Anesthesia E-ssential

AANA Anesthesia E-ssential, April 18, 2019

Vital Signs

Future of Nursing 2020-2030 Initiative to Hold Regional Town Hall Meetings

The Committee on the Future of Nursing 2020-2030 is holding three regional meetings (Chicago, Philadelphia, Seattle) to hear from you. The committee is interested in insights on how to advance the profession of nursing to help our nation create a culture of health, reduce health disparities, and improve the health and well-being of the U.S. population in the 21st century. Learn more and Register.

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The Joint Commission Issues Quick Safety Alert on Drug Diversion and Impaired Healthcare Workers

The Joint Commission alert outlines the threats to patient safety posed by drug diversion, statistics on healthcare workers abusing drugs, and prevention and detection programs within organizations. Fentanyl is the most commonly diverted drug and is a leading cause of death due to opioid overdose. Opioid diversion is seen across the organization and in all clinical areas. The Joint Commission recommends that all staff learn about the organization’s Comprehensive Controlled Substances Diversion Prevention Program (CSDPP), including leadership oversight, legal and regulatory requirements, monitoring and surveillance, automation and technology, and pharmacy controls.

Joint Commission recommendations include:

  • Establishing a just culture where healthcare workers are empowered to speak up when something seems abnormal and unsafe.
  • Surveillance should focus on patterns and trends (e.g., diverting overfilled multidose vials, product containers are compromised).
  • Have systems to facilitate early detection.

Read the alert for additional recommendations on prevention, detection, and response to diversion.

Please note that the AANA recommends development of a facility policy. See AANA Position Statement and Policy Considerations: Addressing Substance Use Disorder for Anesthesia Professionals and for helpful information such as Intervention Essentials, Treatment Recommendations, and Legal Reporting.

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Hot Topics

Malpractice Insurance Coverage Options to Fit Your Needs

For 30 years, AANA Insurance Services has specialized in developing innovative malpractice insurance options for nurse anesthesia professionals. In fact, no other agency provides a wider range of coverage options for CRNAs. Caring has its risks. Learn how AANA Insurance Services can help safeguard your career.

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NewsMaker: CRNA Krogh Named Dean of SDSU College of Nursing

Mary Anne Krogh, PhD, MS, CRNA, APRN, FAAN, has been named the dean of South Dakota State University's College of Nursing, following a national search. Since June 2018, Krogh has served as Mount Marty's dean of nursing.

"My vision for the future is one that empowers people and students to meet the changes and growing opportunities in the healthcare industry," said Krogh. "We will continue to prepare future generations of nurses and hospital administrators to be leaders in South Dakota, the region, and beyond." Read more.

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NewsMaker: UPenn Dean's Award for Teaching Excellence Goes to LoriAnn Winner

The University of Pennsylvania has bestowed the 2019 Dean's Award for Teaching Excellence on LoriAnn Winner, MSN, CRNA, APN. Winner is the associate director of the DNP nurse anesthesia program. She teaches clinical fieldwork for nurse anesthesia practice I and II, basic and advanced principles of nurse anesthesia practice, and several residencies. She also writes questions for the board examination, is a section editor for the International Student Journal of Nurse Anesthesia, and serves on the NJANA board. Learn more.

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NewsMaker: CRNA Cowley to Climb Tall Peaks to Help Cancer Patients

In May, Brent Cowley, MSN, CRNA, will climb Alaska's Mount Denali (20,320 feet in elevation) on a three-week expedition. A portion of the money he raises will benefit the nonprofit Radiating Hope, which donates new and used cancer-fighting radiation equipment to developing countries.

What's unusual, however, is that Cowley will be carrying Tibetan prayer flags in honor of people who have been touched by cancer. Learn more.

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State Government Affairs

Excellence in State Government Relations Advocacy Award Presented at Mid-Year Assembly

At AANA's Mid-Year Assembly, the 2019 Excellence in State Government Relations Advocacy Award was presented to two state associations: The Michigan Association of Nurse Anesthetists (MANA) and the Oklahoma Association of Nurse Anesthetists (OANA). The AANA Government Relations Committee selects the recipients of the award, which is not tied to a specific “victory,” but focuses instead on the overall quality of the state government relations effort.

MANA’s government relations effort resulted in increased grassroots participation by its members, increased recognition for CRNAs with state legislators, and coalition efforts with other APRNs.

OANA’s advocacy effort included increased member involvement in political campaigns and fundraisers, building relationships with healthcare and community organizations, and increased public relations and media presence.

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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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Meetings and Workshops

Students and CRNAs Needed for the Anesthesia College Bowl!

The Anesthesia College Bowl is a spirited event held every year at the AANA Annual Congress. Six teams of six students each compete to answer questions about anesthesia that have been submitted by nurse anesthesia program directors. The winning student team then plays the six-member CRNA Challenge Team to determine the ultimate winner of the College Bowl. The winners hold bragging rights until the following year!

Students wishing to play must inform their program administrator, who can submit a maximum of two students to participate. The submission form is available on the AANA website under CE & Education > Education > Opportunities for Educators.

CRNAs who wish to play must submit the Challenge Team sign-up form available on the AANA website under CE & Education > Education > Opportunities for Educators.

The submission deadline for students and CRNAs is May 6, 2019. Please direct any questions to the Education Department at or 847-655-1161.

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AANA Member Benefits

Laurel Road Logo
Survey: Lacking Personal Finance Education Contributes to Fiscal Woes Later in Life

Nearly all (94%) college-educated Americans think personal finance courses should be required to graduate either high school or college, according to a new report. Findings released by national online lender Laurel Road uncover factors contributing to this demand for early financial education, which is often associated with a lack of fiscal confidence and significant savings gaps later in life, especially among women.


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CRNA: Banner University Medical Group, Tucson, Arizona

BANNER UNIVERSITY MEDICAL GROUP (BUMG) is seeking a CRNA to join our team at Banner University Medical Center – Tucson (BUMC-T). You’ll be involved in clinical management of patients, performance of therapeutic and diagnostic procedures, interpretation of diagnostic tests, prescribing medications, patient education, consultation, and research. Must be able to work autonomously as well as part of an integral team of clinicians and physicians. Banner Health and University of Arizona Health Network have come together to form Banner – University Medicine, a health system anchored in Phoenix and Tucson that makes the highest level of care accessible to Arizona residents. At the heart of this partnership is academic medicine – research, teaching and patient care – across three academic medical centers. Banner Health is one of the largest non-profit healthcare systems in the country with twenty-eight hospitals, six long term care centers and an array of other services, including family clinics, home care services and home medical equipment, in six Western and Midwestern states. Learn more.

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Allied Health CRNA (Cancer Treatment Center of America): Envision Physician Services, Philadelphia, Pennsylvania

Envision Physician Services has a special opportunity for a compassionate, dedicated CRNA for CTCA at Eastern Regional Medical Center in Philadelphia, PA. This facility is a specialty hospital and a premier provider of cancer care. The facility opened in 2005 and continues to be a state-of-the-art center offering advanced cancer treatment. This group of providers is cohesive, collegial and understanding of the special care and concern required for this patient population. Highlights of this position include: CRNA/MD Care Team Model, caseload includes a wide variety of cancer-related surgeries including general, neuro, thoracic, head and neck, Colorectal, GI and advanced endoscopic, excellent schedule, no call! Envision Physician Services offers competitive compensation and benefits plan, CME, generous time off, 401K, relocation assistance, and paid malpractice with tail coverage. Learn more.

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Assistant Professor of Nurse Anesthesia: Westminster College, Bill and Vieve Gore School of Business, Salt Lake City, Utah

MSNA faculty member will primarily teach MSNA courses to CRNA students. This is a full-time (11 month) position beginning August 1, 2019. Principle duties and responsibilities:

  • To participate in selection of students for admission to the MSNA program.
  • To conduct on-site visits with students, clinical coordinators and members of the anesthesia department, and hospital staff at clinical sites.
  • To work with students in the anesthesia simulation laboratory and oversee the ordering of supplies, care and security of simulation equipment, and organization of the simulation lab.
  • To write and proctor examinations.
  • To teach MSNA didactic courses to MSNA (CRNA) students.
  • To participate on school and college-wide committees.
  • Advise/mentor students and review research papers.
  • Serve as a resource for the adjunct instructor(s) in Advanced Physiology/Pathophysiology, Advanced Pharmacology, and Anatomy Review.

Learn more.

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Faculty (Part-Time Nurse Anesthesia): Columbia University School of Nursing, New York, New York

Columbia University School of Nursing has more than a century-long history of achievement in education, a well-known focus on clinical excellence and leadership, and nationally recognized specialty and subspecialty education programs. The School of Nursing is currently recruiting for a part-time faculty member to teach and practice in the Nurse Anesthesia specialty. The incoming faculty will teach in the MS and DNP programs, advise students, and establish or maintain a clinical practice as a Certified Registered Nurse Anesthetist (CRNA). Columbia University offers a part-time academic appointment and competitive salary commensurate with experience and credentials. Learn more.

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Director, Department of Anesthesiology: Atrium Health Central Division, Charlotte, North Carolina

Atrium Health Central Division is seeking an experienced Certified Registered Nurse Anesthetist leader to assume the role of Director, Department of Anesthesiology. The Director, Department of Anesthesiology is responsible for the strategic oversight and operational performance for 180 CRNAs and 30 Anesthesia Technical Assistants. The Director will ensure optimal, quality patient care is provided using resources in an effective and efficient manner. The Director of Anesthesiology reports to the Assistant Vice President of Metro Anesthesia. The area of accountability will include CRNAs and Anesthesia Technical Assistants for CMC, CMC Mercy, and One Day Surgery (ODS). Anesthesia cases total 62K; CMC 23K, in 33 ORs and Non OR Anesthesia Cases 18k at 18 sites. CMC Mercy 12K in 16 ORs, and ODS 9K in 11ORs. The Director is an essential member of the Peri-Operative leadership team and in coordination with the OR Director will oversee scheduling, budget and education of CRNAs and Anesthesia Technical Assistants. The Director will participate in planning and operations for the service line with key administrative, nursing, and medical leaders to meet all organizational, service line, and department goals. CMC has a Nurse Anesthesia program on site and graduates 25 students each year. 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.

Regular Cannabis Users Require Up to 220 Percent Higher Dosage for Sedation in Medical Procedures

Regular cannabis users may need more than double the amount of sedation typically required for surgery and other procedures, according to new evidence. The study looked at the medical records of patients in Colorado who had endoscopies after 2012, the year recreational marijuana was sanctioned in the state. Among 250 patients, those with daily or weekly exposure to cannabis required 220 percent more propofol to optimize sedation for routine procedures such as colonoscopy. When fentanyl or midazolam was administered, researchers noted, cannabis users needed 14 percent and 20 percent more volume, respectively, than normal. "Some of the sedative medications have dose-dependent side effects, meaning the higher the dose, the greater likelihood for problems," cautioned lead researcher Mark Twardowski, DO. "That becomes particularly dangerous when suppressed respiratory function is a known side effect." He said the study, published in the Journal of the American Osteopathic Association, represents a small first step in better understanding the metabolic effects of marijuana and identifying better care management options in this setting. Twardowski and colleagues are designing follow-up research on differences in requirements for sedation and anesthesia as well as post-procedure pain management for habitual cannabis users versus non-users.

From "Regular Cannabis Users Require Up to 220 Percent Higher Dosage for Sedation in Medical Procedures"
ScienceDaily (04/15/19)

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Checklist Helps Providers Know When Patients Need General Anesthesia Before MRI Scans

A new resource is providing greater insight into whether a child or adolescent should undergo general anesthesia (GA) prior to an MRI scan. Researchers at K.K. Women's and Children's Hospital in Singapore developed a five-item checklist that, after observing a pediatric patient, requires just a couple of minutes to complete. The questionnaire focuses on attention span, level of distraction, restlessness, and compliance with instructions. The checklist was applied to more than 700 patients scheduled for an MRI at the hospital between September 2016 and June 2017. The tool accurately predicted which minors needed GA ahead of the procedure. For both the overall population and for a subset of 124 patients younger than eight years old, researchers found that the children designated for GA were significantly younger than the patients for whom GA was deemed not necessary. They also determined that the checklist item gauging a patient's ability to follow instructions had the greatest association with no GA. The findings are published in Clinical Radiology.

From "Checklist Helps Providers Know When Patients Need General Anesthesia Before MRI Scans"
Radiology Business (04/12/19) Walter, Michael

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Once-Weekly Ketamine Infusions Keep Resistant Depression at Bay

Canadian researchers say they have uncovered a more practical strategy for administering ketamine for treatment-resistant depression (TRD). The anesthetic is associated with a rapid but short-lived decrease in depressive symptoms, so the team was interested in how to prolong the effects. Their crossover study randomized 41 adults with TRD to either a single infusion of ketamine or a single infusion of midazolam, and then switched them to the opposite treatment after one week or when depressive symptoms returned. For the second leg of the study, patients who relapsed after one infusion received six ketamine infusions, administered three times per week over 14 days. The 23 patients with a clinically significant response moved on to the four-week third phase, which measured antidepressant effects after dialing back the frequency of infusions to once per week. Scores on the Montgomery-Åsberg Depression Rating Scale held steady even after ketamine administration was reduced to once weekly. "We first demonstrated that a single infusion of ketamine was better at decreasing depressive symptoms than a placebo medication," said lead author Jennifer Phillips, PhD, of the Royal Institute of Mental Health Research in Ottawa. "We showed that administering a series of repeated ketamine infusions resulted in further decrease in depressive symptoms with each infusion and a doubling in the number of patients who responded to ketamine treatment. Third, we tested a novel maintenance strategy and showed that ketamine's antidepressant effects could be maintained when we reduced the frequency of infusions to once weekly." The full study can be found in the American Journal of Psychiatry.

From "Once-Weekly Ketamine Infusions Keep Resistant Depression at Bay"
Medscape (04/11/19) Yasgur, Batya Swift

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Sedation May Work for More Kids in Cath Lab Than Thought

New evidence indicates that operator-directed sedation (ODS) is underutilized as an alternative to general anesthesia in the pediatric and congenital catheterization lab. The study out of The Children's Hospital of Philadelphia (CHOP), which reviewed nearly 4,500 catheterizations done on more than 2,500 young patients over an approximately seven-year period, found that ODS was associated with fewer adverse events compared to general anesthesia. It additionally cut room and sheath time, accelerated exit time, and reduced both professional and hospital charges. "In combination, these findings suggest that the selective use of ODS [operator-directed sedation] can allow for greater efficiency and higher value care without sacrificing safety," CHOP researchers reported in JACC: Cardiovascular Interventions. Despite these benefits, the research team calculated that about nine out of 10 ODS cases would have been considered inappropriate under current guidelines, which recommend a cardiac anesthesiologist in high-risk catheterization cases among pediatric patients. "We propose that careful review of patient history can better identify patients in whom ODS is safe and effective and that its application can reduce resource utilization, specifically case times and costs," they suggested.

From "Sedation May Work for More Kids in Cath Lab Than Thought"
MedPage Today (04/10/19) Lou, Nicole

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IV Lidocaine/Ketorolac Combination Superior to Lidocaine Alone for Renal Colic Pain

Researchers compared the efficacy of intravenous lidocaine plus ketorolac in relation to either agent alone in cases of suspected renal colic pain. For the single-site trial, 150 patients seeking emergency care for acute flank, abdominal, or back pain were randomly allocated to I.V. lidocaine, I.V. ketorolac, or a combination of both. Based on the difference in numeric pain scores between the groups as measured 30 minutes after treatment administration, I.V. lidocaine plus ketorolac provided better analgesic relief than I.V. lidocaine alone but was no better than I.V. ketorolac alone. There were no significant adverse events or other safety concerns across all study participants, according to the research, which was published in the American Journal of Emergency Medicine.

From "IV Lidocaine/Ketorolac Combination Superior to Lidocaine Alone for Renal Colic Pain"
Renal and Urology News (04/09/19) Rothbard, Gary

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Comparative Efficacy of Oral Analgesics for Reducing Morphine Consumption After Hip Surgery

A report in the Journal of the American Medical Association suggests that oral ibuprofen safely and effectively delivers pain relief after hip surgery. The research involved 556 patients—67 years old, on average—who were scheduled for total hip arthroplasty. Based on randomized assignment, participants received 1,000 mg of paracetamol plus 400 mg of ibuprofen; 500 mg of paracetamol plus 200 mg of ibuprofen; 1,000 mg of paracetamol plus placebo; or 400 mg of ibuprofen plus placebo. The medications were administered starting one hour before surgery and at every six hours thereafter for 24 hours. At follow-up, patients in the paracetamol-ibuprofen group had used 20 mg of morphine versus 26 mg for patients who received ibuprofen only, 28 mg for patients who received half-strength paracetamol-ibuprofen, and 36 mg for patients who took paracetamol alone. "Paracetamol plus ibuprofen significantly reduced morphine consumption compared with paracetamol alone in the first 24 hours after surgery," the researchers wrote. "However, the combination did not result in a clinically important improvement over ibuprofen alone, suggesting that ibuprofen alone may be a reasonable option for early postoperative oral analgesia."

From "Comparative Efficacy of Oral Analgesics for Reducing Morphine Consumption After Hip Surgery"
Clinical Pain Advisor (04/03/19) Rice, Tyler

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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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Phone: (855) 526-2262 (toll-free)/(847) 692-7050
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Attn: Cathy Hodson
E–ssential Editor

April 18, 2019