Anesthesia E-ssential

AANA Anesthesia E-ssential, April 25, 2019

Vital Signs

Tonight! 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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Hot Topics

New-to-Practice Discount for Recent Grads

Recent grads can save up to 50% on full-time and supplemental malpractice insurance premiums through AANA Insurance Services. No matter the practice setting, AANA Insurance Services has a policy option to fit your needs. For a quote or to get in contact with a knowledgeable account representative who specializes in the state or states you plan to practice in, visit our Get A Quote page.

For more information see AANA Insurance Services.
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Call for Health & Wellness and Substance Use Disorder Articles

Interested authors invited! Join the Health & Wellness and Peer Assistance Advisors committees in supporting CRNAs and SRNAs by writing a Wellness Milestones or Peer Assistance News article for the AANA NewsBulletin. Learn more about submitting an abstract for consideration at or
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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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Deadline: May 6, 2019
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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NewsMaker: CRNA Aaron Villarreal Opens Hygia Pain Institute in New Mexico

Aaron Villarreal, NSPM-C, CRNA, APRN, has opened the Hygia Pain Institute in Las Cruces, N.M. Villarreal uses a holistic approach to pain management at the institute with tailor-made care plans that provide optimal results for each patient.

In an article in The Las Cruces Bulletin, Villarreal explains that with his holistic approach, "not only do patients take responsibility by getting involved in their own care, but other health and wellness specialists are also brought into the process. That could mean instructing the patient to lose weight, practice yoga or meditate, or sending the patient to see a physical therapist, a chiropractor or psychiatrist."
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Certified Registered Nurse Anesthetist: MedStar Medical Group, Maryland

MedStar Medical Group Anesthesiology (MMGA) is a wholly owned subsidiary of MedStar Health, the largest health system in the region. MMGA is comprised of nearly 400 anesthesia providers delivering care in 12 facilities to more than 120,000 patients, annually. Our focus is on our providers and our patients. By recruiting and retaining the best clinicians, we ensure our patients receive superior anesthesia care. In order to recruit/retain the “best of the best,” we’ve developed a comprehensive compensation plan, robust benefits package, and continuously work to ensure our providers achieve a work/life balance. Due to our continuous growth and maturity, we are seeking full-time, high quality, experienced Certified Registered Nurse Anesthetists (CRNAs) in our Baltimore/DC locations. CRNAs at MedStar enjoy a great work-life balance, excellent environment to practice in, access to our tertiary hospitals, and a multitude of other competitive benefits! Our CRNA practice includes various case types including: orthopedics, general, pediatrics, vascular, GI, GYN, OB, EP, IR, cardiac, and more! Learn more.
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Midwestern Academic Setting - Join University of Missouri's CRNA Team in Columbia, Missouri

University of Missouri Department of Anesthesiology is seeking additional CRNAs to join their dynamic academic health center in mid-Missouri, home to the only children's hospital and Level I Trauma Center between St. Louis and Kansas City. A tremendous opportunity to join a group of energetic, self-motivated and culturally diverse faculty and staff with a strong commitment to support the growth in surgical volumes and expansion of surgical facilities. Home to the University of Missouri (MU), and two other colleges, Columbia is an educational center with an eclectic feel. It serves as a medical, technological and cultural base for central Missouri. Columbia's non-student population is around 120,000. Columbia is well known for its cultural events and venues and is consistently recognized as one of the top places to live in the U.S. Residents can enjoy theater, art galleries, comedy clubs, symphony and a variety of concert venues, including the popular Blue Note. Come join us and make Columbia and central Missouri your home! Learn more.
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Graduate Faculty - Doctor of Nursing Practice Degree Program with Nurse Anesthesia: Marian University, Indianapolis, Indiana

The Leighton School of Nursing at Marian University in Indianapolis seeks a dynamic and innovative leader to serve as the Assistant Program Director for the Certified Nurse Anesthesia Program. The Assistant Program Director assists the Program Director in the daily operations of the Doctoral of Nursing Practice in Nurse Anesthesia Program and assists in assuring compliance with the Council on Accreditation of Nurse Anesthesia Educational Program’s Standards and Guidelines. This position is for a doctoral-prepared Certified Registered Nurse Anesthetist (CRNA) who is experientially qualified to assist the program administrator and if required, assume leadership responsibility for the program. The Assistant Program Director serves as designee for the Program Director, is the coordinator of clinical requirements, and teaches classes as assigned. 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.

Anxiety Sensitivity May Predict Higher Rates of Postoperative Nausea, Vomiting

A high level of anxiety can predispose surgical patients to postoperative nausea and vomiting (PONV), researchers report. Their observational study involved 135 women aged 18 to 75 years old who had elective surgery under general anesthesia. PONV was documented in 56 patients—or more than 41 percent—within 24 hours of their mostly general, gynecological, or urologic procedures. Among the PONV population, 87.5% had higher anxiety sensitivity scores, while only 65.8% of the non-PONV patients scored high on anxiety evaluations. Participants who developed the complication also tended to be younger, to have not received PONV prophylaxis, to have been exposed to postoperative opioids more often, and to have had laparoscopic surgery more frequently. The study results are published in the European Journal of Anaesthesiology.

From "Anxiety Sensitivity May Predict Higher Rates of Postoperative Nausea, Vomiting"
Clinical Pain Advisor (04/18/19) Morr, Madeline

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Tapping Patients' Wisdom for C-Section Pain Management

New study findings highlight a shift away from traditional pain control practices used during and after Cesarean section. Women undergoing surgical childbirth today generally receive the same anesthetic and postoperative opioids. According to the new research, however, most C-section patients know ahead of time what level of pain relief they will require and are more satisfied with their pain management experience if they are given a say in the matter. Stanford University obstetric anesthesia provider Brendan Carvalho, MD, led the study, which randomized C-section patients by a 3:1 ratio into "choice" or "no-choice" groups. The 120 women in the first cohort were allowed to express a preference for low, medium, or higher doses of pain medication. Most—68 percent—chose the medium level, with 18 percent selecting low level and 14 percent specifying high level. The remaining 40 women automatically received standard, or "medium," pain management. Those patients were less satisfied with their pain management protocol than the women in the "choice" group, no matter which level of care they requested. "It makes sense: You know your body and have had previous pain experiences," Carvalho explained. "Instead of physicians trying to predict what the patient will need, this study says we should get the middleman out and let the patient decide." The study results appear in Regional Anesthesia & Pain Medicine.

From "Tapping Patients' Wisdom for C-Section Pain Management"
Scope (04/18/19) Digitale, Erin

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'Prehab,' SSRIs May Reduce Postsurgical Opioid Use

Two new studies involving veterans underscore strategies for lowering postoperative opioid use. The first involved 175 participants with chronic pain and opioid use, about half of whom completed a strict preoperative rehabilitation (prehab) protocol prior to undergoing spinal surgery. Among those who stepped down from opioid therapy to nonopioid drugs and engaged in smoking cessation, exercise, and behavioral programs as needed, 92 percent were not taking any opioids one year later. By comparison, only 28 percent of participants treated before prehab was implemented were opioid-free after 12 months. The prehab group also had better outcomes for pain, chronic pain acceptance, and pain catastrophizing compared with the non-prehab group. The other new piece of research studied total knee replacement surgeries for more than 11,000 veterans. Those findings indicated that perioperative use of selective serotonin reuptake inhibitors (SSRIs) generated a marked reduction in opioid consumption as long as 30 days postoperatively. The same could not be said, however, for norepinephrine reuptake inhibitors (SNRIs) or tricyclic antidepressants (TCAs)—which came as something of a surprise to researchers. "I was expecting more benefit from SNRIs/TCAs instead," said lead author Jordan B. Starr, MD, of the University of Washington. Both studies were presented at the American Pain Society Annual Meeting 2019.

From "'Prehab,' SSRIs May Reduce Postsurgical Opioid Use"
Medscape (04/14/19) Melville, Nancy

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Comparison of Dexmedetomidine and Sufentanil as Adjuvants to Local Anesthetic for Epidural Labor Analgesia

Researchers wondered how sufentanil stacks up as an adjuvant to local anesthesia for epidural labor analgesia when compared to dexmedetomidine, which has proven efficacy in this setting. In a randomized study done in China, they divided 80 nulliparous women into two treatment arms and compared outcomes. Although there was no significant between-group difference in terms of adverse effects, including respiratory depression and nausea and vomiting, dexmedetomidine was favored over sufentanil in some respects. Patients who received dexmedetomidine with ropivacaine experienced lower pain scores on a visual analog scale after cervical dilation of more than three centimeters, for example, and their first stage of labor ended sooner than patients who received sufentanil plus ropivacaine. Ramsay Sedation Scale values also were higher among the dexmedetomidine recipients.

From "Comparison of Dexmedetomidine and Sufentanil as Adjuvants to Local Anesthetic for Epidural Labor Analgesia"
Drug Design, Development and Therapy (04/11/19) Vol. 13, P. 1171 Zhang, Tao; Yu, Yulong; Zhang, Wang; et al.

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Perioperative Lidocaine Infusion for Hip Arthroplasty Linked with Decreased Pain and Opioid Use

An infusion of lidocaine delivered perioperatively, along with usual anesthesia care, curbs pain and opioid demand among hip arthroplasty patients, according to new findings. The study involved 20 participants who were randomly allocated to lidocaine or placebo in addition to standard anesthesia treatment. At 24 hours after surgery, postoperative pain decreased 30 percent on average among the lidocaine recipients and maximum pain was reduced by 48 percent. Moreover, lidocaine infusion was associated with a 39 percent reduction in opioid consumption. Researchers presented the study results at the Regional Anesthesiology and Acute Pain Medicine Meeting in Las Vegas.

From "Perioperative Lidocaine Infusion for Hip Arthroplasty Linked with Decreased Pain and Opioid Use"
Healio (04/12/2019) Jaramillo, Monica

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Safety and Efficacy of Buccal Dexmedetomidine for MRI Sedation in School-Aged Children

Given that dexmedetomine has been effective for pediatric MRI sedation, researchers wondered if buccal dexmedetomidine would also be appropriate. To investigate, a team from the University of Wisconsin-Madison examined the medical records of children who received buccal dexmedetomidine with or without oral midazolam for MRI sedation at a single site during 2015 and 2016. In all, the retrospective study included 220 encounters. Patient satisfaction with sedation was achieved in more than 81 percent, or 179, of the procedures—including 95 when buccal dexmedetomidine was paired with oral midazolam and 84 when it was the only sedative used. Intravenous sedatives were required to reach satisfactory sedation in 35 other cases, and one encounter involved intranasal fentanyl and midazolam in addition to buccal dexmedetomidine. Only five patients did not complete their procedure successfully, including two cases of sedation failure, two cases of severe upper airway obstruction with I.V. sedations, and one case of MRI contrast anaphylaxis during I.V. sedation. The study findings indicate that buccal dexmedetomidine, with or without midazolam, delivers sufficient sedation for most MRI scans with few adverse effects. However, considering that the failure rate is near 20 percent, the researchers recommend research into modifications to buccal dexmedetomidine dosing.

From "Safety and Efficacy of Buccal Dexmedetomidine for MRI Sedation in School-Aged Children"
Hospital Pediatrics (04/19) Boriosi, Juan P.; Eickhoff, Jens C.; Hollman, Gregory A.

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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 25, 2019
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