AANA Anesthesia E-ssential
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Vital Signs

CRNAs Continue Making their Voices Heard for Veterans’ Access to Care – So Should You

With the Department of Veterans Affairs continuing to review the unprecedented 223,000 public comments to the agency’s veterans’ access to care rule for CRNA and APRN Full Practice Authority, AANA members around the country continue making their voices heard for America’s veterans and for CRNA practice.

CRNAs and nurse anesthesia students are seeing their members of Congress at home and answering CRNAdvocacy alerts to reach out to lawmakers via email. As part of the AANA Annual Congress, lawmakers key to this veterans issue will have in-person visits from AANA members just as the U.S. Congress returns to Washington from its summer recess.

Even though the Veterans Health Administration (VHA) received so many comments on this issue, including from AANA members, veterans and nursing groups, and other healthcare industry leaders, the American Society of Anesthesiologists remains hard at work seeking to block CRNAs from Full Practice Authority. When Congress returns to session mid-September after its seven-week summer break, lawmakers will be working on budget legislation, and ASA will be feeding lawmakers anti-CRNA propaganda in hopes of using the budget to block the VHA rule. If the ASA gets its way, veterans would continue waiting and suffering instead of obtaining the timely surgical services and other procedures that they need.


AANA members can take action now at CRNA-PAC.com and clicking Take Action.

See the comments of the AANA, our APRN Workgroup, the​ AARP, the ​American Hospital Association the professional staff of the Federal Trade Commission. See the ASA comment.

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CPC Facts                

CPC Program: Got Questions? Get Answers.
As with any new program, you probably have questions about how the CPC Program works. Questions like: What’s considered a Class B activity? Will excess Class A credit be eligible for Class B credit? How do I document my Class B credits? Will life support courses qualify for the CPC program? Will credits earned through the Core Modules also count toward the Class A requirement? Find out the answers to many of the common questions about the CPC Program in the CPC Program FAQs, which cover questions about Class A credits, Class B credits, Core Modules, program costs, and more.
More information on the program is available on the cpc-facts.aana.com and NBCRNA websites.
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Hot Topics

Updated Fact Sheet on CRNAs Available on AANA Website
A revised and reformatted version of the Certified Registered Nurse Anesthetists Fact Sheet is now available on the AANA website for use by state association leaders, program administrators, individual members, and others. This important, regularly updated document provides key information about CRNAs, student registered nurse anesthetists, and the AANA, and is used for lobbying, media relations, education, and other purposes. A similar and equally important document titled CRNAs at a Glance has also be updated and is available on the CRNAs: Future of Anesthesia Care Today microsite. AANA members are encouraged to refer to these documents for the latest facts and figures about their profession and their professional association, and to put them to good use when advocating for or promoting nurse anesthesia.
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2016 Proposed Bylaw Amendments and Resolutions Available Online
The 2016 AANA Bylaws and Standing Rules proposed amendments and Resolutions to be discussed and voted upon at the September 11, 2016, AANA Business Meeting are posted online at: http://www.aana.com/myaana/AANABusiness/governance/Pages/AANA-Annual-Business-Meeting-Agenda-and-Information.aspx. In the event a member does not have online access, you may request that a hard copy be mailed to you via a message to mscheuermann@aana.com or phone (847) 655-1101.
Please review the Board prepared explanation of proposed Amendment #12 “Electronic Voting on Bylaw Amendments, Standing Rules and Resolutions” and flow chart.
Please note: The September 11, 2016, AANA Business Meeting will be live streamed at approximately 8:15 am EDT accessible via a link on the business meeting page. Member sign in to the AANA website is required for access; however there is no need for advance registration. This stream will be presented in listen and view only mode. There is no provision for online participation or voting due to current requirements in the AANA Bylaws. Please note that individual internet speeds and locations may affect video quality during the live stream.
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New CRNA Checklist for 2016 PQRS Reporting

The AANA Research and Quality Division has created a new infographic to help CRNAs satisfactorily report to PQRS for the 2016 performance year. The infographic, which can be downloaded at Quality-Reimbursement, comprises a checklist that offers a visual overview of 5 simple steps with links to more information on qualified registry and qualified clinical data registry (QCDR) reporting mechanisms.
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2015-16 AANA Annual Report Posted

The 2015-16 AANA Annual Reports is now available on the member side of the AANA Website. Included are reports from AANA standing, elected and other committees; the AANA Journal Editorial Committee; AANA liaisons with other organizations; the AANA Foundation; the Council on Accreditation (COA) for Nurse Anesthesia Educational Programs and the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA); the International Federation of Nurse Anesthetists (IFNA); and AANA Executive Director/CEO Wanda Wilson, PhD, CRNA. Included in the ED/CEO report is data from AANA practice profile and member demographics surveys.        

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We Have a Winner!
The popular microsite for the AANA’s highly successful public education campaign CRNAs: The Future of Anesthesia Care Today recently won the Interactive Media Awards (IMA) Outstanding Achievement award in the Healthcare category. The site, The Future of Anesthesia Care Today is the centerpiece of the campaign, delivering fact sheets, research data, infographics, and other important information about nurse anesthesia to key audiences such as hospital administrators, policymakers, healthcare professionals, payers, patients and other interested parties. According to the IMA, the Outstanding Achievement award is the second highest honor bestowed by the IMA and an extremely challenging award to win. According to the IMA, the AANA’s entry “excelled in most areas of our judging criteria and represents a very high standard of planning, execution and overall professionalism.” The future-of-anesthesia-care-today.com microsite scored 475 out of a possible 500 points in five categories, with a perfect 100 in Feature Functionality and a 97 in Content.
There were 142 entries submitted in the Healthcare category in the 2016 award year, with seven winners selected. To view winners in the healthcare category, go to the Interactive Media Awards website and select “Outstanding Achievement” for the Award Level, and “Healthcare” for the category.
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2015 PQRS Feedback Reports and 2017 Penalties
CRNAs who did not participate in PQRS or who did not satisfactorily report to PQRS during the 2015 performance year will receive a negative payment adjustment notification letter from the Centers for Medicare & Medicaid Services (CMS) sometime in the fall of 2016. During this time, CMS will also release the annual PQRS Feedback Reports, which will allow you to review your individual quality reporting performance for the 2015 program year. To learn more, please visit our updated "PQRS Feedback and Payment Adjustments" FAQ page.
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Attention CRNA Researchers—Access Resources at myAANA Research
The AANA Research and Quality Division has developed several research resources for seasoned and novice researchers including a research abstract repository, hot research topics related to nurse anesthesia and health policy, available research datasets, and webinars that can assist CRNA researchers write a grant or prepare a manuscript. Access these resources and much more at Research Resources (member login required).
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Professional Practice

FDA Recommends Facilities Stop Using Custom Ultrasonics’ System 83 Plus Automated Endoscope Reprocessors (AERs)
The FDA is notifying facilities of Custom Ultrasonics' urgent medical device recall and advising users to stop using its System 83 Plus AERs for reprocessing of duodenoscopes. Read the Custom Ultrasonic customer communication for further information. The FDA has created a website to provide up-to-date information about AERs for which the FDA has reviewed adequate reprocessing validation for duodenoscopes. More information about the scope of the problem, recommendations and FDA activities can be found in FDA’s recent Safety Communication.
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State Government Affairs

NCSL Legislative Summit: AANA's 24th Successful Year as Exhibitor
The AANA welcomed approximately 5,000 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 Chicago, Illinois from August 9 – 11. The 2016 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. An estimated 20 percent of all state legislators attend the NCSL’s Legislative Summit.
The AANA exhibit booth was staffed by local CRNAs: Jeff Adkins, CRNA; Rehema Kasasa, CRNA; Phil Robles, CRNA; and Christine Salvator, CRNA. Sarah Chacko, JD, Assistant Director of State Government Affairs and Legal and Irma Melendez, Professional Practice and State Government Affairs Associate, also represented the AANA at the exhibit booth. The State Government Affairs Division would like to thank the Illinois 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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Meetings and Workshops

Registration Open Now for Fall Leadership Academy
Learn to lead at any level, in all practice settings, at the Fall Leadership Academy: November 11-13, 2016, in Rosemont, Ill. Featuring more than 20 expert speakers and five educational tracks, Fall Leadership Academy is designed to expand your leadership skills as well as your network of colleagues.
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Save the Dates for These Popular Hands-On Workshops
Visit AANA Meetings for further information and to register!
Essentials of Obstetric Analgesia/Anesthesia Workshop
  • AANA Foundation Learning Center
  • November 2, 2016
Upper and Lower Extremity Nerve Block Workshop
  • AANA Foundation Learning Center
  • March 18-19, 2017
Essentials of Obstetric Analgesia/Anesthesia Workshop
  • AANA Foundation Learning Center
  • May 10, 2017

Spinal and Epidural Workshop

  • AANA Foundation Learning Center
  • May 11-13, 2017
Jack Neary Pain Management Workshop 1
  • Rosemont, IL
  • June 3-5, 2017
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    Foundation and Research

    Attend the “State of the Science” at the 2016 Annual Congress
    Competitively-selected investigators will present their research in 15-minute sessions at the AANA Foundation’s “State of the Science” Oral Poster Sessions on Monday, September 12. If you are going to Annual Congress, please plan to attend:
    • Monday, September 12, 2016. 10 am – 12 pm (2 CE credits)
    • 1:30 pm – 3:30 pm (2 CE credits)
    Washington Marriott Wardman Park Room - Maryland ABC Washington, DC Visit  AANA Foundation to view the list of oral and general presenters.
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    Foundation Fundraiser Features Capitol Steps
    Capitol Steps will be performing at the AANA Foundation fundraiser Stepping Out in DC on Sunday, September 11, 2016, from 7 – 11:45 pm at Washington Marriott Wardman Park. Ticket includes dinner, drinks, entertainment, and the Dance Party. We’re in DC during an election year with the Capitol Steps, so for this patriotic event, wearing red, white or blue seems appropriate, or you can even dress as your favorite politician! If you’ve already registered for Annual Congress, contact Margaret Brennan at (847) 655-1180 to purchase a ticket.
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    Federal Government Affairs

    U.S. Justice Department: Georgia CRNA Group Pays $1 Million to Settle Kickback Allegations
    A Georgia nurse anesthesia group paid more than $1 million in fines to the U.S. Department of Justice to settle prosecutors’ charges that the group violated federal and state anti-kickback statutes, according to an August 5 news release from the US Attorney for the Middle District of Georgia.
    Acting on the testimony of a whistleblower, prosecutors said one alleged scheme resolved by the settlement concerned the group’s “provision of free anesthesia drugs to ambulatory surgery centers (ASCs) in exchange for the ASCs granting … an exclusive contract to provide anesthesia services at those ASCs,” according to the release. A second scheme involved the group’s agreement “to fund the construction of an ASC in Marietta, Georgia, in exchange for contracts” to serve as the exclusive anesthesia provider at that facility and its affiliates. The whistleblower shared in the settlement proceeds, the CRNA group at issue cooperated in the investigation and “there has been no determination of liability,” according to the release.
    “The giving of a kickback by one provider to induce referrals from another negatively impacts patient choice and fair competition among providers. For that reason, Medicare and Medicaid prohibit taxpayer money being used to pay for services that arise out of arrangements that violate the Anti-Kickback Statute,” said U.S. Attorney G.F. “Pete” Peterman in the release. Georgia Attorney General Sam Olens said, “Medical decisions, such as the selection of an anesthesia provider, should not be influenced by the payment or receipt of a kickback.”
    Read the news release for further information. AANA members can view an educational webinar titled Protecting Your Practice: Compliance and Enforcement for CRNAs on the members side of the AANA website.
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    U.S. Surgeon General Asks All Healthcare Professionals to Help Combat Opioid Epidemic
    U.S. Surgeon General Vivek Murthy, MD, has a message for all healthcare professionals: Be a part of the solution to the opioid epidemic. In an unprecedented message from the Surgeon General issued Aug. 25, he asks healthcare professionals to review and take a pledge for action and to familiarize themselves with and use opioid prescribing guidelines from the Centers for Disease Control and Prevention.

    Vivek H. Murthy, M.D., M.B.A.

    August 2016 

    Dear Colleague,
    I am asking for your help to solve an urgent health crisis facing America: the opioid epidemic. Everywhere I travel, I see communities devastated by opioid overdoses. I meet families too ashamed to seek treatment for addiction. And I will never forget my own patient whose opioid use disorder began with a course of morphine after a routine procedure.
    It is important to recognize that we arrived at this place on a path paved with good intentions. Nearly two decades ago, we were encouraged to be more aggressive about treating pain, often without enough training and support to do so safely. This coincided with heavy marketing of opioids to doctors. Many of us were even taught – incorrectly – that opioids are not addictive when prescribed for legitimate pain.
    The results have been devastating. Since 1999, opioid overdose deaths have quadrupled and opioid prescriptions have increased markedly – almost enough for every adult in America to have a bottle of pills. Yet the amount of pain reported by Americans has not changed. Now, nearly 2 million people in America have a prescription opioid use disorder, contributing to increased heroin use and the spread of HIV and hepatitis C.
    I know solving this problem will not be easy. We often struggle to balance reducing our patients’ pain with increasing their risk of opioid addiction. But, as clinicians, we have the unique power to help end this epidemic. As cynical as times may seem, the public still looks to our profession for hope during difficult moments. This is one of those times.
    That is why I am asking you to pledge your commitment to turn the tide on the opioid crisis. Please take the pledge. Together, we will build a national movement of clinicians to do three things:
    First, we will educate ourselves to treat pain safely and effectively. A good place to start is this pocket guide​ with the CDC Opioid Prescribing Guideline. Second, we will screen our patients for opioid use disorder and provide or connect them with evidence-based treatment. Third, we can shape how the rest of the country sees addiction by talking about and treating it as a chronic illness, not a moral failing.
    Years from now, I want us to look back and know that, in the face of a crisis that threatened our nation, it was our profession that stepped up and led the way. I know we can succeed because health care is more than an occupation to us. It is a calling rooted in empathy, science, and service to humanity. These values unite us. They remain our greatest strength.
    Thank you for your leadership.

    Vivek Murthy

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    See You at AANA Annual Congress in Washington, DC!
    Thousands of AANA members are on their way to AANA Annual Congress in Washington, DC, Sept. 10-13. As part of your Annual Congress experience, you can learn more about the association’s advocacy mission and take action for your profession.
    • The AANA Federal Government Affairs / CRNA-PAC booth near Registration on Friday and Saturday will have information about CRNA issues, how the AANA works to protect and advance your practice and your reimbursement, contacting Congress effectively, and supporting your CRNA-PAC. It is also the gathering space for Federal Political Directors (FPDs) and other AANA members scheduled to meet lawmakers on Capitol Hill Sept. 13.
    • When the Exhibit Hall opens, be sure to visit the AANA Pavilion where many aspects of AANA member service and engagement opportunities are highlighted, including our advocacy mission.
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    CRNA-PAC Update: Strengthen Your Voice in Washington through a Dues Checkoff Contribution and Respond to ASAPAC “DoC” Campaign
    During the AANA membership dues cycle now under way, AANA members can renew or begin their support for the profession’s strong voice in Washington this election year in two convenient ways: through an AANA dues checkoff contribution, or by clicking CRNA-PAC.com and clicking the “Contribute” button.
    Need one more reason to support CRNA-PAC? The ASAPAC on August 11 conducted a major online development campaign challenging anesthesiologists to support their PAC. “The Day of Contributing ‘DoC’ challenge will give us the opportunity to help our friends who are already in the House and Senate and further our cause in electing more physicians to Congress,” wrote the chair and secretary of the ASAPAC executive board. “As a reminder, our goal is to raise $300,000 during the ‘DoC’ challenge.”
    With Election Day so close, and with such significant issues at hand in Washington shaping CRNA practice and reimbursement, will you join in supporting our CRNA-PAC today? Only your continued voluntary gifts ensure that the CRNA-PAC can be strong for you and your practice on Capitol Hill. Click CRNA-PAC.com to learn more and to make a one-time or sustaining contribution.
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    • The House and Senate are on recess until after Labor Day: See your lawmakers at home! If you plan to see your legislators in Washington or at home, let us know by emailing info@aanadc.com. You can access the House calendar here and the Senate calendar here to see where your members of Congress will be this summer and fall.
    • At the Republican and Democratic National Conventions, the AANA cosponsored “Decoding 2016: The Future of Healthcare” policy forum luncheons hosted by our media partner Real Clear Politics and attended by numerous health industry and policy leaders – including AANA. Former HHS Secretary Tommy Thompson was at the Republican convention in Cleveland, and Clinton and Obama healthcare advisor Chris Jennings attended the Democratic convention in Philadelphia.
    • Have you seen your legislators at home? Let us know and send them to info@aanadc.com!
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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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    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.
    Make Your Regional Anesthesia Safer
    New research indicates that antibiotics can prevent some peripheral and epidural catheter infections during regional anesthesia. Among 40,000-plus patients in the study sample, the rate of infection for peripheral catheters fell to 1.1 percent for those who received a single prophylactic dose of antibiotics compared with 2.4 percent for those who did not. Similarly, the infection rate for epidural catheters fell to 3.1 percent from 5.2 percent with antibiotic administration. The findings could be especially meaningful for people requiring catheter placement for as long as two weeks and for those with a body mass index of 25 or higher, as both populations are particularly susceptible to infection. Considering ongoing problems related to uncritical use of antibiotics, however, it is recommend that practitioners weigh the pros and cons carefully before adopting the prevention strategy on wide scale.
    From "Make Your Regional Anesthesia Safer"
    Outpatient Surgery (08/22/16) Burger, Jim
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    Can Anesthesia in Infants Affect IQ Scores?
    Children's Hospital of Philadelphia has produced the first solid evidence that modifiable factors during cardiac surgery—including anesthetic technique—can affect neurodevelopmental outcomes in infants. The study included 96 neonates with congenital heart defects who were exposed to volatile anesthetic agents (VAA) at the hospital between 1998 and 2003. Researchers tracked all anesthetic exposures until February 2008—at which time the children, then four or five years of age, underwent neurodevelopmental testing to measure full-scale IQ (FSIQ), verbal IQ (VIQ), performance IQ (PIQ), and processing speed. "This study provides evidence that in children undergoing staged reconstructive surgery for HLHS [hypoplastic left heart syndrome], increasing cumulative exposure to VAAs beginning in infancy is associated with worse performance for FSIQ and VIQ, suggesting that VAA exposure may be a modifiable risk factor for adverse neurodevelopment outcomes," study authors report in the Journal of Thoracic and Cardiovascular Surgery. They acknowledge, however, that the findings are preliminary and warrant additional research before a change in practice can be discussed.
    From "Can Anesthesia in Infants Affect IQ Scores?"
    Family Practice News (08/19/2016) Kirkner, Richard Mark
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    Men Experience Greater Pain Relief Than Women After Smoking Marijuana, Study Finds
    Smoking marijuana relieves pain to a greater extent in men than in women, according to new findings. Investigators out of Columbia University Medical Center (CMUC) analyzed data from a pair of studies examining the analgesic effects of the drug in 42 recreational users. Participants smoked a like amount of either placebo or the real thing, then submerged one hand in a cold-water bath until the pain became unbearable. Based on responses to a brief questionnaire afterwards, pain tolerance improved for both sexes after smoking active cannabis; but only the men reported a significant reduction in pain sensitivity. The researchers—who reported the results in Drug and Alcohol Dependence—said more work is necessary to understand how factors like frequency of use, strength, and method of consumption influence the analgesic properties of cannabis. "This study underscores the importance of including both men and women in clinical trials aimed at understanding the potential therapeutic and negative effects of cannabis," said Ziva Cooper, PhD, associate professor of clinical neurobiology at CMUC.
    From "Men Experience Greater Pain Relief Than Women After Smoking Marijuana, Study Finds"
    News-Medical.net (08/19/2016)
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    Effect of General Anesthesia on Preoperative Hip Range of Motion in Patients Undergoing Hip Arthroscopy
    Researchers hypothesized that passive hip range of motion (ROM) during replacement surgery would increase with general anesthesia compared to without it. The team—with representatives from the University of Colorado School of Medicine, the Southern California Hip Institute, and the University of Michigan—enrolled 260 hip arthroplasty patients in their prospective study. ROM measurements were taken bilaterally as part of a thorough clinical examination and again under anesthesia right before surgery began. Overall, induction of general anesthesia was associated with a reduction in hip abduction ROM but an increase in hip external rotation ROM at 90° of hip flexion; while hip internal rotation ROM at 90° of hip flexion was comparable with and without anesthesia. Moreover, in healthy, contralateral hips—so classified because of the absence of a discernible pathology—induction of anesthesia decreased measurements of passive hip flexion ROM and hip abduction ROM. The various differences in ROM before and after general anesthesia were statistically significant, the researchers report, but not clinically so. Therefore, they conclude, hip ROM is not significantly changed for clinical purposes with the induction of general anesthesia.
    From "Effect of General Anesthesia on Preoperative Hip Range of Motion in Patients Undergoing Hip Arthroscopy"
    Healio (08/18/2016) Chadayammuri, Vivek; Pascual-Garrido, Cecilia; Garabekyan, Tigran; et al.
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    Study Suggests Team Agreement Key to Increasing OR Efficiency
    New research concludes that any regional anesthesia service can improve operating room efficiency by adopting a model based on consistency, reliability, and teamwork. The University of Miami study, reported at the 2016 Networking World Anesthesia Convention, observed an established outfit in Belgium in an effort to identify the OR metrics with the greatest impact on finances and operational management. Researchers considered time from entering the room to being anesthesia-ready, from being anesthesia-ready to the start of surgery, from the onset of surgery to the finish, from the end of surgery to being wheeled out of the room, and turnover time from one patient to the next. The model employed in the study consisted of an induction room, where patients receive block anesthesia; an operating room; and a recovery room. With practically no anesthetic administered in the OR, the team found that turnover times and anesthesia control times were impressively low. The model can be duplicated in virtually any other health care facility, according to clinical anesthesiology professor and lead study author Alexandru Visan, MD, MBA, who stressed the importance of getting all team members on board with the same goals. "There is no way to perform at such high rate without coordination between the anesthesia providers, the nurses in the operating room, the ancillary services, the surgeons and the nurses in the perioperative areas," he said.
    From "Study Suggests Team Agreement Key to Increasing OR Efficiency"
    Anesthesiology News (08/17/16) Leung, Martin
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    Scientists Design a Drug That Relieves Pain Like an Opioid Without Some Dangerous Adverse Effects
    A new chemical compound, PZM21, is offering hope for an analgesic that can alleviate pain as effectively as morphine—but without the potential for addiction. The designer drug reduced 87% of pain in mice placed on a hot surface, compared with 92% relief derived from morphine. The effect was longer-lasting with PZM21, however, and the animals exhibited no signs of addiction. The lab mice additionally were less likely to suffer from constipation, a primary complaint of opioid users. But like morphine, they did appear to experience respiratory depression—although breathing recovered much faster than it normally does with morphine. While an ideal analgesic alternative would mimic morphine's pain-relieving properties without affecting breathing, the researchers from Stanford University and the University of California, San Francisco, believe PZM21 represents important progress toward that goal. They report their findings in Nature.
    From "Scientists Design a Drug That Relieves Pain Like an Opioid Without Some Dangerous Adverse Effects"
    Los Angeles Times (08/17/16) Kaplan, Karen
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    Association Between Commonly Prescribed Opioids and Androgen Deficiency in Men
    Although a link has been established between increased likelihood of androgen suppression in men and long-acting opioids compared with short-acting narcotic painkillers, the impact of specific drugs was not considered. To explore, investigators with Kaiser Permanente undertook a retrospective cohort study comparing outcomes in 1,159 male patients taking fentanyl, methadone, oxycodone, or hydrocodone for chronic pain. The researchers recorded participants' serum total testosterone levels each morning for at least 90 days. Logistic regression analysis revealed that men on transdermal fentanyl, methadone, or oxycodone were more likely to experience androgen deficiency than were men on hydrocodone. However, higher doses of hydrocodone—and oxycodone as well—also translated into increased risk for androgen deficiency.
    From "Association Between Commonly Prescribed Opioids and Androgen Deficiency in Men"
    Uro Today (08/11/16) Rubinstein, Andrea L.; Carpenter, Diane M.
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    Carotid Endarterectomy With General Anesthesia Confers Greater Perioprocedural MI Risk vs. Stenting
    Regional anesthesia appears to be a better choice than general anesthesia for carotid endarterectomy (CEA), based on a new look at data from a large randomized trial. The post hoc analysis studied 1,149 patients from the CREST study who underwent CEA and 1,123 patients who underwent carotid artery stenting (CAS). In the CEA group, general anesthesia was administered for 1,038 patients; while local/regional anesthesia was used for the others. The risk of periprocedural myocardial infarction (MI) with regional anesthesia was similar to that posed by CAS, but patients having CEA under general anesthesia were twice as likely to suffer MI as patients who underwent stenting. "These findings suggest that surgeons performing CEA should seriously consider use of [regional anesthesia] to provide optimal outcomes for their patients," the researchers conclude.
    From "Carotid Endarterectomy With General Anesthesia Confers Greater Perioprocedural MI Risk vs. Stenting"
    Healio (08/08/2016) Byrne, Jennifer
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    Do Your Anesthesia Providers Double-Glove?
    Anesthesia providers who double-glove help prevent the spread of microbes to surgery patients but, according to new research, they need to focus more on dirty workstations. Researchers at Virginia Commonwealth Medical Center recruited 20 providers, some wearing a single pair of gloves and some doubled up, to simulate a general anesthesia induction. A dye substance—representing pathogens—was placed in the mannequin's mouth and tracked throughout providers' workspaces after the simulation and standard cleanup. Cart drawers, gas flow dials, medication vials, and ventilator instrumentation were found to be more "contaminated" by single-gloved hands than double-gloved hands. Gloving status was irrelevant, however, when it came to contamination of airway equipment, the breathing system, IV access ports, and rolls of tape used to keep endotracheal tubes in place. The study also found that routine cleaning did not completely remove the dye, making contamination of future anesthesia patients possible. Based the findings, published in the American Journal of Infection Control, the researchers suggest more simulations of clinical processes be conducted in order to identify best practices.
    From "Do Your Anesthesia Providers Double-Glove?"
    Outpatient Surgery (08/05/16) Bernard, David
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    Raman Spectroscopy Differentiates Each Tissue From the Skin to the Spinal Cord: A Novel Method for Epidural Needle Placement?
    Precise anatomical targeting is critical for the delivery of safe, effective neuraxial and epidural anesthesia; but existing research suggests spectroscopic techniques are not the best avenue. To gauge their ability to detect tissues in the needle's path when administering block anesthesia, researchers at Massachusetts General Hospital and MIT looked at Raman spectroscopy (RS), diffuse reflectance spectroscopy, and fluorescence spectroscopy. They suspected that real-time needle-tip spectroscopy could assist needle placement, a hypothesis that panned out. Tests on pigs confirmed that RS is able to distinguish all ex vivo paravertebral and neuraxial tissues encountered during epidural needle insertion. The technology, investigators believe, may be of use during needle placement by offering evidence of its anatomical localization.
    From "Raman Spectroscopy Differentiates Each Tissue From the Skin to the Spinal Cord: A Novel Method for Epidural Needle Placement?"
    Anesthesiology (07/16) Anderson, T. Anthony; Kang, Jeon Woong; Gubin, Tatyana; et al.
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    Abstract News © Copyright 2016 INFORMATION, INC.
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    Anesthesia E-ssential is an executive summary of noteworthy articles of interest to nurse anesthetists. It is distributed bimonthly to AANA members.
    Anesthesia E-ssential is for informational purposes, and its contents should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.
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    August 30, 2016
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