AANA Anesthesia E-ssential
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Vital Signs


Coming Soon!
Watch for the Updated and Redesigned AANA Website

The AANA will continue to improve your online experience with a new website this fall. Soon you'll be able to find the most current, authoritative nurse anesthesia resources you need quicker than ever, and across all AANA websites. Plus, the responsive design means you’ll enjoy a seamless experience on any device, including PC, iPhone, iPad, and Android devices. 
 
Here are just some of the new features:
  • The new personalized MyAANA page is your one-stop shop to check your CE progress, manage your membership account and orders, and view discussions on AANA Connect. You’ll have quick access to important members-only communications and more – all from your AANA member page.
  • We’ve made it easier to find research articles, commentaries, and data in the AANA Journal. Search by topic, and narrow your results by issue. 
  • The new multifaceted search and streamlined navigation will make it easy to get to the information you need, when you need it. You’ll be able to find all the AANA has to offer for a particular topic area and narrow it down by live events, articles, online courses, and other categories.
We can’t wait to unveil the website you’ve been waiting for. Watch your inbox for more details.
 
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Hot Topics


Got MIPS Participation Status Questions?

The Centers for Medicare & Medicaid Services (CMS) has recently introduced new information on its website that indicates whether clinicians have “special status” as determined by rules in the Quality Payment Program for the Merit-based Incentive Payment System (MIPS). (See qpp.cms.gov.) Under MIPS, CMS makes “special status” determinations based on whether you are in a small practice, a non-patient facing clinician, hospital-based clinician, or practice in a health professional shortage or rural area. To check your MIPS participation status with this new information, CRNAs should input their National Provider Identifier (NPI) into the MIPS participation status look-up tool..  If you have questions about your MIPS status, please email qpp@cms.hhs.gov or call 1-866-288-8292
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The Biggest Event in Nurse Anesthesia is Two Months Away! Are you Registered?

Don't miss out: Online registration for the AANA Nurse Anesthesia Annual Congress will close on Thursday, 8/17 at 12 am EDT. Join us Sept. 8-12 in Seattle for nurse anesthesia's premier educational, professional, and social event! Just take a look at the lineup of top-notch sessions and unparalleled networking events on the schedule at a glance.
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What Parents Should Know About Their Child’s Vision

During Children’s Eye Health and Safety Month, the AANA wants parents to know what to expect and what to do when their child is faced with having surgery or another eye procedure requiring anesthesia. Although ophthalmic related surgeries are rarely life threatening, CRNAs understand that procedures involving the eyes can be frightening to patients of all ages, especially children. Read the AANA press release for important information to share with your patients.
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Get a free ebook edition of The Painless Guide
to Mastering Clinical Acid-Base

During the five-day period of August 23 - August 27, you can get a free copy of the new ebook edition of The Painless Guide to Mastering Clinical Acid-Base by Benjamin Abelow, MD. This highly regarded text is great for both first-time learning and review. Simply search the title or Amazon ID number (B06XRM56TY), or visit Amazon, and you will find the ebook priced at $0.00 during those five days. Once you "purchase" the book, it will remain permanently in your Amazon library and you'll be able to load it onto any device (phone, tablet, laptop, etc.) that has a Kindle app linked to your account.

Mark your calendar so you don’t miss out on this special offer! 
 
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Professional Practice


Recall of 0.9% Sodium Chloride Injection

ICU Medical, Inc. is voluntarily recalling one lot of 0.9% Sodium Chloride Injection, USP 1000 mL due to a confirmed customer complaint of particulate matter identified as stainless steel within a single flexible container.  The lot number is 61-841-FW (expiration: January 01, 2018). Read more at FDA.GOV.
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Meetings and Workshops


Register Now for the Fall Leadership Academy
November 3-5, Rosemont, Ill.

AANA Fall Leadership Academy features expert speakers in five educational tracks including Business and Facility Leadership, Federal Political Director, State Grassroots Advocacy, State President-elect, and State Reimbursement Specialist. Hone and develop leadership skills for your practice, state, and business. Plus, you'll expand your network of colleagues around the country.
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Pre-Congress Workshops — Earn Even More CE at #AANA2017!

Plan to attend the Pre-Congress Workshops on Friday, September 8, to make the most of your meeting. Expand your skill set or simply stay current and earn additional Class A CE credits with a Pre-Congress workshop. Sign up for one of these specialty workshops:
  • Airway on Demand
  • Obstetric Anesthesia Hands-On Workshop
  • Fundamentals in Perioperative Transesophageal Echocardiogram (TEE) Workshop 
  • Neuromuscular Block Monitoring Workshop
  • AANA Peer Advisors Volunteer Workshop
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Save the Date for Hands-On Workshops

Space is limited, and these popular hands-on workshops fill up fast. Visit AANA Meetings for further information and to register for the following:
 
Upper and Lower Extremity Nerve Block Workshop
AANA Foundation Learning Center, Park Ridge, Ill.
October 7-8
 
Spinal/Epidural Workshop with Obstetric Essentials
AANA Foundation Learning Center, Park Ridge, Ill.
October 25-28
 
Jack Neary Pain Management Workshop II
Rosemont, Ill.
November 5-6
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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.

Gabapentin Improves Postoperative Pain Control in Regional Anesthesia Setting

Preoperative oral gabapentin reduces post-surgical pain and opioid demand when administered as part of a regional anesthesia protocol, a meta-analysis concludes. Led by Jean-Pierre Ouanes, DO, investigators from Johns Hopkins Bayview Medical Center in Baltimore reviewed two dozen randomized controlled trials involving 2,278 adult patients. "When the 24 trials were analyzed, we found that all pain scores at 12 hours and 24 hours and opioid consumption in the first 24 hours were reduced in patients that received gabapentin in the setting of regional anesthesia," Ouanes informed the 2017 annual spring meeting of the American Society of Regional Anesthesia and Pain Medicine. The finding proved true across a variety of surgery types; but gabapentin also was associated with higher rates of sedation, suggesting that researchers may need to look more carefully at dosing and scheduling. In a promising development, however, a single preoperative dose of gabapentin was shown to be as effective as several postoperative doses, which potentially could improve outcomes without triggering excessive sedation.

From "Gabapentin Improves Postoperative Pain Control in Regional Anesthesia Setting"
Anesthesiology News (08/07/17) Doyle, Chase

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Addition of Droperidol to Prophylactic Ondansetron and Dexamethasone in Children at High Risk for Postoperative Vomiting

Postoperative vomiting (POV) frequently occurs in children having elective surgery under general anesthesia. Researchers questioned whether adding droperidol (DRO) to a combination of the antiemetic agents dexamethasone (DEX) and ondansetron (OND)—standard prophylaxis against POV—would help avoid the complication in this patient population, as it has already been shown to do in adults. The French Ministry of Social Affairs, Health and Women's Rights sponsored the multi-site trial, which proposed that adding DRO to DEX/OND would lower the residual risk of POV by an additional 15 percent in the first 24 postoperative hours. The study included 315 children: 153 randomly assigned to usual care and 162 to the test group. Contrary to the hypothesis, supplementing OND and DEX with DRO did not prevent POV from occurring any less frequently than with the two-drug cocktail. What it did do was elevate the risk of postoperative drowsiness, suggesting that routine use should be avoided. DEX/OND plus DRO should be considered, however, in the case of pediatric patients at high risk of POV, the researchers report in the British Journal of Anaesthesia.

From "Addition of Droperidol to Prophylactic Ondansetron and Dexamethasone in Children at High Risk for Postoperative Vomiting"
Medscape (08/03/17)

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Anesthesia Use Growing in Pediatric MRI

More than ever, researchers from Nationwide Children's Hospital report, pediatric patients are receiving anesthesia ahead of MRI. The team from the Columbus, Ohio, facility reviewed claims data on more than 17,200 MRI encounters and more than 18,500 separate examinations for minor patients. The findings, published in the Journal of the American College of Radiology, reveal that children required anesthesia in 28 percent of MRI encounters in 2014 compared with 21 percent in 2011. The gains were greatest, 0.64 percent per month, among patients between the ages of one and six years and lowest, 0.42 percent per month, among those aged seven to 12 years. The study authors say the growing use of anesthesia in underage MRI patients—which does not appear to be influenced by demographic trends or types of exams ordered—is inflating costs and could present a challenge to care organizations.

From "Anesthesia Use Growing in Pediatric MRI"
Diagnostic Imaging (08/03/17)

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77% of Orthopedic Surgery Patients Report Unused Opioids

New research sheds light on the glut of prescription opioids that go unused following surgery. The analysis covered half a dozen studies, which involved more than 800 patients undergoing several different types of operations. Investigators discovered that 92 percent of general surgery patients did not use all of their prescribed pain medicine, more than patients in any other category. They were followed by oral surgery patients, at 91 percent; women having cesarean section, at 90 percent; dermatology patients at 89 percent, and orthopedic surgery patients, at 77 percent. Overall, between 42 percent and 71 percent of opioids were not taken as prescribed, with between 16 percent and 19 percent of patients reporting discontinued use as a result of opioid-induced side effects. "Increased efforts are needed to develop and disseminate best practices to reduce the oversupply of opioids after surgery," researchers concluded, "especially given how commonly opioid analgesics prescribed by clinicians are diverted for non-medical use and may contribute to opioid-associated injuries and deaths."

From "77% of Orthopedic Surgery Patients Report Unused Opioids"
Becker's ASC Review (08/17) Rechtoris, Mary

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Statistical Analysis to Explain Mechanism in State of General Anesthesia

Researchers continue to gain new knowledge of how drugs achieve the state of general anesthesia (GA). MIT's Emery Brown, who is a statistician as well as a practicing anesthesia provider, recently unveiled new insights involving signal processing algorithms. "Careful signal processing combined with experimentation has allowed us to show that a primary mechanism through which anesthesia works is by creating oscillations that disrupt how communications among different regions of the brain occur," he explained at the 2017 Joint Statistical Meetings. In addition, he said the algorithms enable the use of electroencephalogram (EEG) to monitor brain states of anesthetized patients in real time as well as to identify reliable EEG signatures for various anesthetic drug classes and to establish how brain responses to anesthetics systemically and predictably change with increasing age. As part of his research, Brown has launched a Phase II study using the ADHD drug Ritalin to bring patients out of GA quickly, thereby minimizing the cognitive impairment that often affects older people after exposure.

From "Statistical Analysis to Explain Mechanism in State of General Anesthesia"
ScienceDaily (07/31/17)

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Addition of Liposomal Bupivacaine Linked With Reduced Patient Pain Scores, Opioid Scores After TKA

Reporting in the Journal of Arthroplasty, researchers confirmed that outcomes following total knee replacement were markedly improved in patients who had local infiltration analgesia with liposomal bupivacaine (LB). Led by Michael A. Mont, the Phase IV trial randomly assigned 140 participants to receive local infiltration analgesia with or without LB. At 12-48 hours following the operation, the mean area under the curve of VAS pain scores was 209.3 for the control patients compared to just 180.8 for those who received LB. Additionally, patients in the intervention cohort consumed only a mean 18.7 mg of opioids overall, whereas non-LB patients needed a mean total of 84.9 mg. Moreover, the share of participants who no longer required opioids at 48-72 hours postoperatively was significantly higher in the LB group than in the non-LB group.

From "Addition of Liposomal Bupivacaine Linked With Reduced Patient Pain Scores, Opioid Scores After TKA"
Healio (07/27/2017) Jaramillo, Monica

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

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Attn: Linda Lacey
E–ssential Editor
llacey@aana.com
August 10, 2017
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