June 30, 2016.  Group practices must meet the 2016 satisfactory reporting criteria through the PQRS GPRO in order to avoid the 2018 PQRS payment adjustment.  For more information on GPROs, please visit our new “2016 PQRS Reporting Mechanisms for Group Practices”.

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Professional Practice

Volunteer Opportunities with Health Volunteers Overseas

Health Volunteers Overseas (HVO) has a pressing need for volunteers:

  • Anesthesia professional needed to go with a team to Mbarara University of Science and Technology in Mbarara, Uganda from April 28-May 10, 2016. Funding is provided. For more information, please contact Andrea Moody at a.moody@hvousa.org.
  • Nurse educators, including nurse anesthetists, needed in Bhutan, Cambodia, Tanzania, Uganda, and Vietnam.

Details about these projects are available on the HVO website.

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State Government Affairs

New Laws Advance Florida and West Virginia APRN Practice

New Florida and West Virginia laws will implement changes that advance the practice of CRNAs and other APRNs. The Florida laws (House Bill 1241 (enacted) and House Bill 423 (awaiting governor’s signature)) add controlled substances to APRN prescriptive authority and clarify “ordering” in hospitals and ASCs that is distinct from prescribing. The West Virginia law (HB 4334) removes some restrictions on APRN prescriptive authority.

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Rhode Island Association of Nurse Anesthetists Wins New AANA State GR Award

Congratulations to the Rhode Island Association of Nurse Anesthetists, winner of the first Excellence in State Government Relations Advocacy Award! This new award is based on the quality of the state government relations effort undertaken by a state nurse anesthetist association and will be presented annually at the AANA’s Mid-Year Assembly.

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Meetings and Workshops

Register Now for Business of Anesthesia Conference

On June 24-25, join the AANA for a two-day conference on Chicago’s Magnificent Mile that will arm you with critical tools for navigating the business aspects of anesthesia practice. Get real-world advice from expert speakers with experience in building and maintaining a successful practice.

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Save the Dates for These Popular Hands-On Workshops

Visit Meetings for further information and to register!

Jack Neary Pain Management Workshop

  • Rosemont, IL
  • April 23-25, 2016

Jack Neary Pain Management Workshop II

  • Rosemont, IL
  • October 29-30, 2016

Upper and Lower Extremity Nerve Block Workshop

  • AANA Foundation Learning Center
  • March 19-20, 2016
  • September 24-25, 2016

Essentials of Obstetric Analgesia/Anesthesia Workshop

  • AANA Foundation Learning Center
  • April 20, 2016
  • November 2, 2016

Spinal and Epidural Workshop

  • AANA Foundation Learning Center
  • April 21-23, 2016
  • November 3-5, 2016
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Foundation and Research

Attention Researchers: Application Deadlines May 1

Applications are available for Post-Doctoral and Doctoral Fellowships, “State of the Science” General Poster Presentations, and Research Grants. The deadline date for submission is May 1, 2016.

Visit the applications and program information page on the AANA Foundation website.

If you have any questions, please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com. Thank you!

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Federal Government Affairs

CRNAs, SRNAs Blanket Capitol Hill during 2016 Mid-Year Assembly

With more than 1,200 attendees, the 2016 Mid-Year Assembly witnessed a record-breaking number of Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs) take to Capitol Hill to advocate on behalf of America’s patients, Veterans, and nurse anesthesia practice. After hearing from leaders in healthcare policy and experts in grassroots and political advocacy, Mid-Year Assembly attendees congregated on the west front lawn of the U.S. Capitol for the AANA’s second annual Rally for Nurse Anesthesia. During the event, AANA President Juan Quintana, DNP, MHS, CRNA, presented Senators Jeff Merkley (D-OR) and Mike Rounds (R-SD) the AANA’s 2016 National Health Leadership Award for their support of nurse anesthesia and introduction of Senate legislation (S. 2279) to expand Veterans’ access to care by granting Full Practice Authority to CRNAs and other APRNs in VHA facilities.

AANA members then met with hundreds of federal legislators and congressional staffs to urge support for S. 2279 and its House companion legislation (H.R. 1247), as well as for policies that strengthen rural healthcare and fund CRNA and APRN workforce development. AANA members can view all issue one-pagers on CRNA PAC (login required).

The CRNA-PAC Committee also extends a thank you to attendees for their strong support of AANA’s political efforts. During Mid-Year Assembly, CRNA-PAC raised more than $100,000 and saw a record number of students join the PAC at the Capitol Club level ($25+). These generous contributions, made in conjunction with the PAC’s Bootleggers’ Ball and at other points during the meeting, will serve a critical role in amplifying the profession’s voice in Washington.

Finally, thank you to the CRNAs and SRNAs who took time out of their busy schedules to represent the nurse anesthesia practice in Washington, DC. Here are a few reminders as you reflect on your experience:

  • Let the AANA Washington office know how your Capitol Hill meetings went by submitting the lobby report form provided to you in your Mid-Year Assembly after-action email from the AANA.
  • Remember to follow-up. If your lawmaker pledged to do something, follow-up via email starting this week. If you have questions or need assistance, please contact info@aanadc.com.
  • Write thank you notes to the legislators and congressional aides you met. You can find their office addresses at House.gov or Senate.gov.
  • Share your photos and favorite moments on Facebook and Twitter with the hashtags #AANAMYA and #CRNAs4Vets, or email them to info@aanadc.com, including the names of persons shown in a picture from left to right.

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Update: Expand Veterans Access to Care through Full Practice Authority for VHA CRNAs, APRNs

The AANA continues to work with a broad coalition of groups in support of improving Veterans access to care through Full Practice Authority for CRNAs and other APRNs at the VHA. Here is a brief rundown of activities to keep members apprised of current actions

  • Legislation: The AANA continues to encourage members of the U.S. House of Representatives to cosponsor the “Improving Veterans Access to Quality Care Act” (H.R. 1247) and members of the Senate to cosponsor the “Veterans Health Care Staffing Improvement Act” (S. 2279). The bills currently have 48 and 8 bipartisan cosponsors respectively.
  • Appropriations: The House and Senate Appropriations Committees were scheduled to mark up their respective Military Construction, Veterans Affairs, and Related Agencies appropriations bills for the 2017 Fiscal Year on April 13-14. The AANA continues monitoring the progress of these bills (not yet numbered).
  • Regulation: The White House Office of Management and Budget (OMB) continues to evaluate a proposed rule on APRN Full Practice Authority submitted by Veterans Affairs Secretary Robert McDonald in early January. The OMB has until early April to publish the rule in the Federal Register and trigger a 60-day public comment period, or return it to the VHA for more work. AANA continues urging all members to use Veterans Access to Care to submit regulatory comments ahead of time in support of improving Veterans access to quality healthcare through CRNA and APRN Full Practice Authority. AANA members can also share the site with colleagues, friends, and family—especially Veterans—to take action.
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AANA Submits Funding Requests to House and Senate Appropriations Subcommittees on Labor, Health and Human Services, Education and Related Agencies for Fiscal Year 2017

On March 24, the AANA submitted a written statement for the record to the House and Senate Appropriations Subcommittees on Labor, Health and Human Services, Education, and Related Agencies specifically requesting funding for APRN and CRNA related programs. The statement, submitted by AANA President Juan Quintana, DNP, MHS, CRNA, requested that the committees include $66 million for advanced education nursing out of a total Title 8 budget of $244 million. These numbers represent increases of $1.419 million and $14.528 over FY 2016 enacted levels respectively.

In addition, the AANA requested that the committees include report language supporting at least $5 million for nurse anesthesia education. The testimony stated, “This funding request is justified by the safety and value proposition of nurse anesthesia, and by anticipated growth in demand for CRNA services as baby boomers retire, become Medicare eligible, and require more healthcare services.”

Read the Senate testimony, developed to coincide with the funding requests made by The Nursing Community.

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AANA Urges the Health Care Payment Learning & Action Network (LAN) to Emphasize the Role of CRNAs and Anesthesia in Elective Joint Replacement Bundles

In a March 28 comment letter to the LAN regarding its draft white paper, “Accelerating and Aligning Clinical Episode Payment Models: Elective Joint Replacement,” the AANA requested that the LAN emphasize the important role of CRNAs and anesthesia in elective joint replacement bundled payment.

The letter, signed by AANA President Juan Quintana, DNP, MHS, CRNA, stated, “Anesthesia professionals, such as CRNAs, play an integral role in these episodes of care as proper anesthesia services management can make a tremendous difference in terms of improving patient flow, patient safety, and ultimately in cost savings. Conversely, research shows that suboptimal care in the preoperative, intraoperative, or postoperative phases of surgery may compromise care, resulting in poor patient outcomes and unnecessarily higher healthcare costs. Anesthesia is a portion of the variable costs associated with elective joint replacement procedures. We urge that the white paper emphasize the strategic consideration of the role of anesthesia delivery that is safe and cost-efficient and include the use of techniques such as Enhanced Recovery After Surgery (ERAS) programs, which help reduce costs and improve patient outcomes.”

Read the AANA Comments on draft white paper and the draft white paper.

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Upcoming Presidential and Congressional Elections

The AANA encourages CRNAs to vote and be active in primary elections this spring in support of candidates of their choice. If you are involved in one of the following primary or caucus campaigns below, AANA DC would be delighted to hear from you. Tell your story or send your pictures to info@aanadc.com with “CRNAs in Campaigns” in the subject line.

  • April 16, Republican presidential convention in Wyoming
  • April 19, presidential primary in New York
  • April 26, presidential primaries in Connecticut, Delaware, Maryland, Pennsylvania, and Rhode Island; congressional primaries in Maryland and Pennsylvania
  • May 3, presidential and congressional primaries in Indiana
  • May 7, presidential caucus in Guam
  • May 10,presidential and congressional primaries in Nebraska and West Virginia

For an up-to-date list of 2016 election dates by state and by date



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  • The impact of small healthcare mergers was the focus of an April 8 article in the New York Times.
  • Engage with your profession’s social media feed on Facebook and Twitter.
  • Keep up with the AANA’s new efforts for educating hospital administrators, healthcare policymakers and other health industry leaders about the role and value of CRNA care at Future of Anesthesia Care Today.
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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.

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Visit www.crnacareers.com to view or place job postings

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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.

Painkiller Critics Take Aim at Hospital Surveys, Procedures

Dozens of nonprofit organizations and medical experts dispatched a letter April 13 lobbying the highly influential Joint Commission—a hospital accreditation agency—to revamp pain management strategies used at hospitals. They worry that existing procedures and patient questionnaires unintentionally result in addictive drugs being prescribed unnecessarily. Viewing pain as a vital sign is at the root of the problem, says Michael Carome, MD, of Public Citizen, which endorsed the letter. "All pain was viewed as being bad and so it pushed providers too often to over-prescribe opioids," he remarks. Critics also say surveys that inquire about how a patient's pain was managed while hospitalized inadvertently encourage liberal use of opioid analgesics in order to score high in the area of patient satisfaction. With that in mind, Physicians for Responsible Opioid Prescribing—the same group that mobilized the letter campaign—also filed a petition to have certain pain-related questions stricken from hospital surveys. It is asking the federal government to propose a new questionnaire within 90 days.

From "Painkiller Critics Take Aim at Hospital Surveys, Procedures"
Associated Press (04/13/16)

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AAE 2016: Study Evaluates Anesthetics for Endo Treatments

The 2016 American Association of Endodontists meeting, held in San Francisco on April 7, included research presentations on different anesthetic options for endodontic procedures. One study out of Ohio State's dentistry school compared the efficacy of intraseptal injections of articaine and lidocaine. The 100 dental patients who participated received one of each treatment in mandibular first molars, but on separate days. Assessment of injection pain and postoperative pain, as well as changes in heart rate, were found to be comparable between to the two agents. However, with anesthetic success rates of only 35 percent for articaine and 28 percent for lidocaine, the researchers determined that primary intraseptal injection is not effective enough to warrant its use. Another study from the same university examined the use of supplemental intraseptal injections to treat symptomatic irreversible pulpitis in cases when the conventional approach—inferior alveolar nerve block (IANB)—fails. Of 100 study participants needing emergency treatment for the condition, IANB was effective for 25 percent; the rest were given intraseptal injection to provide pain relief after the block failed. The technique was successful for only 29 percent of those patients, however.

From "AAE 2016: Study Evaluates Anesthetics for Endo Treatments"
Dr. Biscupid (04/11/16) Domino, Donna

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Current Nerve Stimulation Thresholds Insufficient in Diabetic Neuropathy

Guidelines for using electrical peripheral nerve stimulation to direct needle placement during peripheral nerve block may be ineffective. While stimulation currents of 0.3 to 0.5 mA are recommended, researchers say that threshold may not work for patients with diabetic neuropathy and could even lead to nerve injuries. They tracked 55 patients with diabetes and 52 without who had lower-limb surgery under popliteal sciatic nerve block. "[We observed] a direct correlation between the duration of diabetes mellitus and the stimulation threshold for the CPN (common peroneal nerve), the nerve that is typically more affected by diabetic neuropathy than the TN (tibial nerve)," the investigators reported in the British Journal of Anesthesia. A total of 12 diabetic patients needed stimulation currents of 2 mA or greater to elicit a motor response, compared with just two non-diabetic participants. Also, four patients with diabetes experienced intraneural needle placements, compared to just one patient without diabetes. The findings suggest that "nerve stimulation is not as reliable as previously thought and even more so in patients with diabetic neuropathy," according to the researchers. "It is therefore advisable to use additional tools such as ultrasound to decrease the risk of potentially harmful intraneural injections."

From "Current Nerve Stimulation Thresholds Insufficient in Diabetic Neuropathy"
Neurology Advisor (04/08/16) Loguidice, Christina T.

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HHS Releases National Pain Strategy

Coordinated care, professional education, and prevention are the building blocks of a new National Pain Strategy developed by the U.S. Department of Health and Human Services. It is the federal government's first campaign targeting chronic pain, a condition that affects millions of Americans. Pain care providers, patient advocates, insurers, scientists, and other experts contributed their perspectives in formulating the strategy—which recommends workplace changes to prevent repetitive tasks that can cause injuries. In addition, it strives to deliver more education about pain to medical students—an area that is currently lacking. The initiative also takes a "biopsychosocial" approach to chronic pain sufferers, hopefully with better tools that allow coordinated care at all levels. Because the National Pain Strategy also offers opportunities to move away from opioid analgesics, it goes hand in hand with the Centers for Disease Control and Prevention's recent opioid prescribing guidelines, says Linda Porter, PhD, a National Institutes of Health official and member of the working group that shaped the report.

From "HHS Releases National Pain Strategy"
Medscape (04/07/16) Anderson, Pauline

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Study Reveals Retained Blood as Common Culprit Leading to Acquired Infections After Heart Surgery

German researchers warn that Retained Blood Syndrome (RBS), which occurs when chest tubes to evacuate blood around the heart and lungs clog up, presents a risk for infection and other complications following cardiac surgery. The study included about 6,900 subjects—more than 19 percent of whom needed surgical reinterventions to address complications related to RBS. Hospital-acquired infections occurred much more frequently in those patients, the investigators found. Higher mortality rates, extended hospital and ICU stays, longer ventilator time, and greater incidence of hemodialysis were also all associated with RBS. The findings were presented at the Society of Cardiovascular Anesthesiologists 2016 Annual Meeting and Workshops, held this month in San Diego.

From "Study Reveals Retained Blood as Common Culprit Leading to Acquired Infections After Heart Surgery"
Business Wire (04/06/16)

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Similar Results Seen With Liposomal Bupivacaine Injection vs Modified Ranawat Suspension After TKA

A prospective study of 105 patients having total knee arthroplasty determined that liposomal bupivacaine delivers similar postoperative pain relief as a modified Ranawat suspension. About half of the study population received a periarticular injection of anesthetic, with the remainder receiving a modified Ranawat suspension. Pain levels and other outcomes were evaluated periodically over six weeks after surgery. In addition to pain relief, liposomal bupivacaine was comparable to Ranawat suspension in terms of active knee range of motion, length of stay, and discharge to home or rehab. Although the liposomal bupivacaine cohort initially used more narcotics than the Ranawat suspension group, the difference became statistically insignificant after the second postoperative day. Patients receiving liposomal bupivacaine also exhibited improved walking distances, but not meaningfully so.

From "Similar Results Seen With Liposomal Bupivacaine Injection vs Modified Ranawat Suspension After TKA"
Healio (04/05/2016) Jaramillo, Monica

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Why Are Black Patients Undertreated for Pain?

Various studies indicate that African-American patients are routinely undertreated for pain compared with white patients suffering similar symptoms, with new research suggesting that dynamic may be driven in part by provider bias. University of Virginia investigators probed white medical students and residents about their beliefs concerning biological differences between the races. While many of them failed to correctly identify truthful statements—like African Americans are more vulnerable to heart disease—researchers were surprised that more than 50% agreed with untrue, and sometimes far-fetched assumptions—such as nerve endings are more sensitive in white patients. Additionally, respondents who bought into such falsehoods often assigned lower pain scores to African Americans. The study also presented medical students and new physicians with case studies involving one patient from each race. Their assessments of pain and subsequent treatment advice for each scenario were then compared against those of 10 experienced doctors who reviewed the case studies without racial identifiers. "What we found is those who endorsed more of those false beliefs showed more bias and were less accurate in their treatment recommendations," said lead investigator Kelly Hoffman, a doctoral candidate in psychology.

From "Why Are Black Patients Undertreated for Pain?"
Washington Post (04/05/16) P. A3 Somashekhar, Sandhya

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More Than Half of Fentanyl Patch Prescription Use Remains Unsafe

About 50 percent of fentanyl patches are prescribed for people without the necessary previous opioid exposure, according to a new study published in the Canadian Medical Association Journal. The 25 mcg/h fentanyl patch is recommended for people who have already used an opioid equivalent to 60 mg morphine a day for at least a week. However, the 12-year analysis revealed that 74 percent of cases had prior opioid use deemed insufficient. The researchers also found that 18 percent of first-time patients started with higher than recommended doses. During the study period, the rate of unsafe prescribing dropped from 87 percent to 50 percent. The study found that women and older adults were more likely than men and younger adults to have inadequate prior opioid exposure.

From "More Than Half of Fentanyl Patch Prescription Use Remains Unsafe"
Medical News Today (04/05/16) Brazier, Yvette

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Local Liposomal Bupivacaine Linked With Reduced Need for IV Opioids, Analgesics After Surgery for Gynecologic Malignancy

Mayo Clinic researchers evaluated the efficacy of replacing bupivacaine HCL with liposomal bupivacaine (LB), a slow-release form of the analgesic, for local wound infiltration during surgery for gynecologic cancer. When included as part of an enhanced recovery after surgery (ERAS) protocol—a multidiscipline approach of best practices designed to accelerate and improve postoperative recovery—positive outcomes were achieved. Patients having complex cytoreductive surgery with LB reported similar pain levels to historical controls treated with bupivacaine HCL; but their cumulative need for opioids, need for rescue intravenous analgesics, and need for patient-controlled analgesia were meaningfully less. The LB group additionally experienced ileus and postoperative nausea at a lower rate than the control group. There was, however, no significant difference between the two cohorts in terms of length of hospital stay, 30-day complications, and health care and pharmacy costs—although these markers had shown improvement in other studies. Lead researcher Sean Dowdy, MD, speculates that these benefits were not observed in the Mayo investigation because "we had already optimized the perioperative care" through ERAS.

From "Local Liposomal Bupivacaine Linked With Reduced Need for IV Opioids, Analgesics After Surgery for Gynecologic Malignancy"
Cancer Therapy Advisor (03/31/16) Aymes, Shannon

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Modeling Shows Potential Cost Savings With Capnography Monitoring

Research shows that capnography monitoring results in fewer patients experiencing multiple adverse events (AEs) during procedural sedation for endoscopy. Used in conjunction with standard care—which consists of pulse oximetry and visual assessment—that subsequent 27% decrease yields savings that more than offset the upfront expensive of the monitor and the cost of disposables. The findings may discredit worries about costs and clinical value, which have limited the use of capnography monitoring in sedated patients. Researchers demonstrated the economic viability of the approach using a decision tree model that compared outcomes with standard of care against outcomes with standard of care plus capnography during gastrointestinal endoscopy. The model indicated that 34.18 percent of patients suffered an AE under the standard of care protocol, compared to 24.89 percent who also had capnography monitoring. "Reduced adverse events led to reduced incidence of adverse incomes," said Rhodri Saunders, DPhil of Switzerland's Ossian Health Economics and Communications, "and increased patient safety led to a mean cost savings with capnography of $85 per procedure."

From "Modeling Shows Potential Cost Savings With Capnography Monitoring"
Anesthesiology News (03/30/16) Doyle, Chase

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Epidural Injections Effective for Managing Chronic Spinal Pain

Epidural injections can successfully manage a range of spinal conditions—including disk herniation, central spinal stenosis, and postsurgery syndrome—a new systematic review confirms. The project encompassed 52 randomized trials that were judged on the strength of their evidence. On a scale of I through V, with I representing the highest quality, researchers identified Level II to III evidence backing the use of epidural injections to manage chronic spinal pain. Study co-author Laxmaiah Manchikanti, MD, founder and chairman of the American Society of Interventional Pain Physicians, said the results give epidural injections more credibility as a pain management tool. Earlier studies suggesting that it is not a viable approach, he noted, skewed the findings by using a local anesthetic injection as a placebo. Because data indicates that local anesthetics may work even better than steroids, he explained that using a treatment with equal or greater efficacy as a baseline essentially made it impossible to demonstrate epidural injections as effective.

From "Epidural Injections Effective for Managing Chronic Spinal Pain"
Pain Medicine News (03/29/2016) Raj, Ajai

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Researchers Warn of Pediatric 'Ultrarapid' Metabolizers of Oxycodone

Researchers warn that genetics may influence how oxycodone is metabolized in children, sometimes with fatal results. According to estimates, about 5 percent to 10 percent of the white population are "ultrarapid metabolizers" who can absorb high concentrations of the drug in very little time. Genetic testing might have saved the lives of two pediatric tonsillectomy patients, later identified as members of this population, who developed apnea and died after taking oral codeine following their 2007 procedures. This type of screening could eventually become part of the standard of care for children, speculates Patcharee Sriswasdi, MD, an anesthesia instructor at Boston Children's Hospital. A study she spearheaded found that of 20 children studied, some took four hours or longer to absorb less than 4 ng/mL of oxycodone, while others absorbed up to 10 ng/mL in a much shorter time frame. "By using pharmacogenomic analysis, you may be able to know which drug they'll respond to, so you can customize the analgesia and make the patient as comfortable as possible," she says.

From "Researchers Warn of Pediatric 'Ultrarapid' Metabolizers of Oxycodone"
Anesthesiology News (03/25/16) Vlessides, Michael

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

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April 15, 2016
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