Anesthesia E-ssential

AANA Anesthesia E-ssential, August 23, 2018

Vital Signs

Redesigned Microsite Provides Members with Improved Resources for Advocacy Efforts

The Future of Anesthesia Care Today microsite has been redesigned to create a user-friendly experience for members to communicate the value CRNAs bring to the healthcare team.

The updated site includes helpful information to demonstrate the quality, safety and cost-effectiveness of CRNAs. The site also includes information designed to help policy makers and hospital administrators better understand the value CRNAs bring to patients and healthcare teams alike. We encourage you to visit the site and share the resources as part of your advocacy efforts for your practice and the profession as a whole. Learn more at Future of Anesthesia Care Today.                     
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AANA Announces New Career Center

CRNA Careers is the premier resource to connect highly qualified nurse anesthetists with career opportunities. Access the career center through the device of your choice—smartphone, tablet or desktop at CRNA Careers.

The new site will allow CRNAs to:

  • Search and apply to nurse anesthetist jobs at institutions that value your credential.
  • Upload your anonymous resumé—employers may contact you, but you maintain control of your information and choose to whom you release it.
  • Receive an alert every time a job becomes available that matches your personal profile, skills, interests, and preferred location(s).
  • Access career resources and job searching tips and tools.

Start managing your career now at CRNA Careers.

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Hot Topics

CMS Renews DNV GL Healthcare’s Accreditation Deeming Authority

After undergoing a rigorous review by the Centers for Medicare & Medicaid Services (CMS), DNV GL Healthcare’s accreditation-deeming authority was extended until the third quarter of 2022. This means that DNV GL may accredit hospitals to participate in the Medicare and Medicaid programs. CMS first granted DNV deeming authority in 2008. Currently, DNV GL Healthcare accredits more than 500 hospitals in 49 states, making it the second largest national healthcare accreditor. Most hospitals become accredited in order to be certified by CMS to receive federal reimbursement from Medicare and Medicaid programs. Read DNV GL Healthcare’s news release.
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Get Answers to Your Malpractice Insurance Questions

Have a question regarding your malpractice insurance coverage? Whether you have a policy with us or not, AANA Insurance Services is a resource to all membership. Contact us today! 
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NewsMaker: CRNA's Family Honored as Family of the Year

Tiffany Johnson-Dunn, CRNA, her husband Jason Dunn, and their two children, Mya and Jason II, were honored as the Black Family Reunion's Family of the Year in Cincinnati last weekend.
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NewsMaker: Military Publication Profiles CRNA Maricela Soberanes

The Defense Visual Information Distribution Service (DVIDS) has profiled U.S. Navy Reserve Lt. Cmdr. Maricela Soberanes, DNP, CRNA. She is the "commander of Expeditionary Medical Facility Dallas' Detachment Q, and she balances her military service with a civilian career as a CRNA."

Soberanes comes from a family of nine, and worked hard to earn her education—not just through study, but financially also. "In Mexico, you have to pay for high school. We didn't have money to pay for school, so when I finished middle school, that was the end. Generations go in that circle," says Soberanes. "When mom told me I couldn't go to high school, that was a very devastating thing to me to learn. I knew she wanted me to go, but she couldn't afford it."

Read more about this dedicated, high-achieving CRNA.
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NewsMaker: AANA Archivist George Kutsunis Featured in Article

In "The Business of Memory Keeping," Forum profiles how an association's archives and archivists do more than collect artifacts or document the collection of artifacts within the archive. Records are more likely not to be paper-based either. AANA Archivist and Records Manager George Kutsunis is featured in the article and explains how digital content is more and more of what occupies an archivist's time and efforts.
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NewsMakers: CRNAs Dan Lovinaria and Joshua Lea Named APSF Social Media Ambassadors

Dan Lovinaria, DNP, MBA, CRNA, APRN, and Joshua Lea, DNP, MBA, CRNA, have been named social media ambassadors for the Anesthesia Patient Safety Foundation (APSF). They are the sole CRNA social media ambassadors for the foundation.

The APSF social media ambassadors help facilitate and grow the presence of APSF on social media. Some of the most popular ways for both the public and medical professionals to get their information about evidence-based practice and best practices associated with anesthesia patient safety is through Twitter, Facebook, Instagram, and LinkedIn. 
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Meetings and Workshops

Pre-Congress Workshops: Maximize Your CE Opportunities

The Pre-Congress Workshops take place on Friday, September 21, 2018 prior to the AANA 2018 Annual Congress. Topics include:
  • Advanced Physical Assessment for Pain Management Practice Workshop - The workshop will provide CRNA knowledge and hands-on practice for advanced physical assessment useful for differential diagnosis in pain management.
  • Writers Workshop: Writing for Professional/Scholarly Publication - The workshop will include presentations and a discussion regarding what constitutes a good idea, the process of marshaling that idea to a tangible product that merits consideration for publication, and anticipating what will occur during the peer review process. Exemplars will be used to explore optimizing the process and the workshop will be led by senior leaders of the AANA Journal Committee.
  • Fundamentals in Perioperative Transesophageal Echocardiogram Workshop - The workshop will provide didactic and hands-on learning opportunities featuring individualized and group instruction using cardiac and TEE simulation tools and intraoperative recordings to improve the understanding of real-time monitoring of cardiac function.
  • Airway on Demand Workshop - Attendees of this program will be exposed to both didactic and hands-on learning opportunities aimed at reinforcing learned knowledge and skills, as well as providing the opportunity for new learning, related to airway management under both normal and emergent conditions.
  • Crisis Resource Management Simulation Course - The Center for Medical Simulation's Crisis Resource Management Simulation Course will allow nurse anesthetists to improve their skills in managing and debriefing routine and critical clinical events, particularly in the realm of acutely deteriorating clinical situations, and managing difficult conversations with colleagues.
  • Neuraxial Regional Anesthesia-Epidural Workshop - The core faculty of the popular “AANA Regional Anesthesia Workshops” offers an opportunity to update current knowledge of epidural anesthesia techniques and clinical applications.
  • Gateway to Debriefing with Good Judgment Course - The Center for Medical Simulation’s Gateway Debriefing Skills Workshop introduces healthcare education faculty to the foundational practices of the Debriefing with Good Judgment© method of debriefing. This innovative workshop combines an immersive, day-long, in-person learning experience with supplemental online learning that includes customized peer-to-peer and mentor feedback. Participants will have the opportunity to learn how to efficiently improve future performance, set high standards while holding high regard for the learner, treat learners as thinkers and not just doers and practice various debriefing phases.
  • Neuromuscular Block Monitoring Workshop - Attendees of this didactic and hands-on instruction program will: 1) Review the incidence and outcomes of residual paralysis. 2) Explore techniques to improve the management and reversal of neuromuscular block. 3) Examine current and developing technologies available to assess neuromuscular block and reversal.
Please note: There is an additional registration fee for these workshops, they are not included in the Annual Congress registration fee. Learn more or register for the Pre-Congress Workshops.
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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.

Intravenously Administered Lidocaine and Magnesium During Thyroid Surgery in Female Patients for Better Quality of Recovery After Anesthesia

Researchers in South Korea designed a prospective study to investigate the individual use of intravenous lidocaine, magnesium, and saline as perioperative analgesic adjuvants. The team compared the overall impact on anesthesia recovery in 135 open thyroidectomy patients, each of whom was randomized to receive one of the study agents immediately following anesthesia induction. On the first postoperative day, the only statistically significant difference in mean quality of recovery (QoR) score was observed between women in the lidocaine group and those in the saline, or placebo, group. In addition, three of the five dimensions on the QoR survey—emotional state, physical comfort, and pain—were superior in the lidocaine patients than in the control patients. Magnesium, on the other hand, had no better effect on recovery than saline—at least not at the dose used in the study.

From "Intravenously Administered Lidocaine and Magnesium During Thyroid Surgery in Female Patients for Better Quality of Recovery After Anesthesia"
Anesthesia & Analgesia (09/18) Vol. 127, No. 3, P. 635 Kim, Myoung Hwa; Kim, Min Soo; Lee, Jae Hoon; et al.

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Effects of a Hypnosis Session Before General Anesthesia on Postoperative Outcomes in Patients Who Underwent Minor Breast Cancer Surgery

They HYPNOSEIN clinical trial questioned whether preoperative hypnosis might provide a postoperative benefit in women undergoing minor breast cancer surgery. Researchers in France randomly assigned 150 patients, all having minor breast cancer surgery, to either a brief hypnosis session prior to general anesthesia or to usual care.
The results did not support the use of hypnosis as a pain control strategy in this patient population, with no meaningful reduction in breast pain scores before discharge from the postanesthesia care unit (PACU) and after. At the same time, the hypnosis patients were less fatigued following surgery, were less anxious, and expressed greater satisfaction with their experience. Additionally, hypnosis recipients required fewer intraoperative opioids and hypnotics and spent less time in the PACU. While hypnosis may not alleviate breast pain after surgery, it may offer other benefits—although more research must be conducted to verify these findings.

From "Effects of a Hypnosis Session Before General Anesthesia on Postoperative Outcomes in Patients Who Underwent Minor Breast Cancer Surgery"
Journal of the American Medical Association (08/17/18) Amraoui, Jibba; Pouliquen, Camille; Fraisse, Julien; et al.

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Cost-Benefit Analysis of Maintaining a Fully Stocked Malignant Hyperthermia Cart vs. an Initial Dantrolene Treatment Dose for Maternity Units

Research reveals that the benefits do not justify the cost of keeping a stocked malignant hyperthermia (MH) cart with a full treatment dose of dantrolene at the ready on maternity units. The Malignant Hyperthermia Association of the United States recommends that a full dantrolene supply be available for use within 10 minutes. However, because general anesthesia—a triggering agent for MH—is not frequently used in this setting, doing so is not cost-effective. Maintaining a MH cart with a 250-mg dose of dantrolene in every U.S. maternity unit would lower morbidity and mortality costs by $3.3 million annually, according to the cost-benefit analysis, but would cost nearly $6 million. The only cost-effective option, the analysts conclude, would be to have an initial 250-mg dose of dantrolene on the maternity unit, with a central supply on tap within a half-hour.

From "Cost-Benefit Analysis of Maintaining a Fully Stocked Malignant Hyperthermia Cart vs. an Initial Dantrolene Treatment Dose for Maternity Units"
Anesthesiology (Summer 2018) Vol. 129, P. 249 Ho, Phi T.; Carvalho, Brendan; Sun, Eric C.; et al.

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Suprazygomatic Sphenopalatine Ganglion Block May Quickly Relieve Status Migrainosus Pain

Patients suffering from status migrainosus pain may get fast relief from regional anesthetic suprazygomatic sphenopalatine ganglion (SPG) block, according to new evidence. Investigators worked with 88 participants who did not benefit from previous therapies and subsequently underwent a collective 242 suprazygomatic SPG blocks. Self-reported pain, as measured on the 1-to-10-point Likert scale, was more than 67 percent improved just half an hour after injection. No significant adverse events or complications occurred following the blocks, and the single case of cranial nerve IV palsy was completely resolved after six hours. "[Suprazygomatic SPG block] may provide a relatively inexpensive, therapeutic abortive therapy in patients with [status migrainosus], which in turn would reduce the number of patients' visits to the [emergency department] and need for hospitalization," the researchers report in Headache.

From "Suprazygomatic Sphenopalatine Ganglion Block May Quickly Relieve Status Migrainosus Pain"
Clinical Pain Advisor (08/15/18) Dellabella, Hannah

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Children's Intensive Care Units Are Failing to Monitor Breathing Adequately

A new U.K. audit of intensive care units (ICUs) has found the takeup rate low for seven-year-old guidance governing airway management in babies. One key recommendation, for example, called for standard use of capnography to monitor breathing. While the majority of adult ICUs surveyed have adopted this simple technique, the researchers reported, pediatric and especially neonatal ICUs have not followed suit. Anaesthesia published the study, which found that capnography was available in all pediatric ICUs audited but in just 46 percent of neonatal ICUs. Meanwhile, 78 percent and 34 percent, respectively, did not formally identify babies with a difficult airway during staff handover; and only 67 percent and 40 percent had protocols in place for high-risk patients. Other findings from the audit revealed that a pre-intubation checklist was used in 70 percent of pediatric and 42 percent of neonatal ICUs; a difficult intubation trolley was present in 96 percent and 50 percent, respectively; and a videolaryngoscope was on hand in 55 percent and 29 percent of the children's ICUs.

From "Children's Intensive Care Units Are Failing to Monitor Breathing Adequately"
BMJ (08/16/18) Vol. 362 Torjesen, Ingrid

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New Training Tool Designed for US-Guided, Needle-Based Procedures

Researchers have come up with a simulator that they hope can serve as a training tool for ultrasound-guided needle-based anesthesiology procedures, which can be tricky and delicate. The haptic-force device applies the steady rate of insertion needed to perform procedures on different tissue types and thicknesses, simulating the sensation of insertion under a variety of scenarios. It also evaluates the user's performance through a computer application, providing feedback on whether and where the user is improving. "Mannequins are very constant; if you do it two or three times, it becomes the same," says researcher Sanjib Adhikary, MBBS, an associate anesthesiology professor at Penn State Health Milton S. Hershey Medical Center. “But in real life, every situation is a different situation, and every patient is a different patient.” And, at an anticipated price of less than $100, the developers say it could facilitate a range of ultrasound-guided procedures, especially for inexperienced users. A provisional patent application for the simulator is currently pending.

From "New Training Tool Designed for US-Guided, Needle-Based Procedures"
Anesthesiology News (08/16/18) DePeau, Deanna

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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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August 23, 2018
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