Anesthesia E-ssential

AANA Anesthesia E-ssential, August 2, 2018
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AANA Board Approves Statement on Titles and Descriptors for CRNAs

Dear AANA Members,

This past February, the AANA Board of Directors created the Nurse Anesthesiologist Descriptor Task Force and charged it with analyzing the pros and cons of the AANA recognizing the descriptor "nurse anesthesiologist" for use by CRNAs. After more than five months of information gathering, analysis, and discussion, the task force presented its recommendations to the AANA Board of Directors during the open session of the Board meeting held July 27, 2018.

Following a robust discussion by the Board, a statement concerning the use of titles and descriptors by CRNAs was developed and unanimously approved. The statement, which incorporates input from the task force and the membership at large, is as follows.

The Board wishes to thank the task force members for the time and effort they dedicated to this important assignment.

The practice of anesthesia has been a recognized nursing specialty for more than 100 years. The AANA presents this statement in an effort to clarify for the public the many ways someone may refer to a CRNA.

The AANA recognizes the following titles:
  • Certified Registered Nurse Anesthetist
  • CRNA
  • Nurse Anesthetist
The AANA acknowledges additional descriptors for nurse anesthetists which could include, but are not limited to, the following:
  • Advanced Practice Registered Nurse (APRN)
  • Licensed Nurse Practitioner (LNP)
  • Licensed Independent Practitioner (LIP)
  • Advanced Practice Provider (APP)
  • advanced practice professional
  • nurse anesthesiologist
Regardless of the title or the descriptor being used, as a profession we believe it is time for the focus to be on the quality of the healthcare provided and not the title of the healthcare provider.

It remains the responsibility of each individual CRNA to remain aware of and comply with the legal requirements of any state or facility in which they practice.


2018 AANA Board of Directors
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New State Opioid Collaborative Toolkit Available Online

As the opioid crisis surges throughout the U.S., there are many opportunities for CRNAs to be involved and advocate for solutions through leadership or participation in collaborative initiatives within their community. Each state’s opioid epidemic experience, resources and needs are unique. Therefore, state leaders and the AANA have developed a toolkit to provide considerations to identify opportunities to create, lead or serve on a state or community opioid-related initiative. The toolkit and state resource repository are available at  Opioid Safety and Advocacy Toolkit. If you or your state has references to contribute to further build the toolkit resource repository or you have any questions about this toolkit, please contact
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Hot Topics

MIPS “How To” Video Modules Available – 2017 Performance Feedback and Targeted Review

If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS final score and performance feedback are now available for review on the Quality Payment Program website. If you believe that an error has been made in your 2019 MIPS payment adjustment calculation, you can request a targeted review until October 1, 2018 at 8:00 pm (ET).

To help you access your performance feedback for the 2017 performance year or request a targeted review, CMS has posted video modules to help you access your MIPS performance feedback or request a targeted review.
  1. How to Access Performance Feedback for Individuals - demonstrates how to access 2017 MIPS performance feedback for a clinician whose performance was scored separately from his or her group. You can also review the performance feedback user guide for more detail.
  2. How to Request a Targeted Review - demonstrates how MIPS eligible clinicians or groups can request a targeted review of their 2019 MIPS payment adjustment. You can also review the targeted review user guide for more detail.
To review the 2017 MIPS program requirements, CRNAs may visit the 2017 MIPS portion of the AANA Quality Reimbursement website.
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Call for Committee Members: Respond by September 1, 2018

The Foundation is currently looking for committee members to serve on the Research and Scholarship Committees. The mission of the AANA Foundation is to advance the science of anesthesia through education and research. You can play an active role in supporting these important aspects of the CRNA profession by participating on an AANA Foundation committee.

The AANA Foundation Research Committees are comprised of CRNAs who are interested in research. Tasks include reviewing applications for research grants, fellowships and poster sessions. The Board of Trustees makes funding decisions based on the recommendations of these committees. Members of the Research Committees also are called upon occasionally to assist on research advisory panels.

The AANA Foundation Scholarship Committee is comprised of CRNAs. The task of this committee is to review student scholarship applications. The Board of Trustees bases funding decisions on the recommendations made by this committee.

Many members of the AANA Foundation Board of Trustees, both past and current, have served on the Research and/or Scholarship Committees. Please consider giving back to your profession by serving on one of these committees.

If you are interested, please submit a statement of interest along with your CV to by September 1, 2018. Any questions, please contact the Foundation at (847) 655-1170.
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Malpractice Insurance Coverage Options to Fit Your Needs

For nearly 30 years, AANA Insurance Services has specialized in developing innovative malpractice insurance options for nurse anesthesia professionals. In fact, no other agency provides a wider range of coverage options for CRNAs. Caring has its risks. Learn how we can help safeguard your career: AANA Insurance Policy Options for Members
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Applications Available for Open Submission Grant Funding

Grant funding for the AANA Foundation's Open submission grants includes Office Based and Veterans Affairs grants, as well as the Art Zwerling Grant (research and education in wellness, pain management, and peer assistance/substance use disorder). Submissions are accepted on a rolling basis. Learn more at Open Submission Research Grant Applications
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NewsMaker: Major John Buen Participates in El Paso Army Training Exercise

Approximately 30 soldiers with the 7248th Medical Support Unit based out of El Paso Texas, conducted an annual training event at William Beaumont Army Medical Center, providing additional healthcare support to soldiers, retirees, families and other beneficiaries in the El Paso, Texas area, July 8-20.

Maj. John Buen, CRNA, ANC, USA, is the officer in charge of the detachment. "Our missions was to support this hospital in various departments," said Buen. "We had soldiers supporting for two weeks. The training helped supplement our own training to keep (reserve-component soldiers) competent in their skills."

Read more in DVIDS.
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Meetings and Workshops

Tap into Technology at the AANA 2018 Annual Congress

Held September 21 - 25, 2018, at the Hynes Convention Center in Boston, the 85th AANA Annual Congress promises to deliver the latest research, technology, clinical and practice information. Nurse anesthetists can acquire CE credits, network with peers from around the country, and update or refresh their technical and practice skills. Maximize your CE opportunities with a Pre-Congress Workshop (additional registration required). If you haven't registered yet, it's not too late. We hope to see you at the 85th AANA Annual Congress.

See all upcoming events on our AANA Meetings and Workshops page.
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Practice Leadership Assembly Improves Business and Practice Accumen

The Practice Leadership Assembly, held November 9-11, 2018, in Rosemont, Illinois, covers anesthesia practice models, chronic pain management, reimbursement, leading beyond anesthesia, mitigating daily practice risks, understanding malpractice insurance, engaging your staff, negotiating contracts and RFPs, healthcare IT, business savvy, and healthcare entrepreneurship. Plus, attendees will join us for a reception at the AANA national headquarters on Friday evening. This new assembly is designed to give current and prospective business owners, as well as practice and facility leaders, the insight and confidence to lead the way in a rapidly changing healthcare environment. Learn more are Practice Leadership Assembly.
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AANA Member Benefits

NationwideNationwide: What to Do After a Car Accident

Even if you're a safe driver, it never hurts to go over what to do after an accident and how you can be prepared. That's why Nationwide brings these words of advice on how to handle it.

Nationwide What to Do After a Car Accident
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Quicken Loans$1,500 in Mortgage Savings from Quicken Loans

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Si desea hablar con un experto en prestamos hipotecarios de Quicken Loans, por favor llame a (855) 245-5911, y marque ocho.

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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.

Intraneural Ultrasound-Guided Sciatic Nerve Block

Because local anesthetic for sciatic nerve block has the potential to trigger axonal nerve damage, it may be helpful to keep the administered volume to a minimum. With this in mind, Italian researchers sought to identify the lowest amount of intraneural ropivacaine needed to achieve complete sensory nerve block in 90 percent of the patient population. The study involved 47 participants undergoing ultrasound-guided popliteal intraneural nerve block, at a starting volume of 15 ml. The investigators were able to cut the local anesthetic dose more than in half, to 6.6 ml, and still achieve effective sensory-motor block in 98 percent of the study sample. Enrollees underwent electrophysiologic tests at baseline and five weeks and six months after the procedure. Latency and velocity measurements did not change from baseline levels; but amplitude of action potential at ankle, fibula, malleolus, and popliteus declined markedly at five weeks and at six months. While none of the patients reported neurologic symptoms at six months, the persistence of electrophysiologic changes are a red flag for axonal damage, according to the researchers, and warrant further investigation.

From "Intraneural Ultrasound-Guided Sciatic Nerve Block"
Anesthesiology (Summer 2018) Vol. 129, No. 8, P. 241 Cappelleri, Gianluca; Ambrosoli, Andrea Luigi; Gemma, Marco; et al.

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Is Dexmedetomidine a Silver Bullet for Ventilator Weaning?

The role of dexmedetomidine in removing intensive care patients from mechanical ventilation was a topic of debate at the 2018 annual congress of the Society of Critical Care Medicine. The agent's primary benefits include anxiolysis, morphine-sparing properties, and noninterference with respiratory drive, experts agreed; but it still is not the hands-down top choice among the variety of options available. For one, they noted, it can lead to unfavorable hemodynamic effects; and dexmedetomidine also is much more expensive than benzodiazepines or propofol in this setting. Some of that cost disadvantage is offset, however, by the daily savings achieved by cutting the amount of time patients are ventilated and housed in the ICU. At the same time, while research has suggested that dexmedetomidine outperforms benzodiazepines for extubating ICU patients, there is also evidence that propofol accelerates the process compared to dexmedetomidine — although both have been associated with more ventilator-associated risks than benzodiazepines. Considering the mixed results, "is dexmedetomidine the silver bullet to facilitate extubation?" wonders Gilles Fraser, PharmD, a critical care pharmacist at the Maine Medical Center in Portland. "We use it all the time, but we don't have any firm data." He stresses that care decisions around removal from mechanical ventilation should be based on the patient's individual circumstances.

From "Is Dexmedetomidine a Silver Bullet for Ventilator Weaning?"
Anesthesiology News (07/30/18) Rosenthal, Thomas

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Opioids for Obstructive Sleep Apnea Should Be Used With Caution

The results of a review support using opioids sparingly in patients with obstructive sleep apnea (OSA) in order to avoid opioid-induced respiratory depression. A search of the literature from 1946 to 2017 yielded 40 qualifying studies that reported on postoperative outcomes in OSA patients receiving short-term opioid therapy. The included investigations were found to have major limitations, including risk of bias; and the quality of the evidence was not considered high. Even so, there was some measure of consistency in the finding that narcotic analgesics may be harmful in patients with OSA — especially in the first 24 hours of use. "While more research is needed, retrospective analyses suggest that opioid-related serious adverse events may be largely preventable with a more cautious approach to opioid use," the researchers wrote in Anesthesia & Analgesia. "This includes the utilization of multimodal analgesia to reduce opioid requirement, caution, or avoidance of concurrent administration of sedatives and opioids by multiple pathways (eg, [patient-controlled analgesia] plus background infusion)."

From "Opioids for Obstructive Sleep Apnea Should Be Used With Caution"
Clinical Pain Advisor (07/27/18) Dellabella, Hannah

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Paravertebral Block Effective in Patients with High Pain Catastrophizing and Amplification

New evidence suggests that regional anesthesia curtails pain and opioid use in mastectomy patients who present higher pain catastrophizing and amplification at baseline. The finding comes from a prospective, observational study conducted at a single site in Boston, with 121 participants. The women underwent the procedure with or without thoracic regional anesthesia — paravertebral or proximal intercostal block — based on surgeon preference, patient preference, and anesthesia provider preference and availability. While thoracic regional anesthesia lowered postoperative pain in all participants who received it, the effect was statistically meaningful only in the subset of patients who had high levels of baseline pain catastrophizing and amplification. "The interesting thing is, you would expect that in patients with high catastrophizing, even if you gave them a nerve block, they might still have more pain. Because catastrophizing is so much about rumination and worry, often even a smaller degree of injury is experienced as very painful," explains lead investigator Kristin Schreiber, MD, PhD, an assistant professor at Harvard Medical School. "However, we saw that high catastrophizing patients had much less pain with a block, and the same was true of how much opiate was given. They got less both intraoperatively and in the recovery unit." Schreiber sees the study results as validation that screening for patients who are at higher risk for pain can allow researchers to study smaller groups of patients. "That would allow us to perform more effective testing of novel analgesics in this group that actually needs intervention," she says.

From "Paravertebral Block Effective in Patients with High Pain Catastrophizing and Amplification"
Pain Medicine News (07/25/18) Raj, Ajai

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IV Lidocaine May Be Safe, Efficacious for Pediatric Status Migraine

New research points to intravenous lidocaine as a viable approach for treating status migraine in children and teens. A total of 26 minors with the condition were included in the investigation, each of them having been in the hospital for a mean 4.6 days. It took 19.3 hours on average to completely resolve pain with lidocaine bolus or infusion. The rate of pain resolution was 90.3 percent, but more than half of study participants suffered a relapse. For certain cases, "IV lidocaine may be a safe and effective treatment for children and adolescents with status migraine," according to the study authors, who reported their findings in Pediatric Critical Care Medicine. "Larger prospective studies need to be done not only to evaluate safety and efficacy but also the analgesic longevity of IV lidocaine post discharge."

From "IV Lidocaine May Be Safe, Efficacious for Pediatric Status Migraine"
Neurology Advisor (07/25/18)

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Ketamine Could Help Reduce Opioid Use in the ER

The authors of a new meta-analysis believe that, in the face of raging opioid abuse and dependence, ketamine could be a safe and reasonable alternative for treating acute pain in the emergency room (ER). Although the powerful anesthetic has gained a reputation as a club drug, it is safe, effective, and well-tolerated in the medical setting. It is not especially addictive and is not known to trigger respiratory depression, although it does have some dissociative psychological effects. Its use has been studied for the purpose of treating migraine, addiction, and depression, among other conditions; and now, researchers at the Washington University School of Medicine in St. Louis are exploring its possible use to independently manage acute pain in the ER. A search of the literature turned up only three trials that met their criteria. Looking at data for the 261 participants, the review authors concluded that ketamine was not inferior to morphine. The drug was associated with more adverse events, but these were not severe in nature. Based on the findings, the researchers declare that "emergency physicians can feel comfortable using [ketamine] instead of opioids" when appropriate, but not universally. The meta-analysis results appear in Academic Emergency Medicine.

From "Ketamine Could Help Reduce Opioid Use in the ER"
Medical News Today (07/23/18) Collier, Jasmin

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Anesthesia E-ssential is an executive summary of noteworthy articles of interest to nurse anesthetists. It is distributed weekly to AANA members.

Anesthesia E-ssential is for informational purposes, and its contents should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

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E–ssential Editor
August 2, 2018