Anesthesia E-ssential

AANA Anesthesia E-ssential, August 29, 2019

Vital Signs

Ketamine Infusion Therapy for Psychiatric Disorders Position Statement Issued by American Association of Nurse Anesthetists and American Psychiatric Nurses Association

The two nursing organizations have partnered to issue a statement defining the roles that nurse anesthetists and psychiatric-mental health nurses play in ketamine infusion therapy for psychiatric disorders. Learn more.
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Hot Topics

National Conference of State Legislatures Legislative Summit: AANA's 27th Successful Year as Exhibitor

The AANA welcomed approximately 7,000 state legislators, legislative and executive agency staff, and representatives from trade and professional associations to its booth at the National Conference of State Legislatures (NCSL) Legislative Summit in Nashville, Tenn., from August 6-8. The 2019 meeting was an invaluable opportunity for local nurse anesthetists and AANA State Government Affairs staff to visit informally with legislators and their staff from all 50 states.

The AANA exhibit booth was staffed by local volunteers:
  • Vincent Cagungun, RN (SRNA),
  • Katie Cooper, CRNA,
  • Linda Hill, CRNA,
  • David Klappholz, CRNA,
  • Charles Sharbel, CRNA and
  • Tausha Alexander, JD.
Sarah Chacko, JD, assistant director of State Government Affairs and Legal represented the AANA at the exhibit booth.

The State Government Affairs Division would like to thank the Tennessee Association of Nurse Anesthetists for coordinating local volunteers, and thank all of our local volunteers for making this a successful event.
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Caring has Its Risks. Let Us Help Safeguard Your Career

For over 30 years, AANA Insurance Services has specialized in CRNA malpractice insurance – in fact, did you know that no other insurance agency offers a wider range of coverage options for nurse anesthesia professionals? Whether you are looking to get a quote or have a malpractice insurance question, AANA Insurance Services is happy to be of service!
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NewsMakers: CRNA Major Michael Livingston Honored with Soldier's Award

The U.S. Army's Major Michael Livingston, CRNA, and Lt. Col. Christopher Sloan were honored with the Soldier's Award for acts of heroism outside of combat. Both are employed at Madigan Army Medical Center, just outside Lakewood, Wash. "They risked their lives to render first aid and offer assistance to 34 passengers in life-threatening conditions due to the Amtrak Cascades Passenger Train 501 derailment on to Interstate 5. Their heroic actions are in keeping with the highest traditions of military service, honor, and personal courage, and reflect great credit upon them, Madigan Army Medical Center, and the United States Army," said the proclamation from the Secretary of the Army, Mark T. Esper.

Two years ago, Lt. Col. Sloan and Major Livingston, along with 1LT Robert McCoy, helped rescue passengers from an Amtrak train that had derailed and plunged off an I-5 overpass in Tacoma, Wash. One of the train cars was hanging perilously from the bridge, and Lt. Col. Sloan, Major Livingston, and 1LT Robert McCoy, also from Madigan Army Medical Center, evacuated passengers from the derailed cars. A civilian nurse, Tanya Porter, also tended to those who had fallen from the train cars onto the highway below. 1LT McCoy was honored with the Soldier's Award and Porter was honored with the Award for Valor several months ago. All were honored at the August 26 ceremony at Madigan Army Medical Center. Learn more.
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AANA Member Benefits

Househunting? Mortgage Application Volume Decreases, Sales Increase, Interest Rates Level Off

According to an article by CNBC, "Overall mortgage application volume decreased 0.9%...according to Mortgage Bankers Association's seasonally adjusted index. Volume was still 70% higher annually, thanks to a stronger overall refinance market this year." Learn more about the market.

Reuters concurred, "U.S. home sales rose more than expected in July, boosted by lower mortgage rates and a strong labor market, signs the Federal Reserve’s shift toward lower interest rates was supporting the economy."  Learn more.

Quicken Loans - start simply. Mortgage better. For mortgage resources for buying or refinancing a home, learn more.
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Sharpen Your Intubation Skills With a Real-Life Case Study via a Virtual Simulation App

AANA Corporate Partner Medtronic supported the development of a virtual simulation mobile app to help anesthesia providers practice their intubation skills. With this app you’ll simulate an actual patient case that was vetted by medical experts. This environment will help you practice your technique and learn from the cases presented.

Plus, check out your skills as you can compare your score to other users. To download the app, visit either the Apple App Store or Google Play and search “Airway Ex” by Level Ex, Inc. Visit Level Ex for more details about the program.
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CRNA: Cleveland Clinic Indian River Hospital, Vero Beach, Florida

  • Performs pre-anesthetic evaluation of patients, writes appropriate notes in chart, orders and evaluates appropriate laboratory work.
  • Formulates an anesthetic care plan based on current knowledge concepts, and scientific principles, explains procedures to patient and answers questions as necessary.
  • Writes preoperative notes, charts accurate anesthesia record, maintains confidentiality and demonstrates concern for patient and family.
  • Administers anesthesia according to commonly accepted standard of the AANA and FANA.
  • Maintains appropriate knowledge of anesthesia equipment, follows standard medical practice in the induction, maintenance and emergencies of anesthesia.
  • Ensures sterile technique is preserved and work area is free of obstacles.
  • Monitors patient continuously throughout the anesthetic with appropriate documentation, recognizes abnormal physiological responses and takes corrective action, requests appropriate tests when needed, and provides emergency care when necessary.
  • Maintains responsibility for safe emergence from anesthesia under accepted, standard guidelines.
Learn more.
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CRNA: The University of Vermont Health Network/Porter Medical Center, Middlebury, Vermont

Porter Medical Center has opportunities for CRNAs to practice in its updated surgical suite! Schedule is typically four 10-hour days with rotating call coverage. Annual salary of approximately $175,000 with additional compensation for weekend call. Student loan reimbursement and negotiable sign-on bonus/relocation assistance available! Willing to entertain new grads.

For more information, please contact Hollie Bachilas, HR Recruiter, at or Matthew Breckenridge, MD, at Learn more.
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Certified Registered Nurse Anesthetist: UPMC Pinnacle, Harrisburg, Pennsylvania

Join UPMC Pinnacle — a growing, multisite health system with seven acute care hospitals — as a Certified Registered Nurse Anesthetist, an essential member of the UPMC Pinnacle healthcare team who is responsible for assessing, planning, implementing, evaluating, and coordinating the total anesthesia care of patients. Through collaboration with all members of the anesthesia care team, the nurse anesthetist diagnoses and treats the human response of the patient and family to the anesthesia process, continuously monitoring, analyzing, and improving the performance of clinical activities. The nurse anesthetist is self-directed, empowered, and accountable for the direct supervision of all team members delivering care to assigned patients.

Multiple opportunities are available including UPMC Pinnacle Harrisburg, Community Osteopathic, and West Shore hospitals.

CRNA's practice includes various case types including General, Pediatric, Vascular, ENT, GI, GU, GYN, EP, Robotics, Thoracic, Orthopaedics, OB, Transplant, and IR.

For the latest information on advanced practice provider opportunities at UPMC Pinnacle, please contact: Jaci Caralle, FASPR, Office: 717-231-8583; Learn more.
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CRNA: Centra Southside Community Health, Farmville, Virginia

 Full-time and part-time options available.

The Centra Southside division of Centra Medical Group (CMG) anesthesia offers a care team model practice opportunity for the experienced CRNA who enjoys challenging cases. One anesthesiologist supervises a mix of full time and PRN CRNAs staffing four ORs, a busy two-room endoscopy suite, a bronchoscopy suite, and labor and delivery. Surgeons, hospitalists, and ER physicians round out the care team model when the anesthesiologist is unavailable. Three general surgeons, three OB-GYNs, one urologist, two orthopedic surgeons, two ophthalmologists, one gastroenterologist, one pediatric dentist, and one pulmonologist offer a great case mix. No hearts, no heads, and very rare trauma.

CRNAs have lots of opportunity for independence, regional anesthesia procedures, and central venous access procedures. First call is taken by the CRNA staff with back-up call provided. Anesthesiologist consultation available at all hours from either the medical director or a call physician from the CMG anesthesia in Lynchburg. Regional and central venous access training will be provided but experience, and interest, in these skills is a plus.

For more information, please contact Robin Moon, Provider Recruiter at Learn more.
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Professor/Associate Professor of Anesthesiology: Barry University, Hollywood, Florida

Barry University, College of Nursing and Health Sciences, Anesthesiology Program is seeking a full-time faculty member for the Hollywood classroom with travel to four (4) other geographical classroom sites for the entry level DNP in Anesthesiology. This position also would involve teaching didactic courses in the Post-Master’s Doctor of Nursing Practice (DNP) with a Specialization in Anesthesiology. Both programs utilize innovative curricula through technology-mediated synchronous and asynchronous instruction. The entry level DNP Program is a full time 36 month intensive residency program with students located in five geographical locations. The locations are Ocala, Orlando, Tampa, West Palm and South Florida. Faculty must be flexible to teach from all locations as needed but primarily the South Florida location. The Post Masters DNP with a Specialization in Anesthesiology is a 24-month part-time completion DNP program utilizing blended distance learning. The Post Masters DNP Program requires synchronous webinars, scholarly project advising and face to face meetings with students. Some administrative responsibilities also are expected with this role. Learn more.
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How Does Your Career Grow?

Are you looking to further your career? CRNA Careers is a valuable resource to help you both in your job search and with your career advancement. It's more than a job board. CRNA Careers is where those searching for fulfillment, opportunity, and challenges go to find helpful career tips, search for jobs, and upload anonymous resumes to be found by recruiters and employers.

Here's how to grow your career on CRNA Careers:

  • Seek and find the best jobs in your industry.
  • Set up job alerts to be notified when the jobs you're looking for are posted on the site.
  • Upload your anonymous resume and allow employers to contact you.
  • Access career resources and job searching tips and tools.

Growing your career requires regular care and cultivation. CRNA Careers has the tools to move your career toward your goals. Learn more today!


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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.

Surgical Smoke Exposure in Operating Room Personnel

Surgical smoke presents a health risk to operating room (OR) staff, a review has concluded, although the extent of the threat remains unknown. The authors note that smoke produced during cauterization and other OR activities contains small-particulate matter that may cause any number of health problems after collecting in the lungs, circulatory system, and other organs. The plumes also may include dangerous levels of toxic gases that are known carcinogens, although the literature lacks any concrete evidence that OR personnel have higher cancer rates compared with the general public. With no clear understanding, either, of what constitutes safe or unsafe levels of surgical smoke, it would be prudent to reduce exposure to it and eliminate it altogether, if possible. As it stands, most ORs do not require smoke evacuation. Those that try to eliminate it use a variety of approaches—including dispersion and mechanical evacuation/filtration. Research should target better, cost-effective strategies for eliminating smoke from the OR, including further work on the new generation of electric filters. In addition, the review authors conclude, researchers must study respiratory and cancer sequelae of exposure to surgical smoke in personnel who have sustained exposure over the long term.

From "Surgical Smoke Exposure in Operating Room Personnel"
JAMA Surgery (08/21/19) Limchantra, Ice V.; Fong, Yuman; Melstrom, Kurt A.

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This Medical Mishap Kills 33,000 Americans a Year—And It's Totally Preventable

According to new research, unplanned extubation (UE)—the accidental or inadvertent removal of a breathing tube—is a significant patient safety problem in this country. Reportedly, 7.3 percent of intubated adult patients in the intensive care unit and 18.2 percent of neonates in the ICU experience this event, which can have tragic results. UE results in senseless deaths as well as inflated health care costs for those that survive the event; however, it is a completely avoidable problem. With that in mind, a patient safety movement is taking off. One of the biggest changes that needs to take place is for healthcare institutions to establish UE as a key performance measure and start monitoring it. Because the Center for Medicare and Medicaid Services does not currently require them to do so, however, many do not track UEs. Still, it is in critical to adopt standardized best practices and quality measure now. Important steps institutions can take in this direction include assessing UE at the facility, getting executive support for improvement measures, and creating a quality improvement plan.

From "This Medical Mishap Kills 33,000 Americans a Year—And It's Totally Preventable"
MedPage Today (08/19/19) Kanowitz, Art

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Surgical Conditions with Rocuronium Versus Suxamethonium in Cesarean Section

Researchers compared time to delivery and quality of surgical conditions for childbirth in pregnant women who underwent deep neuromuscular block with rocuronium versus suxamethonium. The investigation took place in the Czech Republic, with a study population of 90 women scheduled for cesarean section under general anesthesia. Participants were randomly assigned to either rocuronium or suxamethonium for tracheal intubation and delivery. Based on the five-point Surgical Rating Scale for Delivery, rocuronium's score of four topped suxamethonium, which landed at three. Although the overall amount of time from induction to delivery was about the same for both approaches, the researchers found that rocuronium produced better surgical conditions for easier fetal delivery. In particular, the time from incision to delivery was shorter with rocuronium—although the opposite was true for time from induction to intubation.

From "Surgical Conditions with Rocuronium Versus Suxamethonium in Cesarean Section"
International Journal of Obstetric Anesthesia (Summer 2019) Vol. 39 Bláha, J.; Nosková, P.; Hlinecká, K.; et al.

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No Eating, No Drinking, And Now, No Marijuana Before Surgery, Doctors Say

Doctors are adding abstinence from marijuana to the traditional preoperative mantra of no food or drink several hours in advance. The updated instruction is tied to findings that cannabis users often require extra anesthesia to achieve and maintain sedation. More anesthesia, in turn, ups the odds of complications—especially for patients who partake in marijuana use shortly before receiving anesthesia. Cardiac problems are of particular concern, given that anesthesia already affects the heart and that marijuana use accelerates the heart rate and lowers blood pressure. Increased airway sensitivity also might affect someone who smoked pot just before sedation, potentially causing respiratory complications. The risks appear to abate for patients who indulge weeks or even a few days before a procedure. Regardless of when they used cannabis, patients should always practice full disclosure with their providers. "We're not going to have any judgment—there's no stigma," assures David Hepner, MD, an anesthesia provider at Brigham and Women's Hospital. "It's just important for us to know, because the cannabis could interact with the anesthetic and we need to know how to adjust." That might mean delaying surgery for a couple of hours if the patient smoked or vaped cannabis or putting it off for eight hours if he or she consumed edible marijuana, which is in line with guidelines that prohibit eating and drinking before an operation to avoid aspiration pneumonia. Clinicians also need to know about cannabis use because these patients may need more pain medication postoperatively. Full-fledged research on marijuana use and surgery, currently held back by federal prohibitions, could unlock the unknown—such as what physiological changes occur when abnormalities occur in cannabis users—and lay the groundwork for clinical guidelines.

From "No Eating, No Drinking, And Now, No Marijuana Before Surgery, Doctors Say"
Boston Globe (08/21/19) Martin, Naomi

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Scoring Systems to Detect Severe OSA Compared

Developers of the STOP-Bang scoring system, which is designed to screen for obstructive sleep apnea (OSA) based on factors such as snoring and tiredness, came up with a new algorithm in 2016 in hopes of flagging severe cases. The change targeted patients at intermediate risk for moderate to severe OSA, as reflected by a score of 3-4 on the rating system. According to the modified algorithm, patients could be reclassified as high risk if they score at least two points on the "STOP" side of the model and also collect an additional point for body mass index, neck circumference, or gender from the "Bang" side. Belgian researchers, however, have not found the new approach to be any better than the original STOP-Bang. The team also compared the two STOP-Bang models with the P-SAP, OSA50, and DES-OSA clinical scoring systems, judging their ability to detect severe OSA. They determined the DES-OSA score to be most effective because of its high specificity and superior positive predictive value, although more research is needed.

From "Scoring Systems to Detect Severe OSA Compared"
Anesthesiology News (08/22/19) Vlessides, Michael

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Impact of Postoperative Dexmedetomidine Infusion on Incidence of Delirium in Elderly Patients Undergoing Major Elective Noncardiac Surgery

In light of growing evidence that dexmedetomidine sedation may curtail delirium in intensive care unit (ICU) patients, researchers wondered if the agent might have a similar effect on older adults in the general surgery ward. The team from China's Xuzhou Medical University recruited 557 patients aged 65 years or older who were scheduled for major elective noncardiac surgery with no planned ICU stay. They randomized 281 patients to receive a continuous infusion of dexmedetomidine via patient-controlled intravenous analgesia device and 276 to receive placebo. Both treatments were administered immediately following the operation. The main outcome was the incidence of delirium during the first five postoperative days, which turned out to be not significantly different between the two cohorts. Dexmedetomidine-related adverse effects also were comparable in the intervention and control groups. However, patients who received dexmedetomidine reported much lower numerical pain scores at 3, 12, 24, and 48 hours after surgery than did those who received placebo. They also registered significant improvement on the Richards Campbell Sleep Questionnaire during the first three postoperative days. Based on the results, dexmedetomidine did not decrease the incidence of postoperative delirium in elderly patients admitted to general surgical wards after noncardiac surgery.

From "Impact of Postoperative Dexmedetomidine Infusion on Incidence of Delirium in Elderly Patients Undergoing Major Elective Noncardiac Surgery"
Drug Design, Development and Therapy (08/19/19) Vol. 13, P. 2911 Sun, Yuanyuan; Jiang, Mingming; Yungjing, Ji; et al.

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News summaries © copyright 2019 SmithBucklin

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.

If you are interested in advertising in Anesthesia E-ssential contact HealthCom Media at 215-489-7000.

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

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Phone: (855) 526-2262 (toll-free)/(847) 692-7050
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Attn: Cathy Hodson
E–ssential Editor
August 29, 2019
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