AANA Anesthesia E-ssential
McGrath MAC Intubation Made Easy

Vital Signs

NEW at the August 30 Annual Business Meeting – Watch It Live!

For the first time ever, the AANA Business Meeting will be live streamed on Sunday, Aug. 30, 2015, beginning at 8:15 a.m. MDT! If you are unable to attend the Aug. 30 Business Meeting, you will be able to watch it live via a connection through the Members' Side of the AANA website. No pre-registration needed. Check the AANA website for details and access.

Highlights include the President’s, Treasurer’s, and Executive Director/CEO’s Reports and the discussion of the proposed bylaw amendments and resolutions. See the related article in this edition regarding an important proposed bylaw amendment from the Virtual Meeting Task Force.
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CPC Facts

When Does CPC Start for Me?

For currently certified nurse anesthetists, Continued Professional Certification (CPC) begins in 2016 or 2017. If you currently recertify in even years, then you are in the middle of your current two-year recertification cycle. You will finish up that two-year recertification the same way you have always done and then recertify by July 31, 2016. Once you have recertified in 2016, you will enter into the CPC Program Aug. 1, 2016. If you currently recertify in odd years, then you just recertified this year (2015). You will need to complete one more two-year recertification cycle (2015-2017), just as you have before, and recertify by July 31, 2017. Once you have recertified in 2017, you enter into the CPC Program Aug. 1, 2017. For students and recent graduates, your initial year of certification (not your graduation year) will determine when you enroll in CPC.

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

Renew Your Membership Online: It's Easy!

Renewing your AANA membership for the fiscal year September 1, 2015, through August 31, 2016, is easy and convenient. Just click here (AANA member login and password required) and complete the online process using your credit card. You can also renew your membership using the paper forms sent to you through the mail. See the AANA website for further information about membership and its benefits. Installment payments and automatic renewal are now available!
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The PQRS Clock Is Ticking!

Are you still trying to decide on how to report to the Physician Quality Reporting System (PQRS)? Don’t delay any longer—there are only five months left in the 2015 reporting period! The Group Practice Reporting Option (GPRO) already expired on June 30, 2015. If you are reporting as an individual eligible professional (EP), registry reporting is still an option with the added benefit of the March 31, 2016, registry data submission deadline. Visit our Quality-Reimbursement web site to learn how to satisfactorily report and avoid the PQRS penalty. For our AANA members, we have also added a new “Registry Reporting for CRNAs” FAQ Page, which features information on the AANA’s Member Advantage Program with PQRSwizard (login required).
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Open Session of the August 28, 2015, AANA Board of Directors Meeting to be Live Streamed

Click here to register for the live stream of the Open Session of the AANA Board of Directors Meeting, which will be held on Friday, Aug. 28, at 1 p.m. MDT. AANA members are also welcome to attend the Open Session, which will be held at the Salt Palace in Rooms 150 D-G, in person.
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Groundbreaking Bylaw Amendment Proposed at AANA Annual Business Meeting

The Virtual Meeting Task Force was appointed in fiscal year 2015 to address AANA members’ strong interest in participating in the governance of the association, even if they cannot attend the AANA Annual Business Meeting. The Task Force is pleased to present a bylaw amendment this year that, if passed, will allow members to vote on the bylaw amendments and resolutions after the Business Meeting concludes! See the article for more information on the proposed amendment (member login and password required).
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Calling all Nurse Anesthetists! Your Thoughts on Professional Competence are Needed

The AANA, AANA Foundation, Council on Accreditation of Nurse Anesthesia Educational Programs and National Board of Certification and Recertification for Nurse Anesthetists are working on developing a document identifying professional competencies that are representative of nurse anesthesia practice. We value your feedback and want to hear the professional competencies that you have used for successful practice and role transitions from your preparation for entry into practice and across your career. Your input will help us create an evidence-based document that will define the fundamental professional competencies for nurse anesthesia practice excellence.
  • Where: Nurse Anesthesia Annual Congress, Salt Lake City
  • Date and Time: Friday, Aug. 28, 5:30-6:30 p.m. MT
  • Location: Salt Palace Convention Center, Grand Ballroom AC
Visit the project webpage at www.aana.com/professionalcompetence for more project information.
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Proposed Bylaw Amendments and Resolutions Available Online

The proposed Bylaw Amendments and Resolutions to be debated at the August 30, 2015, AANA Business Meeting are available online here (AANA member login and password required).
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Positive Clarifications for CRNAs in ACS Level III Trauma Facilities

The American College of Surgeons (ACS) trauma verification program released its Clarification Document Resources for Optimal Care of the Injured Patient 2015, which clarifies ACS trauma verification criteria of interest to CRNAs. Clarifications for ACS-verified Level III trauma facilities state that CRNAs may serve as trauma committee anesthesia liaisons and provide anesthesia without physician supervision in states where they practice independently. The AANA is pleased with these clarifications and will continue to collaborate with ACS and advocate for removal of unnecessary barriers to high-quality trauma anesthesia care provided by CRNAs. View the ACS Resources Repository for the Resources for Optimal Care of the Injured Patient.
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AANA Annual Reports Available Now

The 2014-2015 Annual Reports of AANA committees and affiliates have been posted on the member side of the website at www.aana.com/annualreports (AANA member login and password required).
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See You on September 15

Due to the timing of the Nurse Anesthesia Annual Congress, the Anesthesia E-ssential will not come out on Aug. 28, and it will resume publication on September 15. Before and during the Annual Congress, watch your inbox for the 2015 AANA Congress Daily. The Daily will once again be distributed via email to all AANA members, not just Annual Congress attendees. The first preissue will debut on August 17. You will receive the next preissue on Monday, Aug. 24 and daily issues Aug. 30 through Sept. 1 during the congress.
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Professional Practice

Cybersecurity Vulnerabilities of Hospira Symbiq Infusion System

The U.S. Food and Drug Administration (FDA) is alerting users of the Hospira Symbiq Infusion System to cybersecurity vulnerabilities with this infusion pump. The Symbiq Infusion System could be accessed remotely through a hospital’s network. This could allow an unauthorized user to control the device and change the dosage the pump delivers, which could lead to over- or under-infusion of critical patient therapies. The FDA encourages that health care facilities transition to alternative infusion systems, and discontinue use of these pumps. Read more in the FDA’s safety communication. FDA’s safety communication.
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Severe Maternal Morbidity Review Webinar

Join the Council on Patient Safety in Women’s Health Care on Thursday, August 20 at 12:00 pm ET for the August Safety Action Series webinar titled “Using the Revised Severe Maternal Morbidity Review Forms.” The webinar will explore how to conduct a debrief session following a severe maternal morbidity event including: which events to review, who would conduct the review, and appropriate time to review. More information and registration can be accessed here.
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Meetings and Workshops

AANA Annual Congress: We Have an App for That!

The mobile app for the AANA 2015 Nurse Anesthesia Annual Congress is ready for download on both the iTunes and Google Play app stores—for free! The app is the go-to place for information regarding the Annual Congress—users can view every educational session, every speaker, and get general information about the convention and Salt Lake City—all within a few taps. Attendees can even personalize a schedule and save it within the app to make sure they never miss a session of interest.

To download, just search for “AANA 2015” in the app store on your mobile device. Otherwise, iPhone users can download here, and Android users can download here.
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#AANA2015: Online Pre-registration Deadline Approaching Fast

The 2015 Nurse Anesthesia Annual Congress is only four weeks away! (August 29 - September 1, in Salt Lake City.) Avoid the lines and register online by August 16. After that date, only onsite registration is available.
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AANA Fall Leadership Academy Registration is Now Open

Find out why past attendees rave about our Fall Leadership Academy conference. Join us Nov. 5-8 for three days of intense leadership training just for CRNAs. Learn to lead change and become an influencer with expert speakers and five educational tracks including Business and Facility Leadership, Federal Political Director, State Grassroots Advocacy, State President-Elect, and State Reimbursement Specialist. Pre-conference workshops also available. Register today and save more than 10 percent! Single-day registration also available. www.aana.com/leadership. www.aana.com/leadership
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Register Now for Popular Hands-On Workshops

Check out the Meetings and Workshops webpage on the AANA website and future issues of the AANA NewsBulletin and Anesthesia E-ssential for further information.
  • Upper and Lower Extremity Block Workshop: September 26-27, Park Ridge, Ill. (Register here)
  • Essentials of Obstetric Analgesia/Anesthesia Workshop: October 21, 2015, Park Ridge, Ill. (Register here)
  • Spinal and Epidural Workshop: October 22-24, 2015, Park Ridge, Ill. (Register here)
  • Jack Neary Advanced Pain Management Workshop Part II, October 10-11, 2015, Rosemont, Ill. (Register here)
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Save the Dates for AANA Meetings and Workshops

Make the most of your professional development this fall! Check out what's coming up here, and find out more and register here.
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Foundation and Research

AANA Foundation presents One Night – Twice the Fun... Register Today!

Plan to attend One Night – Twice the Fun on Sunday, August 30, 2015, at The Grand America Hotel in Salt Lake City, Utah.

One Night – Twice the Fun features fabulous live entertainment by Hollywood Revisited – click here for a sneak preview video.

Star-Studded Main Event and Shake It for a Cause Dance Party
Registration fee is $250
7:00 - 11:45 p.m.
Ticket includes dinner, drinks, entertainment featuring Hollywood Revisited, and the dance party.

Shake It for a Cause Dance Party
Registration fee is $50 for CRNAs and $25 for SRNAs
9:30 pm - 11:45 p.m.
Ticket includes the dance party only featuring a DJ playing all your favorite songs.

Please register today!
Not only will you have a fun time, but a portion of your donation is tax deductible and will support the AANA Foundation and our grand profession.

Thank you in advance for your support!
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Attend the “State of the Science” at the 2015 Annual Congress

Sixteen competitively-selected investigators will orally present their research in 15 minute presentations at the AANA Foundation’s “State of the Science” Oral Poster Sessions. If you are going to Annual Congress, please plan to attend:

Monday, August 31, 2015
10:00 a.m. - 12:00 p.m. (2 CE credits)
2:00 p.m. - 4:00 p.m. (2 CE credits)
Salt Palace Convention Center
Salt Lake City, Utah
Room 150 D-G

Visit www.aanafoundation.com to view the list of oral and general presenters.
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Support Nurse Anesthesia Research and Education—Make Your Fiscal Year-End Donation to the AANA Foundation Today

The AANA Foundation funds critical research that benefits all nurse anesthetists and their patients. Evidence provides proof and proof is power!

Take a moment today to make your tax-deductible, fiscal year-end gift to AANA Foundation’s Proof is Power campaign—click here to access the Foundation’s secure donation page. The fiscal year ends August 31, 2015. Please make your donation today!

Thank you in advance for your support!
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Federal Government Affairs

AANA and APRN Organizations Launch “Veterans Access to Quality Healthcare Alliance” Advocacy Site: Tell Your Friends

In a message to membership, the AANA has announced the newest phase of our campaign to promote veterans access to quality healthcare through recognition of CRNAs and other APRNs to their Full Practice Authority: the formation of the “Veterans Access to Quality Healthcare Alliance” and launch of a new professional advocacy website to share with colleagues in general and with veterans in particular—http://www.Veterans-access-to-care.com.

Lawmakers need to hear from CRNAs, other healthcare professionals, and veterans in support of ensuring Veterans access to quality care through Full Practice Authority for CRNAs and other APRNs. But they won’t hear unless you take action now—even if you have already contacted Congress on these issues in months past. We encourage members to take action: Share this site with colleagues, friends and family and urge them to take action by writing their member of Congress here.

Share this website with your network and encourage their support today via: http://www.Veterans-access-to-care.com. See the AANA’s press release on the newly formed Alliance here.
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Medicare Considering Value of Anesthesia Delivery Models for Future Rulemaking

Medicare is considering the benefits and costs associated with various anesthesia delivery models as it considers future rulemakings, spurred by AANA. The action by the largest payer for healthcare services appears likely to encourage other health plans and major hospital systems to do likewise – and to consider the safety, access and cost-efficiency benefits of CRNA services.

In a statement accompanying its Hospital Inpatient Prospective Payment System final rule issued July 31, the Centers for Medicare & Medicaid Services acknowledged the AANA’s recommendation to include the costs incurred from medical direction, such as waiting costs for anesthesiologists to be present at induction and at emergence, as hospital quality measures. The
preamble of the final rule, said that “one commenter” submitted a letter describing “peer-reviewed literature indicat[ing] that Certified Registered Nurse Anesthetists (CRNAs) acting as the sole anesthesia provider are the most cost-effective model for anesthesia delivery without any measurable difference in quality of care.” CMS also acknowledged the AANA’s comment that “…literature shows that anesthesiologists fail to comply with federal requirements and noted lapses in anesthesiologist supervision is [sic] common which adds hospital costs while the patient remains anesthetized.” CMS added that it will take into consideration the AANA’s recommendation on including the cost of anesthesia subsidies per anesthetizing location as a possible hospital measure.

Read the preview of the CMS final rule here. Please note that the link expires on August 17 when the final rule is published in the Federal Register. Read the AANA comment letter on the CMS proposed rule here. (requires AANA login and password).
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Senate Action on Veterans Health Bill Clears Way for Veterans Agency to Advance Full Practice Authority for CRNAs, APRNs

Action in the Senate Veterans Affairs Committee on July 22 helps to clear the way for the Veterans Health Administration (VHA) to publish in the Federal Register a proposed rule recognizing CRNAs and other APRNs to their full practice authority, following extensive advocacy by the AANA and CRNAs.

By including parts of S 297, but not the problematic provisions that brought concern to AANA for excluding CRNAs from “independent practice” for APRNs in the VHA, into a new bill that the committee approved and moved to the full Senate (S 1203), the committee allows the VHA to move forward with publishing a proposed rule later this year. AANA President Sharon Pearce, CRNA, MSN applauded the committee’s actions in a statement saying, “By passing S 1203 and its provisions of the ‘Frontlines to Lifelines Act’ (S 297, Kirk, R-IL) without language that would have disrupted the VHA from recognizing CRNAs to their full practice authority, the committee is letting the VHA do the job it needs to do to protect and advance veterans’ access to quality healthcare.”

To view the President Pearce’s full statement, see: http://www.aana.com/veterans-access. To view AANA’s previous testimony on S 297, here. (AANA member login required) and see the AANA and APRN letter here (AANA member login required).
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AANA Requests Medicaid Managed Care Organizations Fully Recognize CRNAs in All Network Plans

In a July 27 letter to the Centers for Medicare & Medicaid Services (CMS), the AANA requested that Medicaid managed care plans fully recognize CRNAs by including CRNAs in all of their network plans. The AANA’s action was in response to a proposed rule that the agency published reforming its rules for Medicaid managed care plans nationwide for the first time since 2002.

In the letter from AANA President Sharon Pearce, CRNA, MSN, the AANA also recommended that managed care plans adopt alternative payment systems that recognize and reward all qualified healthcare providers such as CRNAs for ensuring patient access to safe, cost-effective healthcare services. The AANA also supports the proposal that states should ensure nondiscrimination in access to provider services under managed care plans.

View the Medicaid Managed Care Proposed Rule here. View AANA Comments here.
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Update on AANA’s Efforts to Ensure Veterans Access to Quality Care

The AANA and its members continue to advocate for legislation and a Veterans Health Administration (VHA) proposal that would authorize all advanced practice registered nurses (APRNs), including CRNAs, to practice as full practice providers in the VHA and help improve access to quality healthcare for all veterans. Here is a status update:
  • The AANA is supporting legislation in the House, HR 1247, the “Improving Veterans Access to Quality Care Act,” sponsored by Reps. Sam Graves (R-MO) and Jan Schakowsky (D-IL). The bill has 36 bipartisan cosponsors. The AANA encourages members whose U.S. Representative has cosponsored this legislation to send a thank you note (here). Please continue to contact your U.S. Representative and encourage co-sponsorship of this bill (here). View the AANA and APRN Workgroup letter of support here and also view the Nursing Community letter here.
  • The AANA continues to strongly support the VHA’s efforts to recognize CRNAs and other APRNs to their full practice authority, consistent with the recommendations of the Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health. According to the VHA, the agency intends to publish regulatory rulemaking later this year recognizing CRNAs and other APRNs as full practice partners in the VHA. Thousands of AANA members have already contacted the VHA in support of this work.
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At Institute of Medicine Meeting, AANA Outlines Impacts of 2010 “Future of Nursing” Report and What Remains to be Done

Several policy and reimbursement barriers to the use of CRNAs have been eliminated with the help of the Institute of Medicine’s (IOM) 2010 report “The Future of Nursing: Leading Change, Advancing Health.” But more remains to be done for patients and the healthcare system to enjoy the full patient safety, access to care and cost-effectiveness benefits of CRNAs, according to testimony that the AANA submitted to the IOM July 28.

The Future of Nursing report helped health plans to expand coverage of CRNA services, Medicare to cover CRNA pain management services, and Congress to repeal harmful “sustainable growth rate” (SGR) cuts in a way that covers physicians, CRNAs and other APRNs equally, said the statement by AANA President Sharon Pearce, CRNA, MSN. But further work remains at the local, state and federal levels to fully recognize CRNA practice and coverage, implementing the SGR relief legislation and its Medicare payment reforms, and in the Veterans Health Administration publishing and finalizing a rule recognizing CRNAs and other APRNs to their Full Practice Authority.

Learn more about the IOM Committee for the Evaluation of the Impact of the IOM Report, The Future of Nursing: Leading Change, Advancing Health, here. See the AANA’s statement here.
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Special Events for FPDs and SRSs at AANA Annual Congress

If you’re a Federal Political Director (FPD) or State Reimbursement Specialist (SRS), the AANA Annual Congress in Salt Lake City, Utah, includes special events for you.

The Annual Congress FPD meeting takes place on Sunday, Aug. 30, from 1-2 p.m. Mountain time, in 254 A Convention Center. Led by AANA Associate Director Political Affairs Kate Fry from our Washington, D.C., office, this meeting will update FPDs on current issues and political trends for CRNAs, preview the FPD educational program at AANA Fall Leadership Academy this November, and provide FPDs professional networking opportunities.

An informal get together will be hosted for SRSs Monday, Aug. 31, from 9-9:45 a.m. Mountain time, in front of the CRNA-PAC booth in the Exhibit Hall in the convention hotel. It is great opportunity to connect with your fellow SRSs and get the latest news about reimbursement issues and trends affecting CRNAs.
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Support your CRNA-PAC; Become a Triple Crown Honoree this AANA Dues Season

When you pay your AANA member dues this summer, earn eligibility for AANA Triple Crown recognition and help build your profession’s future by also contributing to the AANA Foundation and to the CRNA-PAC.

At AANA meetings, Triple Crown members are recognized by a special Triple Crown ribbon. You will also be enrolled in a separate recognition program for the CRNA-PAC and the AANA Foundation. The Triple Crown signifies your commitment to three crucial aspects to the nurse anesthesia profession: (1) membership in the national association, (2) enrollment in the
Foundation in support of research and scholarships, and (3) participation in the CRNA-PAC, which helps elect and re-elect CRNA-friendly members of the U.S House and Senate who help shape CRNA reimbursement and practice.

A joint initiative of the AANA, CRNA-PAC, and AANA Foundation, Triple Crown recognition for 2016 is available for those members who have also given $250 to the CRNA-PAC and $250 to the AANA Foundation, in a given AANA fiscal year.

To renew your membership, click here and support the CRNA-PAC at www.crna-pac.com (requires AANA member login and password). Give to the AANA Foundation at

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  • The Senate and House have begun their summer recess — a great opportunity for CRNAs to see their lawmakers at home! If you see your legislators or their staffs at home, let us know how your visits went by logging your visit on the CRNA-PAC website at https://www.crna-pac.com/legisreport.aspx (AANA login required) and sending us pictures to info@aanadc.com. To see when Congress is in Washington or at home, go to House schedule, Senate schedule.
  • The Healthcare Payment and Learning Action Network announces its third webinar on Aug. 17 from 12:00-1:30 pm Eastern, highlighting the federal government’s experience with testing bundled payments associated with hip and knee replacements. Your AANA is participating and will be reporting on this webinar. Register for the webinar here.
  • The AANA encourages CRNAs to engage with the presidential campaign of their choice, particularly in the early caucus and primary states of Iowa, New Hampshire, South Carolina and Nevada. Neither the AANA nor the CRNA-PAC support or endorse candidates for President. If you have any questions, contact your AANA team in Washington at info@aanadc.com.
  • Stay up to date on CRNA reimbursement issues by obtaining Version 3 of the AANA’s “Issues Briefs on Reimbursement and Nurse Anesthesia,” available only for AANA members here (requires AANA member login and password).
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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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Featured Career Opportunity

Certified Registered Nurse Anesthetist (CRNA) – U.S. Army Nurse Corps

Provide specialized care to patients requiring general anesthesia, respiratory care, cardiopulmonary resuscitation and fluid therapy. Work as part of a multidisciplinary team, surrounded by dedicated professionals who share your values.

Read more about this position
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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.

Seniors at Increased Risk Following Outpatient Surgery

A new study published in the Journal of the American Geriatrics Society says it is essential to make sure elderly patients fully grasp discharge instructions and the amount of pain medication they should take following procedures performed at ambulatory surgery centers (ASCs). Doing so will help lower readmissions, according to the study by researchers at the Northwestern University in Chicago. They reviewed the records of 1,370 hospital admissions that occurred following nearly 54,000 surgeries performed in ASCs. They found that patients 65 years or older were 54 percent more likely to be admitted to hospitals following their procedures, regardless of their preoperative health. Study author Gildasio De Oliveira Jr., MD, recommends that caregivers at ASCs verify if patients are able to take care of themselves at home and determine if they have adequate support from friends or family. "If not, patients should be admitted to the hospital after surgery or have some type of formal support by a nurse to help them at home," he says. The report notes that taking too many opioids can land patients in the ER while taking too few can result in cardiovascular problems, slowed wound healing, and increased discomfort requiring hospital care.

From "Seniors at Increased Risk Following Outpatient Surgery"
Outpatient Surgery Magazine (08/15) Cook, Daniel

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Music in the OR Can Be a Distraction

Music is played in nearly 75 percent of operating rooms (ORs) worldwide, but new research published in the Journal of Advanced Nursing finds that it interferes with communication among surgical team members and puts patients at risk. To determine how music affected surgery, U.K. researchers analyzed video footage from cameras placed in multiple locations during 20 operations. They found that surgeons were five times more likely to repeat requests for instruments when music was playing, potentially prolonging total procedure time by a minute or more. The researchers also said music-related difficulties in communication could spawn staff frustration and compromise patient safety. Ideally, the entire surgical team must agree if music should be played and, if so, decide on music type and an acceptable volume, the study authors conclude. Surgical facilities also should institute policies that dictate how and when music is played in the OR and add music volume concerns to pre-surgical checklists.

From "Music in the OR Can Be a Distraction"
Outpatient Surgery Magazine (08/15) Cook, Daniel

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Yale Study: Higher Risk of Death Among Veterans Taking Opioids Long-Term

A Yale School of Medicine study of veterans shows that long-term prescription opioid use may increase patients' risk of death. About 64,000 veterans who took opioids or benzodiazepines over an extended period of time were observed for 90 days or more. The risk of death, of any cause, was higher for those who took the medication than those who did not. The risk was even greater for patients who took both types of medication at the same time. Patients who took opioids had a 40 percent higher risk of death, and patients who took benzodiazepines had a 26 percent greater risk. It was one of the few studies to assess the risks of benzodiazepines. "Now we have convincing evidence that physicians should think twice before prescribing both of these medications at the same time," study leader Daniel Weisberg, MD, said. "We really have to be cautious about the number of prescribed meds that patients are on."

From "Yale Study: Higher Risk of Death Among Veterans Taking Opioids Long-Term"
New Haven Register (08/06/15) Rosner, Cara

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Selective Low Dose Spinal Anesthesia for Transrectal Prostate Biopsy: A Prospective and Randomized Study

Investigators in Turkey sought to assess the use of spinal anesthesia for prostate biopsy. Their study compared the efficacy and tolerability of selective low-dose spinal anesthesia versus intrarectal local anesthesia (IRLA) plus periprostatic nerve blockade (PPNB). The research included 100 patients between the ages of 40 and 80 who between September 2012 and April 2013 had prostate specific antigen (PSA) at or above 4 ng/ml and abnormal digital rectal examinations. Anal sphincter relaxation, patient satisfaction with the anesthesia technique, and motor response were evaluated. Pain during probe insertion, biopsy, and 30 minutes after biopsy—assessed using visual analog scale—was significantly lower in the low-dose spinal anesthesia group; and anal sphincter relaxation degree was significantly higher. Patients' overall satisfaction with the procedure was significantly higher in the spinal anesthesia group, and no motor blockade was observed in this cohort. The researchers concluded that selective low-dose spinal anesthesia provides better pain relief than IRLA plus PPNB and was associated with willingness for a repeat biopsy without differences in procedure duration, tolerance, and complications.

From "Selective Low Dose Spinal Anesthesia for Transrectal Prostate Biopsy: A Prospective and Randomized Study"
Uro Today (08/04/15) Kucur, M.; Göktas, S.; Kaynar, M.; et al.

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Study Suggests Prehabilitation as Effective Way to Improve Cancer Patient Outcomes

Some specialists believe cancer patients who prepare before they begin treatment recover more quickly from surgery, chemotherapy, or radiation; however, insurance coverage for cancer "prehabilitation" can vary. Typically, the process involves a structured exercise program to improve patients' endurance, strength, or cardiorespiratory health under baseline measurements established by the clinician—such as determining how far a patient can walk on a treadmill in six minutes. The clinician also evaluates and addresses existing physical impairments, such as a breast cancer patient's limited shoulder mobility. Some prehab programs also offer patients services like psychological and nutritional counseling. In a randomized controlled trial of 77 people with colorectal cancer who were awaiting surgery, two groups of patients participated in an exercise, relaxation, and nutritional counseling program. Half went through the program in the four weeks prior to surgery and half in the eight weeks after it. Eight weeks after their procedures, the performance of 84 percent of prehab patients on a six-minute walking test indicated recovery equal to or surpassing their baseline measurements compared to 62 percent of rehab patients, according to the study, published in 2014 in Anesthesiology.

From "Study Suggests Prehabilitation as Effective Way to Improve Cancer Patient Outcomes"
MedCity News (08/02/15) Andrews, Michelle

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Intubation via Supraglottic Approach Preferred in Pediatric Difficult Airways

The Pediatric Difficult Airway Group conducted a large-scale review of cases in an effort to compare the efficacy of the fairly new supraglottic airway (SGA) approach to intubation against more advanced airway management techniques. "The technique has a lot of promise, as it allows for continuous oxygenation and ventilation throughout intubation, frees up the provider's hands by displacing some of the pharyngeal tissue, and allows clear access for the fiber-optic intubations (FOIs)," said Nicholas Burjek, MD, who led the research. His team analyzed 897 pediatric difficult airway cases, 115 of which included at least one attempt with an SGA and FOI. For the 61 cases where FOI-SGA was the initial intubation technique, 32—or more than half—were successful on the first attempt. In the other 54 cases, FOI-SGA was successful on the first try 55.6 percent of the time when applied as a rescue technique after failure with another intubation method. "Those numbers are pretty similar to what we saw with respect to initial success rates with fiber-optic intubation without an SGA, as well as video laryngoscopy," Burjek noted. "This illustrates that this new technique ... is living up to the gold standard of the best other techniques out there."

From "Intubation via Supraglottic Approach Preferred in Pediatric Difficult Airways"
Anesthesiology News (08/01/15) Vol. 41, No. 8 Vlessides, Michael

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NSAIDs, Opioids Found Similar for Chronic Pain Risk After Vehicular Accidents

Emergency room patients who have been in motor-vehicle accidents have an elevated risk for developing chronic pain, but the odds are no greater if they are prescribed opioids at discharge than if they are prescribed nonsteroidal anti-inflammatory drugs (NSAIDs). In a study of 859 crash victims, Brown University researchers found that 49 percent who received NSAID prescriptions reported moderate or severe musculoskeletal pain six weeks later. The share was higher—56 percent—but not statistically significant, for subjects who were given narcotic painkiller prescriptions upon discharge from the emergency department. The finding appears to support a growing challenge to current opioid prescribing practices. According to study author Francesca Beaudoin, MD, MS, there seems to be no standard for prescribing pain medication people hurt in vehicular accidents; and best practices may be warranted.

From "NSAIDs, Opioids Found Similar for Chronic Pain Risk After Vehicular Accidents"
Pain Medicine News (08/01/2015) Vol. 13, No. 8 Dunleavy, Brian

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Interscalene Blocks With Periplexus Approach Reduces Risk for Nerve Injury

Following a periplexus, rather than intraplexus, approach during ultrasound-guided interscalene block reduces the likelihood of nerve injury, report researchers from Canada's Dalhousie University. To determine the risk for subepineurial needle-tip placement, they performed 26 blocks using the periplexus technique and 26 using the intraplexus approach on cadavers. Once block needles were in position, black acrylic ink was injected. Inspection of tissue samples revealed subepineurial ink deposits in three of the intraplexus injections, suggesting an 11.5 percent probability that the needle-tip position may be subepineurial. There was no ink spread detected, meanwhile, in any of the periplexus injections. According to study author Kwesi Kwofie, MD, the needle tip was, on average, 0.36 mm from the nearest nerve root with the periplexus injections, indicating a high success rate if performed on actual patients. "Previous studies ... demonstrated, using an up-down methodology, that a distance of 1.6 mm away from the neural structures would result in a 95 percent efficacy," he explained.

From "Interscalene Blocks With Periplexus Approach Reduces Risk for Nerve Injury"
Anesthesiology News (08/01/15) Vol. 41, No. 8 Leung, Martin

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Paravertebral Catheters Reduce Post-Breast Surgery Opioid Use, Length of Stay

Paravertebral catheters (PVCs) are already known to curb opioid use and cut length of stay (LOS) in the hospital following mastectomy; while non-opioid gabapentin has shown a narcotic-sparing effect in breast cancer patients. Now, researchers say a multimodal pain protocol pairing the two approaches offers a number of benefits over traditional on-demand pain management with opioids. After reviewing the charts of 139 breast surgery patients—who were split into cohorts for conventional treatment, PVC alone, and PVC with gabapentin (PVC+G)—the investigators confirmed that LOS, opioid use, and postoperative nausea all were lower in the PVC group compared to the conventional group. The gap widened even further, however, when comparing the conventional approach against the PVC+G protocol. "We noticed not only drastic—almost a 50 percent—decrease in narcotic usage and subsequent decrease in opioid side effects," said lead study author Vlad Frenk, MD. "Our average length of stay decreased from 2.3 days to 1.6 days. What it translates to is that patients who used to spend two nights in the hospital now spend one night in the hospital."

From "Paravertebral Catheters Reduce Post-Breast Surgery Opioid Use, Length of Stay"
Pain Medicine News (08/01/2015) Vol. 13, No. 8 Leung, Martin

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Lidocaine Nixes Pain and Improves Sex in Breast Cancer Patients

Researchers say treating painful intercourse with topical liquid lidocaine can improve sexual function in postmenopausal breast cancer survivors. For their study, the investigators randomly assigned 46 estrogen-deficient survivors experiencing severe pain during penetration to apply either aqueous lidocaine or a placebo to the vulvar vestibule. The findings, published online in the Journal of Clinical Oncology, showed that 95 percent of the women who used the lidocaine compress followed by a silicone lubricant were able to engage in pain-free sex. That, in turn, suggests that dyspareunia associated with menopause may be caused by pain in the inner vulva or entryway to the vagina rather than factors in the vagina itself—including lack of moisture, thinning of vaginal tissue, and atrophy. "Our success when focusing on pain rather than on atrophy raises questions about current assumptions regarding postmenopausal dyspareunia," reports lead researcher Martha Goetsch, MD, MPH, of Oregon Health & Science University.

From "Lidocaine Nixes Pain and Improves Sex in Breast Cancer Patients"
Medscape (07/31/15) Nelson, Roxanne

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Tramadol/Acetaminophen Improves Quality of Life in Chronic Pain Patients

Fibromyalgia patients who took an analgesic combination of tramadol and acetaminophen saw their pain subside and their health-related quality of life improve as a result, researchers report. The trial, which enrolled 313 patients with moderate-to-severe pain, paired the two analgesic agents because they work in different ways to tackle pain. Patients received the medication four times a day every day, for up to 91 days. The treatment produced significant positive outcomes as far as physical function, bodily pain, stiffness, and more. "Moderate-to-severe fibromyalgia pain significantly impairs health-related quality of life, and effective pain relief in these patients significantly increases health-related quality of life," wrote the team from Oregon Health and Science University in the journal Arthritis & Rheumatism.

From "Tramadol/Acetaminophen Improves Quality of Life in Chronic Pain Patients"
Fibromyalgia News Today (07/31/15) Newman, Maureen

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New Treatment Option for Long-Term Chronic Back, Leg Pain

While low-frequency electrical stimulation is a common treatment for chronic pain, new research has discovered that high-frequency spinal cord stimulation (SCS) offers even greater benefits. Known as HF10 therapy, the approach delivers 10,000 hertz (Hz) compared to 40 Hz to 60 Hz under the traditional protocol. Testing on 171 people with both chronic back and leg pain revealed that three months of treatment at the higher frequency cut back pain at least in half for 84.5 percent of those 90 patients and reduced leg pain in 83.1 percent of the cohort. By comparison, back and leg pain subsided in 43 percent and 55.5 percent, respectively, of patients in the low-frequency group, which included 81 subjects. Additionally, HF10 patients did not develop paresthesias, which is a common outcome with traditional SCS. The findings, reported in Anesthesiology, suggest that higher-frequency SCS can provide long-term analgesia for chronic pain patients while avoiding the limited efficacy and side effects of opioid therapy.

From "New Treatment Option for Long-Term Chronic Back, Leg Pain"
HCPLive (07/29/15) Fitzpatrick, Caitlyn

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