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Novitas Update: MAC Voluntarily Suspends LCD 36920


In response to the injunction sought by the AANA, and as a result of discussions with the government, Medicare Administrative Contractor (MAC) Novitas Solutions has agreed to voluntarily suspend implementation of Local Coverage Determination (LCD) L36920 from May 4, 2017, until June 5, 2017. This 30-day window is intended to allow AANA to continue negotiations with the Centers for Medicare & Medicaid Services (CMS) and Novitas, and for the legal process to occur. We will continue our efforts to advocate for an agreed resolution, but if one is unavailable, a hearing on our request for a Temporary Restraining Order (TRO) has been scheduled for June 1, 2017.

As reported in the April 14 Anesthesia E-ssential, the AANA filed a lawsuit in federal court on April 11 to prevent the LCD issued by Novitas from taking effect on May 4. The LCD would limit payment to CRNAs for epidural injections for pain management in 12 states and the District of Columbia. The AANA’s legal complaint alleges that the constitutional rights of CRNAs have been adversely affected without due process. The claim rests in the idea that the recent LCD constituted an improper attempt at rulemaking and that Novitas exceeded its authority by promulgating the LCD.

On April 13, the AANA filed a motion for a TRO and a brief in support of the TRO.

Several documents about the lawsuit can be found on the member side of the AANA website (login required), including:

The AANA will continue to update members on this important issue as new information becomes available.

Sincerely,


Cheryl Nimmo, DNP, MSHSA, CRNA
AANA President

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Hot Topics


Be Sure to Vote in the AANA 2017 Election!
Voting Ends May 23, 2017, at noon CT


The AANA 2017 election started on April 25, 2017, and will continue until May 23, 2017, 12 noon CDT. By now, active AANA members should have received their ballot materials, including their election passcode and voting instructions, electronically or in the mail from Survey & Ballot Systems (SBS), the AANA's election coordinator. The email with the voting credentials originates from noreply@directvote.net. Please make sure this email did not end up in your spam or junk mail folder.

To vote online and view candidates’ biographical information and position statements visit the election site and enter your member number and the election passcode provided to you by SBS.

If you do not have your election login information, click on the “Email me my login information” link on the login page, enter the email address on file with AANA, and your election login information will be emailed to you. SBS can be reached by phone at (952) 974-2339 (Monday through Friday, 8 a.m. to 5 p.m. CDT) or by email at support@directvote.net.

If it’s more convenient, please feel free to contact lrivera@aana.com or vgiannopoulos@aana.com, and they will ask SBS to resend you your voting credentials.

To view Board Candidates’ Video Speeches
Board candidates’ speeches presented at the April Mid-Year Assembly are available on the AANA website through the Election Center.

AANA Connect Community for Candidates for the AANA Board of Directors
The AANA Connect Community for Candidates for the AANA Board of Directors is available for members to interact with Board candidates during the voting cycle. This community will be available until the voting cut-off date of May 23, 2017.

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AANA Position Statement on Securing Propofol Updated at MYA


At Mid-Year Assembly (MYA), the AANA Board of Directors approved the updated position statement titled Securing Propofol. Read the statement at www.aana.com/propofol. This position statement continues to support the well-being, safety, and professional self-care of CRNAs and SRNAs. The AANA recognizes that anesthesia professionals have an increased occupational risk of substance use disorder as well as the professional and personal consequences of substance use disorder. Therefore, the AANA strongly recommends that facilities with propofol on formulary develop and implement methods to reduce the likelihood of propofol diversion, such as placing propofol in a secure environment only accessible by those professionals identified in a medication management policy.

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Vietnam Voices


Captain Ernest Ayo, DP, CRNA, gives voice to his experiences on the island of Okinawa during the Vietnam War. From manufacturing neurosurgical instruments to inspecting more than 30 buildings to meeting movie star John Wayne, Captain Ayo recounts the everyday experiences of the U.S. Army on a remote Japanese island. Read more.

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CRNA Featured on “Dr. Miami” Reality TV Show


Fans of reality TV and We TV cable channel may already be familiar with Michael Salzhauer, MD, also known as “Doctor Miami,” but did you know that the celebrity cosmetic and plastic surgeon’s go-to anesthesia provider is retired USAF veteran Barry Miller, CRNA? Miller says that while he has played a big role in the practice’s patient care for over 10 years, his role during season one of the reality show has been mostly on the periphery of the on-screen activity…that is until tonight’s episode. According to Miller, he is front and center advising a patient with a difficult airway that she is not a good candidate to have her elective procedure done in an outpatient setting. In a series that offers plenty of outrageous antics outside the OR, tonight’s episode mixes in a poignant look at an important consideration for many patients and their healthcare providers. Dr. Miami airs tonight, April 28, at 10:05 p.m. (EST), and again on April 29 at 12:11 a.m. You can follow Miller here.

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AbbVie Offers Drug Information Web Portal


AANA Corporate Partner AbbVie offers an online educational portal developed to help support providers using the company's anesthesia drugs in their practice. See Aesthesiology Hub for important safety and prescribing information regarding Ultane, Nimbex, and Mivacron.

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New Courses Available on AANA Learn

Recertification season is here, and AANA Learn has just added three new courses offering Class A CE credits.

 

AANA Journal Course No. 37, Part 1: A Tour of Autonomic Reflex Activity Relevant to Clinical Practice
Categories on AANA Learn- “New Courses!”, “Clinical Topics” and “AANA Journal Course” categories.
Member Coupon Code: Yes
Pharm Credit: None

New Modes of Mechanical Ventilation
Categories on AANA Learn: “New Courses!” and “Clinical Topics”
Member Coupon Code: No
Pharm Credit: None

Non-Barbiturates and the Brain
Categories on AANA Learn: “New Courses!” and “Clinical Topics”
Member Coupon Code: Yes
Pharm Credit- 1 CE

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Professional Practice


FDA Issues Codeine and Tramadol Recommendations


The Food and Drug Administration (FDA) has issued a drug safety communication restricting the use of codeine and tramadol medicines in children. See FDA.gov. These medicines carry serious risks, including slowed or difficult breathing and death, which appear to be a greater risk in children younger than 12 years, and should not be used in these children. The FDA also recommends against the use of codeine and tramadol medicines in breastfeeding mothers due to possible harm to their infants. Patients and healthcare professionals may report side effects involving codeine- and tramadol-containing medicines to the FDA MedWatch program.

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AANA endorses AAACN’s position paper on RN Role in Ambulatory Care


The AANA has endorsed the American Academy of Ambulatory Care Nursing (AAACN) position paper, The Role of the Registered Nurse In Ambulatory Care. The position statement affirms that RNs enhance patient safety and the quality and effectiveness of care delivery, are responsible for the design, administration, and evaluation of professional nursing services within an organization, provide the leadership necessary for collaboration and coordination of services, and are fully accountable in all ambulatory care settings for all nursing services.

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Joint Commission Releases Top 10 2016 Sentinel Events


This list reflected in the Sentinel Event Data Summary varies little from the 2015 list. The Joint Commission reviewed 824 events in 2016, compared to 936 in 2015. Medication errors and criminal events were added to the list. For the third consecutive year, the most common sentinel event remained the same: unintended retention of a foreign body (120). This event is followed by:

  • Wrong-patient, wrong-site, wrong-procedure (104)
  • Fall (92)
  • Suicide (87)
  • Unassigned (70)
  • Delay in treatment (54)
  • Other unanticipated event, including asphyxiation, burn, choked on food, drowned or found unresponsive (47)
  • Operative/postoperative complication (45)
  • Medication error (33)
  • Criminal event (32)
  • Perinatal death/injury (23)

Four anesthesia-related sentinel events were reviewed in 2016.

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AANA Endorses ASPAN’s Position Statement on Air Quality


AANA has endorsed the American Society of PeriAnesthesia Nurses (ASPAN) Position Statement on Air Quality and Occupational Hazard Exposure Prevention. ASPAN’s position statement affirms that necessary, appropriate, and evidence-based protective engineering controls, technologies, work practices, and personal protective equipment be utilized in the perianesthesia environment. Additionally, the statement makes recommendations of adherence to regulations and guidelines for occupational waste gas exposure and respiratory pathogens for the protection of healthcare workers and patients.

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Joint Commission Announces 2016 Top 10 Most Challenging Requirements for Ambulatory Care Accreditation Program


This list, used to identify trends and direct educational efforts, identifies the requirements most frequently identified as “not compliant” during 2016 surveys and reviews. Unsurprisingly, infection control and credentialing and privileging top the list. The full list includes:

  1. IC.02.02.01 – The organization reduces the risk of infections associated with medical equipment, devices, and supplies.
  2. HR.02.01.03 – The organization grants initial, renewed, or revised clinical privileges to individuals who are permitted by law and the organization to practice independently.
  3. EC.02.03.05 – The organization maintains fire safety equipment and fire safety building features.
  4. MM.03.01.01 – The organization safely stores medication.
  5. EC.02.04.03 – The organization inspects, tests, and maintains medical equipment.
  6. EC.02.05.07 – The organization inspects, tests, and maintains emergency power systems.
  7. MM.01.01.03 – The organization safely manages high-alert and hazardous medications.
  8. EC.02.02.01 – The organization manages risks related to hazardous materials and waste.
  9. MM.01.02.01 – The organization addresses the safe use of look-alike/sound-alike medications.
  10. EC.02.05.01 – The organization manages risks associated with its utility systems.
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Foundation and Research


Friends for Life Deadline – June 15, 2017


Friends for Life help support the future of the nurse anesthesia profession through meaningful, lasting gifts. Contributions through Friends for Life help fund and sustain programs that further research and education in anesthesia.

Friends for Life receive a medallion at the AANA Annual Congress Opening Ceremonies, an engraved plaque in the AANA Park Ridge office, and an invitation to the Annual Awards and Recognition Event.

The minimum gift commitment to join Friends for Life is $25,000. Members may fulfill this commitment through a cash gift, but there are many other ways to meet the commitment through planned gifts. Some of the most popular planned gift options for becoming a Friend for Life include:

  • A gift (bequest) in the will for a specific amount or a percentage of the total estate
  • Gift of personal property or real estate
  • Including the Foundation as a beneficiary on a retirement plan or a whole life insurance policy

For further information, please contact Nat Carmichael at (847) 655-1175 or ncarmichael@aana.com. The Friends for Life submission deadline for recognition at this year’s Annual Congress in Seattle, Wash., is June 15, 2017.

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AANA Foundation Annual Congress Fundraiser: Purchase Your Tickets Today!

The AANA Foundation is planning another great fundraising event at the AANA 2017 Nurse Anesthesia Annual Congress in Seattle. On Sunday, Sept. 10, 2017, from 7-11 p.m., CRNAs Live at the Hard Rock Café will offer a night of fun for everyone, including food, drinks, dancing, and live band karaoke.

Hard Rock Café Seattle’s best-kept secret is the second-floor music venue, dubbed Cavern Club, an homage to the iconic Liverpool basement rock club where The Beatles forged their musical identity in the early 60s. Cavern Club is a destination for local original acts and national touring acts. This night we will be singing and dancing to the tunes of the local favorite live Karaoke Band Rock-Bot!

Rock-Bot has hundreds of songs to choose from, and CRNAs and SRNAs will get to sing with some of the best musicians around. It's just like karaoke with words scrolling by on a screen, but a live band is there to play the music, sing back-ups, and keep you company on stage.

For those who would like to take in the city views and have a quieter setting throughout the evening, Hard Rock Café’s prime downtown location offers an adjacent rooftop terrace overlooking Pike Place Market.

 

Tickets are $250 in advance and $275 once onsite at Annual Congress registration.

Please support this event and help make this evening a success. Join the fun while benefiting the AANA Foundation and its mission. See you in Seattle!

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Looking for a Mother's Day Gift?
Shop Amazon and Support the AANA Foundation!


Amazon has it all, and the AmazonSmile website offers the same wide selection of products and low prices as Amazon. The difference is that the Amazon Smile Foundation will donate 0.5 percent of the price of eligible purchases to the AANA Foundation.

To shop at AmazonSmile, go to smile.amazon.com. You may want to add a bookmark to make it even easier to return and shop.

To go directly to the AmazonSmile webpage supporting the AANA Foundation.

Please log on and shop today! Select a special gift for mom from the millions of products marked “Eligible for AmazonSmile donation” on their product detail pages.

Thank you in advance for participating in this easy way to support the AANA Foundation. Your mom will thank you, too!

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Jobs


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.


Clinical Effectiveness and Safety of Intraoperative Methadone in Patients Undergoing Posterior Spinal Fusion Surgery

University of Chicago and Northwestern University researchers investigated whether intraoperative methadone could safely alleviate severe pain in the days immediately following spinal fusion surgery. They hypothesized that long-acting, opioid-sparing methadone might promote enhanced recovery compared to patient-controlled analgesia with hydromorphone. The single-site double-blinded trial analyzed results from 115 participants, who were randomly assigned to either methadone administration at the start of the procedure or hydromorphone at the end of it. Anesthetic care was otherwise identical for both treatment arms. Intravenous hydromorphone use on the first day after surgery, the primary outcome, was lower in the methadone recipients not only the day after but on the next two postoperative days as well. In addition, pain scores—measured upon arrival to the post-anesthesia care unit, at one and two hours after admission, and in the mornings and afternoons of the first three days post-surgery—were lower in the methadone patients. Participant satisfaction with the pain management protocol, gauged at the same intervals, also was greater in the methadone cohort up until the morning of the third postoperative day. The investigators believe their findings warrant dose–response studies to better identify the optimal dose of methadone in spinal fusion patients with severe postoperative pain.

From "Clinical Effectiveness and Safety of Intraoperative Methadone in Patients Undergoing Posterior Spinal Fusion Surgery"
Anesthesiology (05/17) Vol. 126, No. 5, P. 822 Murphy, Glenn S.; Szokol, Joseph W.; Avram, Michael J.; et al.

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UA Faculty Develop New Pain Treatment Method

Researchers at the University of Arizona (UA) are working on a new treatment for anesthesia-induced hypothermia, a dramatic drop in body temperature that can occur during surgery. Their hopes are built around TRPV1, a pain receptor that reacts to heat-based stimuli, which was initially investigated as a potential analgesic. That possibility was ruled out when the experimental drug produced dangerous fevers during clinical studies. Nonetheless, the UA team—including anesthesiology professors Frank Porreca, PhD, and Amol Patwardhan, MD—saw another use for the agent. "Here's a drug which is potentially pain medication, but which also reverses body temperature, which is dropped under anesthesia," Patwardhan explains. "In one hand you can get two results, both of which are highly desirable under anesthesia." He and Porreca want to manipulate the fever-inducing side effects of the TRPV1 drug to stabilize body temperatures that have fallen due to open skin incisions and exposure to anesthetic gases. If successful, their alternative to warming blankets and uncomfortably hot operating rooms promises to minimize pain, accelerate recovery, possibly promote wound healing, and decrease postoperative opioid requirements. The drug has only been tested in rat models, but both Porreca and Patwardhan are encouraged by the evidence to date.

From "UA Faculty Develop New Pain Treatment Method"
Daily Wildcat (Arizona) (04/23/17) Dahl, Hannah

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Benefit of Epidurals for Hernia Surgery Questioned

New findings challenge the use of perioperative epidurals in patients undergoing hernia surgery. The Cleveland Clinic's Ajita Prabhu, MD, and colleagues analyzed data from the Americas Hernia Society Quality Collaborative (AHSQC), which houses information on more than 15,000 operations. For their study, the sample population included 1,526 patients who had ventral hernia repair without transverse abdominis plane (TAP) blocks. There appeared to be no added benefit in the 763 participants who received postoperative epidural analgesia—and, in fact, they remained hospitalized about a half of a day longer than the 763 who did not receive epidurals. They also had higher pain intensity scale scores and were at greater risk for post-surgical complications. "These findings should encourage us to look at and examine some of our foregone conclusions about epidurals," Prabhu declared. "Patients did not have a shorter hospital length of stay related to epidurals, which has previously been described as one of the potential benefits of using them in other patient populations." A second analysis based on AHSQC data, meanwhile, suggested that TAP blocks can shorten hospital stay after some hernia surgeries without increasing patient pain. Conducted by Jeff Blatnik, MD, of Washington School of Medicine in St. Louis, that study included more than 750 patients with large ventral hernias—none of whom received epidurals. The 252 participants who underwent TAP block cut their hospital stay by nearly two days compared with the 504 participants who did not; and they experienced no greater rate of surgical site infections or other unfavorable outcomes as a result.

From "Benefit of Epidurals for Hernia Surgery Questioned"
General Surgery News (04/21/17) Frangou, Christina

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How Do Former Opioid Addicts Safely Get Pain Relief After Surgery?

The American opioid crisis, which has left so many in the grips of addiction, is creating a dilemma for surgeons and anesthesia providers seeking to manage pain in patients who need an operation but who also have or have had a dependency. Currently, surgical teams have no clear direction in terms of the best way to anesthetize this population—or how best to treat them for postoperative pain. They do not want them to suffer, yet there is concern that analgesics and other medications might lay the foundation for relapse. Access to addiction specialists, both before and after a procedure, might be a step in the right direction. If a surgeon or anesthesia provider were treating someone with severe diabetes, it would not be unusual to consult an endocrinologist; so it stands to reason to bring in an addiction specialist when a patient has a history of drug dependency, argues Stuart Gitlow, MD, past president of the American Society of Addiction Medicine. "Whether [the patient] gets the opioids or not is less of the question," he insists. "The biggest question is what to do to ensure this patient's safety going forward during the period for which he's experiencing pain?"

From "How Do Former Opioid Addicts Safely Get Pain Relief After Surgery?"
NPR Online (04/20/17) LeMoult, Craig

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Anesthesia Machine Cover Designed for OR Infection Control

As hospitals look for new ways to keep infections down, many are turning their focus to anesthesia machines and the touchscreens, keyboards, and other accessories that go with them. Anesthesia providers "insert an IV, get blood on their hands and then touch the machine. They intubate their patient, come into contact with saliva, and then touch the machine," laments Murlikrishna Kannan, MD, of Mount Sinai Medical Center in Miami Beach, Fla. "They're exposed to patients' gastric secretions or sputum and then touch the machine. It's nonstop, back and forth." As a result, the equipment—already known for being tough to clean—harbors pathogens that can potentially contaminate the intraoperative environment. With that in mind, a team led by Kannan developed the Anesthesia Hygiene Organizer (AHO) to help prevent transmission of bacterial organisms. The transluscent, nonpermeable cover offers barrier protection for the anesthesia machine and its accessories while also offering a sterile location to lay instruments before and after use. The AHO is removed and replaced after each surgical case. To eliminate conflict of interest, Kannan and his colleagues are working with academic universities to evaluate the impact of the innovation on infection control. "More studies are required to evaluate the effect of these devices in everyday anesthesia practices," he remarks.

From "Anesthesia Machine Cover Designed for OR Infection Control"
Anesthesiology News (04/19/17) Doyle, Chase

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Continuous Postoperative Infusion of Remifentanil Inhibits the Stress Responses to Tracheal Extubation of Patients Under General Anesthesia

Researchers in China tested an extubation approach pairing a nonsteroidal anti-inflammatory drug with a short-acting opioid µ-receptor stimulant, to gauge the impact on stress responses and vital signs upon tube removal. Coughing and other reactions during this process increase the risk of adverse events, including hypertension and tachycardia. The team from Kunming Medical University worked with a group of 120 adult patients undergoing thyroidectomy under general anesthesia, dividing them evenly into one of four treatment arms. Participants were randomly assigned to intravenous parecoxib along with a continuous infusion of 0.1 µg/kg/min (R1), 0.2 µg/kg/min (R2), or 0.3 µg/kg/min (R3) of remifentanil during wound suturing, while randomized controls were given a saline injection. Continuous infusion of remifentanil, at an optimal dose of 0.2 µg/kg/min, effectively reduced cough and improved patient comfort during emergence from general anesthesia and extubation without significant adverse outcomes like nausea, emesis, dizziness, and headache. The researchers suspect the continuous injection of the analgesic after surgery inhibits airway reflex and mutes the stimulus of tracheal tubes. However, they add, patients under remifentanil infusion may take longer to extubate and require more time to emerge from general anesthesia.

From "Continuous Postoperative Infusion of Remifentanil Inhibits the Stress Responses to Tracheal Extubation of Patients Under General Anesthesia"
Journal of Pain Research (04/17) Vol. 10, P. 933 Zhao, Guoliang; Yin, Xiaoyue; Li, Ya

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Checklist Program Reduced Large-Scale Post-Surgery Deaths

A study of the World Health Organization's (WHO) Surgical Safety Checklist documented fewer postoperative deaths at institutions that adopted the 19-item guideline. While the checklist, which debuted in 2008, has been shown in smaller investigations to curtail complications and mortality, its large-scale efficacy in a population was unknown. The setting for the new experiment was South Carolina, where 14 hospitals volunteered to implement the WHO resource. A coordinator at each location ensured tasks were completed during each phase: before anesthesia administration, before the incision, and before wheeling the patient out of the operating room. The number of patients who died within 30 days of inpatient surgery declined by 22 percent to 2.84 percent after checklist implementation in 2013 from 3.38 percent prior to implementation in 2010. The rate at the 44 state hospitals that declined to participate, by comparison, rose to 3.71 percent from 3.5 percent over the same time frame. The results, according to lead author Alex Hayes, MD, of Ariadne Labs' Safe Surgery Program, suggest that "when done right, the Surgical Safety Checklist can significantly improve patient safety at large scale." Ariadne conducted the study in collaboration with Harvard's T.H. Chan School of Public Health and the South Carolina Hospital Association. Their report appears in the Annals of Surgery.

From "Checklist Program Reduced Large-Scale Post-Surgery Deaths"
Medical News Today (04/18/17) Paddock, Catharine

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Sevo the Dragon Uses Fire Breath to Distract Kids From Getting Anesthesia

Lucile Packard Children's Hospital Stanford has found a way to minimize the fussiness and tears that often come with anesthetizing patients ahead of surgery. A video game on a screen attached to the front of a wheeled hospital bed introduces kids to Sevo the Dragon, who cooks food with the heat of his own breath. Instead of using a controller to make the animated character breathe fire, children inhale and exhale into an anesthesia mask. The institution has had such success with the approach that it will soon make it routine for all patients undergoing sevoflurane inhalational anesthesia induction.

From "Sevo the Dragon Uses Fire Breath to Distract Kids From Getting Anesthesia"
Medgadget (04/18/17)

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Behavior Pain Assessment Tool Measures Pain in Patients Who Cannot Communicate Verbally

Researchers have developed the Behavior Pain Assessment Tool (BPAT) to help clinicians measure pain in patients who are under sedation, mechanically ventilated, or otherwise unable to verbally respond. The tool—which considers facial expressions, muscle reaction, and six other behavioral cues—was tested in 3,850 patients cared for at 192 intensive care units in 28 different nations. In the 67 percent of patients able to convey their pain, investigators used both BPAT and a standard 10-point scale. BPAT scores lined up with traditional pain scores in this group and was able to identify patients who required opioid-based relief. "The BPAT was found to be reliable and valid for use in critically ill patients unable to self-report," according to the study, which appears in PAIN. However, the investigators note, the new technique was able to explain only a third of the variation in pain scores; therefore, additional research is warranted to identify pain behaviors.

From "Behavior Pain Assessment Tool Measures Pain in Patients Who Cannot Communicate Verbally"
Oncology Nurse Advisor (04/17/17) Garbutt, Tiffany

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Single-Dose IV Acetaminophen for Ambulatory Pediatric ENT Surgery Does Not Reduce Need for PACU Analgesics

A study conducted at University of Michigan Medical School indicates that intravenous acetaminophen does not curtail the analgesic needs of children in the post-anesthesia care unit (PACU) following ear, nose and throat (ENT) surgery. Led by pediatrics and anesthesiology professor Olubukola Naifu, MD, the investigators enrolled 229 minors who underwent elective, ambulatory ENT procedures. A single-dose of intraoperative IV acetaminophen was administered to 102 of them, in the hopes that it would alleviate their PACU pain levels and reduce the need for opioids and other analgesia. "With every single metric that we used—whether it be the need for IV opioid or the need for any analgesic whatsoever—the use of intraoperative IV acetaminophen was associated with higher rates of requiring those interactions in the PACU," Naifu reported. He noted that previous research finding a positive effect from IV acetaminophen involved multiple doses of the drug. However, Naifu added, "when single-dose IV acetaminophen has been studied, the results have been similar to what we found."

From "Single-Dose IV Acetaminophen for Ambulatory Pediatric ENT Surgery Does Not Reduce Need for PACU Analgesics"
Anesthesiology News (04/17/17) Vlessides, Michael

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Meds Contribute to Falls in OA

Users of opioids or antidepressants who suffer from low-extremity osteoarthritis (OA) are more at risk for repeated falls, according to new findings. Researchers examined 4,231 patients from the Osteoarthritis Initiative (OAI), monitoring their analgesic use for three years and recurrent falls for four years. During the 36-month period, opioid use rose from 2.7 percent to 3.6 percent, while use of other prescription pain medicines declined from 16.7 percent to 11.9 percent. The authors also determined that opioid or antidepressant users had significantly higher rates of recurrent falls in the following year. Specifically, persons with knee OA who used opioids had a 22 percent higher risk of recurrent falls in the following year, compared with individuals who were not taking any analgesics; and OA patients taking antidepressants were 25 percent more likely to fall two or more times. "Our findings were generally consistent with prior reports that suggest opioids and antidepressants increase risk for falls in older adults," the authors noted. "Clinical management of OA pain with opioids or antidepressants in older patients at risk of falls warrants caution."

From "Meds Contribute to Falls in OA"
MedPage Today (04/16/17)

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New Persistent Opioid Use After Minor and Major Surgical Procedures in U.S. Adults

University of Michigan investigators sought to calculate the postoperative rate of new, persistent opioid use among Americans aged 18–64 years. Nationwide insurance claims data from 2013–2014 yielded a representative sample of 36,177 patients who had no opioid use in the year before undergoing surgery. The primary outcome—opioid prescription fulfillment 90–180 days after the procedure—was compared in 29,068 participants who had minor operations, such as for carpel tunnel or varicose veins, with 7,109 who had major surgeries including colectomy and hysterectomy. The incidence of new persistent opioid use was similar for the two groups, ranging from 5.9 percent to 6.5 percent, but was markedly lower, at 0.4 percent, in a nonoperative control cohort. Preoperative smoking, alcohol and/or drug abuse, mood disorders, anxiety, and preoperative pain disorders all independently predicted new persistent opioid use. The study results indicate that the outcome is a common one after surgery but is tied to behavioral and pain disorders rather than to actual surgical pain. Greater attention and awareness should be focused on addressing patient-level predictors to new persistent opioid use following an operation, they conclude.

From "New Persistent Opioid Use After Minor and Major Surgical Procedures in U.S. Adults"
JAMA Surgery (04/12/2017) Brummett, Chad; Waljee, Jennifer F.; Goesling, Jenna; et al.

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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 28, 2017
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