Anesthesia E-ssential

AANA Anesthesia E-ssential, December 12, 2019
National CRNA Week

Vital Signs

FTC Submits Comment Cautioning Against Adding Physician Supervision to CRNAs in Texas

The Federal Trade Commission (FTC) submitted a comment to the Texas Medical Board cautioning it against adopting a proposed rule that would add physician supervision requirements on CRNAs. The FTC's Office of Policy Planning, Bureau of Economics, and Bureau of Competition cites that the proposed rule "could harm competition by impeding access to surgical and other healthcare services that require anesthesia or related services."

AANA staff, its anti-trust counsel and the Texas Association of Nurse Anesthetists have been working closely with FTC staff in recent weeks to coordinate a strong response on this highly anti-competitive proposal. The FTC's comments warn the Texas Medical Board not to adopt the rule, since it would impede CRNA practice in ways that are inconsistent with the intent of current state statutes and which would potentially decrease the availability of services and increase costs of anesthesia services in the state.

Physician supervision for CRNAs raises several competitive concerns for patients. By restricting CRNAs' access to the marketplace, supervision can:
  • Increase cost of care.
  • Restrict provider innovation in healthcare delivery.
  • Create provider shortage and access problems, particularly for rural America and underserved populations that lack adequate cost-effective healthcare.
Most counties in Texas are rural. And, like other rural settings across the country, CRNAs provide most of the anesthesia care in the state. There are more than 4,500 CRNAs practicing in Texas, and their education, certification and clinical experience have positively impacted the state through the practice of cost-effective, high quality and safe anesthesia care.

The AANA is pleased that the FTC is keeping a critical, cautionary eye on this unwarranted attack on CRNA practice. The AANA will not stand for the kind of behavior that limits a patient's right to access high quality, safe anesthesia care delivered by CRNAs.

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Volunteer Opportunity: Doctors Without Borders Seeks Nurse Anesthetists for Urgent Field Need

Doctors Without Borders/Médecins Sans Frontières (MSF) is actively recruiting general and pediatric anesthesia providers to work in field projects.
  • Minimum 6 week commitment
  • Relevant experience with pediatrics
  • 2+ years relevant professional experience
These anesthesia providers often work in conflict settings to provide care to communities without access to functioning healthcare systems. Surgical cases include: general, trauma, obstetrics, orthopedic, pediatrics, burn and reconstruction, working with patients of all ages.

Basic diagnostic equipment and facilities needed to run an operating room will be limited: there may not even be an X-ray machine. Responsibilities include providing anesthesia, pain management, teaching and supervising of local staff, reporting, and at times assisting the ICU. Learn more.
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Interested in Serving on a FY2021 AANA Committee?

Deadline: April 30, 2020
The online application site for FY2021 AANA Committee members is now open! More information is available on the AANA Committee page of The application deadline is April 30, 2020.
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Future of Nursing 2020-2030 Technical Panel Webinar: Video, Presentations Available

The recorded video from the Technical Panel Webinar held on November 20, 2019, is now available. Presentations from the speakers of the meeting also are located on the event page.

The committee on the Future of Nursing 2020-2030 held a technical panel and discussion with healthcare industry leaders about how their organizations or members prioritize efforts to promote health equity into delivery and care models. View Resources.

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Holiday Wellness Tips

This time of the year brings much joy! Creating and experiencing all the merriment also can be exhausting. Try to make your rest a priority. Sleep deprivation is linked to higher levels of anxiety, depression, and deficiencies in decision-making and memory, among others. Visit for tips to get your best sleep. Remember too, help is available:
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Hot Topics

AANA Journal: December 2019 Articles and Volume 87 Index

AANA Journal Chief Editor Chuck Biddle, PhD, CRNA, reviews the offerings of the December 2019 issue. 

Combined General and Epidural Anesthesia for Emergency Cesarean Delivery of Twins in a Parturient with Coarctation of Aorta
The authors report on a near ‘perfect storm’ of challenges confronting the anesthetic and surgical providers in providing care for a most complex obstetrical patient. While there are a number of approaches that might be employed in the setting of this patient, readers will be charged with critiquing the interventions employed by the reporting authors in terms of how the case might have been managed differently. Compelling reading.

Preliminary Psychometric Evaluation of the Nurse Anesthesia and the Aftermath of Perioperative Catastrophes Survey (PCS) and the Ways of Coping Questionnaire (WCQ)
The reliability and validity of the PCS and WCQ in terms of their applications to CRNAs who may be directly or indirectly involved in a perioperative catastrophe are examined. This work builds significantly on work previously done by the authors in a domain that is desperately in need of scholarly activity: what happens to providers in the wake of patient disasters. The work reported here has enormous implications and applications to those clinicians and clinician scholars who are interested in this all too relevant aspect of our practice.

Marijuana Use in the Anesthetized Patient: History, Pharmacology, and Anesthetic Considerations
The authors explore what has become a matter of everyday practice, especially in light of recent legislation and social/cultural evolution as it relates to the use of marijuana. Recent literature demonstrates significant anesthetic issues that must be considered when providing anesthetic care to those using marijuana. The current work by our nurse anesthesia colleagues brings us up to date with their state-of-the-art review.

Barriers and Facilitators to Intraoperative Alternatives to Opioids: Examining CRNA Perspectives and Practices
This article, an investigation of how we might ‘do better’ with our use of opioids in the perioperative period, is essential reading as it applies to everyone’s practice on a daily basis. The national opioid crisis has given all of us pause, as the literature is clear that we play a role in some cases. Strategies are identified to assist the everyday clinician in formulating an approach to more effective, and safer use of opioids in their practices. The work represents an evidence-based approach that is actually workable, in dealing with a compelling problem.

Preventable Closed Claims in the AANA Foundation Closed Malpractice Claims Database
We all owe a great deal to the tireless activity of the AANA’s Closed Claims team of clinicians and researchers. Their latest offering examines the ongoing lessons that can be learned by identifying themes that emerge from the analysis of bad (catastrophic) events that can occur when patients are cared for. The epidemiology of negative events is such that when compiled in the aggregate healthcare associated errors may account for the third leading cause of death in the United States. The current work focuses on anesthetic-related issues and will provide sobering, but essential reading for the CRNA.

Operating Room Waste Reduction
The authors tackle an issue that is like the elephant in the room. Every day, every one of us observes a monumental amount of waste generated by even the simplest of operative cases. We see this, may wonder where it goes….and some of us may even give serious thought to its eventual impact on the earth itself. The authors approach the question with rigor, noting that on average, we contribute a significant amount (~25%) to the total, and address the essential question of ‘can we do more’, to do less. Excellent and stimulating reading awaits our readers.

Anesthetic Management of a Laboring Patient with a Closed-Loop Stimulation Pacemaker: A Case Report
The management of the latest technology associated with the management of patients receiving “closed loop stimulation pacemakers” is covered. In this particular case, the authors critically examine its use, and considerations of significance to the anesthesia provider, in their case report involving a laboring patient. While the case is of an obstetrical nature, the clinical information provided extends well beyond the pregnant patient and delivery suite.

Update on the Physiologic Effects of Ketamine in General Anesthesia and Spinal Blockade: A Review of the Literature
The “rebirth” of ketamine and its widening utility in, and out of the operating room, is remarkable, and this update is yet another evidence-based critique of the drug. The work is solidly grounded in the very latest pharmacological science as it details the drug’s pharmacodynamics as well as issues related to inflammation, oxidative stress and what is going on in the central nervous system. Ketamine is a complex drug with complex and diffuse effects on our physiology. Understanding these effects will better allow us to use the drug safely and optimize its effectiveness in a patient-centric manner.

AANA Journal Course: Update for Nurse Anesthetists—Current Evidence-Based Practice for Pediatric Emergence Agitation
The AANA Journal has a long history of bringing clinically relevant and probing critiques of topics encountered by the nurse anesthetist in the form of compelling CEU offerings. This latest installment continues that tradition with the author tackling the contentious topic of how to manage pediatric emergence agitation. This is extremely valuable reading and has the added benefit of allowing the reader to gain valuable continuing education credit.

And don’t miss our exclusive “online” content where you can peruse the index to Volume 87 of the AANA Journal. Another calendar year is coming to a close with an enormous depot of clinical, educational, research and administrative information available to you with instantaneous electronic access.
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Seeking Candidates: Delegate to Education Committee

The AANA Education Committee is seeking candidates to serve a two-year term as a Delegate. The deadline for receiving completed candidate packets is January 6, 2020. The election will be held, and the winner announced, at the Assembly of Didactic and Clinical Educators (formerly called the Assembly of School Faculty) meeting in February 2020.

Delegates must be CRNAs who spend at least 50% of their time in the didactic and/or clinical instruction of nurse anesthesia students at the time of application. During their tenure on the committee, they must:
  • Be continuously involved in the didactic and/or clinical instruction of nurse anesthesia students.
  • Attend the February Assembly of Didactic and Clinical Educators and Nurse Anesthesia Annual Congress during both years of their term.
  • Attend Education Committee meetings and conference calls for the two-year term which begins immediately following the AANA Annual Congress in the year elected.
The candidate information packet is available on the AANA website under CE & Education, Opportunities for Educators. Questions? Contact the Education department at 847-655-1161 or
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FY2021 CRNA-PAC Committee - New Application Deadline is now April 30, 2020!

CRNAs and SRNAs interested in serving on the CRNA-PAC Committee beginning in the 2021 AANA fiscal year are encouraged to submit an application through the AANA online committee submission form located on the committee page

Responsibilities of Committee members include:
  • Setting the CRNA-PAC income and expenditure policy;
  • Participate in fundraising duties;
  • Reviewing open-seat and challenger candidates for federal office; and
  • Volunteering at CRNA-PAC events and national meetings.
Committee members are expected to attend two in-person meetings per year (Joint Committee Conference in September 2020 and Mid-Year Assembly in April 2021) and conference calls on an as-needed basis.

If you have any questions, please contact Catharine Harris, AANA Associate Director of Political Affairs, at or call (202) 741-9087.

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 U.S. Citizen.

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CRNA Week Promotional Materials - T-Shirts and Mugs Make Great Gifts!

Show your National CRNA Week pride - get a CRNA Week t-shirt or coffee mug and surprise your CRNA or SRNA friends with a great holiday gift! Order now while supplies last!

2020 National CRNA Week T-shirts

Be sure to see the other CRNA Week merchandise in the AANA Bookstore also: travel mugs, pens, buttons, hats, and more!
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Do You Know an Outstanding CRNA? Nominate Your Colleague for an AANA Recognition Award!

Nomination Deadline: March 15, 2020.
Do you work with an outstanding program director, didactic instructor, or clinical instructor? Do you know someone who has spent a lifetime advancing the practice of nurse anesthesia as a practitioner, educator, clinician, or advocate? Consider nominating your colleague for one of the national AANA recognition awards.

Visit Recognition Awards for details on the:
  • Agatha Hodgins Award for Outstanding Accomplishment,
  • Helen Lamb Outstanding Educator Award,
  • Alice Magaw Outstanding Clinical Practitioner Award,
  • Ira P. Gunn Award for Outstanding Professional Advocacy,
  • Clinical Instructor of the Year Award,
  • Didactic Instructor of the Year Award, and
  • Program Director of the Year Award.
Nomination deadline is March 15, 2020.
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Anesthesia Business Seminars – Limited Seats Left!

If you want to go out on your own, but don’t know the business side of anesthesia, here’s your chance to learn from Juan Quintana and Larry Hornsby, former AANA presidents, who both have launched multimillion-dollar anesthesia group practices. They’re hosting this 8-week university-level course exclusively for AANA members online! They’ll engage with you each week to cover topics such as billing and reimbursement, negotiations, contracts and proposals, differences in practice models, and more.

AANA Membership Exclusive - Earn 16 CE Credits; Next Session starts January 6, 2020.

Seats are limited!
Spring 2020 Session
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New: Five Things You Need to Know About CRNA Malpractice Insurance

Malpractice insurance can be complicated. Gain a basic understanding of CRNA Malpractice Insurance with AANA Insurance Service’s new Five Things You Need to Know resource. Learn more.
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Council on Accreditation (COA) Seeking Qualified Applicants for Onsite Reviewers

Deadline to apply: December 16, 2019
The COA is seeking qualified candidates for Educator Practitioner and Educator Administrator Onsite Reviewers. Please note candidates must meet specific criteria as detailed on the COA website. Candidates must be available to conduct one onsite accreditation review per year. Onsite reviews are typically scheduled for 2-3 consecutive weekdays in April and October. To be assigned to an onsite accreditation review, appointed onsite reviewers must attend a mandatory workshop training; trainings are held in conjunction with the Assembly of Didactic and Clinical Educators (ADCE) in February and the AANA Annual Congress in August. The term of appointment is three years, beginning January 2020. The appointed candidates then would be eligible to be considered for reappointment to a second three-year term. The deadline to apply is December 16, 2019. For position criteria and application requirements, please visit
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NewsMaker: CRNA Terry Schiowitz Joins Wilkes-Barre Area School Board

Terry Schiowitz, CRNA, was elected to the Wilkes-Barr, Pa., school board last month.

According to The Citizen's Voice, Schiowitz "wants to change the board's hiring policy to allow board confirmation of employment decisions made by 'an impartial committee' that anonymously vets job candidates." Learn more.
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Meetings and Workshops

Last Chance! Join the March 2020 CRNA Delegation to Greece

Class A CE Credits: 12.00
When: March 14-20, 2020
Location: Athens, Greece
Sign-up Deadline: December 19, 2019

‘Tis the season to plan your travel for 2020. Connect with fellow CRNAs and international advanced practice nursing colleagues in Greece through the World Learning CRNA delegation. Led by Debbie Malina, DNSC, MBA, CRNA, FY2012 AANA president, the World Learning program will give you a unique opportunity to learn about the state of healthcare and the role of nurse anesthetists and advanced practice nursing professionals in Greece.

Be sure to take advantage of this unique opportunity. Register today!
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ADCE Registration is Open!

Join us in Braselton, Ga., at the Château Élan Winery & Resort for the premier nurse anesthesia educational program forum: the Assembly of Didactic and Clinical Educators (ADCE). Meet with leading educators in the field and help define the future of the CRNA profession!

When: February 19-22, 2020
Location: Château Élan Winery and Resort, Braselton, Ga.
Early Registration Savings: Save up to $100.00*

*Resort reservations for ADCE include FREE shuttles to/from Hartsfield-Jackson International Airport.

Wide-Range of Topics include:
  • Leadership to improve faculty/student satisfaction and academic outcomes.
  • Common legal issues faced within nurse anesthesia education.
  • Doctoral curriculum and scholarship.
  • Challenges of clinical education amid production pressure.
  • Health and wellness of faculty and students.
  • Research, and more!
More about the Château Élan - Southern charm meets luxury French splendor with 3,500 acres of grapes, spa treatments, gourmet dining, and golf.
  • Wine tours and tastings held daily.
  • Spa mansion with 14 spa suites.
  • 7 onsite restaurants.
  • 45 holes of championship golf.
Register Today!
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Mid-Year Assembly 2020: Advocate for Your Profession on Capitol Hill

When: April 18-22, 2020
Location: Renaissance Washington D.C. Downtown, Washington, D.C.

The Mid-Year Assembly is the most important nurse anesthesia advocacy meeting. Join us on Capitol Hill as we gather, rally, and impress the importance of nurse anesthesia on our legislators.

Save the Date
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Foundation and Research

AANA Foundation – Call for Review Committee Members; Respond by January 31, 2020

The Foundation is currently looking for CRNAs to serve on the Research and Scholarship Committees. The Research Committee reviews applications for research grants, fellowships and poster sessions. The Scholarship Committee reviews student scholarship applications. The Board of Trustees makes funding decisions based on the recommendations of these committees. If you are interested, please submit a statement of interest along with your CV to by January 31, 2020.
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AANA Foundation Awards; Nominations Due January 1, 2020

AANA Foundation awards are presented each year at Annual Congress in the areas of research, philanthropy, advocacy, and humanitarianism. In 2019, the Foundation honored: Those who receive awards are humbled and honored. We encourage you to nominate a deserving CRNA who is making a difference in these areas. Applications for nominations that will be awarded at the AANA 2020 Annual Congress in San Diego are now available on the Foundation’s Applications & Program Information webpage and are due January 1, 2020. Nominations are carried forward for three years.

As Juan Quintana shared in his comments upon receiving the award:
"This recognition touches my heart and I thank you. As Mahatma Gandhi once said, 'The best way to find yourself is to lose yourself in the service of others.' Remember, our best work lies in the future we create."

Recognize a CRNA who goes above and beyond in the areas of research, philanthropy, advocacy, or humanitarianism to create a better future for all.
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Support the AANA Foundation: Shop AmazonSmile this Holiday Season

When you give to others, AmazonSmile gives to nurse anesthesia. You can easily support the AANA Foundation every time you make a purchase on Amazon. When you shop at AmazonSmile, Amazon donates 0.5% of the purchase price to the AANA Foundation. Please bookmark the link and support the Foundation while you shop!
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AANA Member Benefits

Innovation Lab Offers Free Obstetrics Hands-on Cadaver Lab and Workshop

This free course is for the healthcare professional seeking to advance a platform enhancing patients' experiences after surgery. Lectures, hands-on workshops on fresh frozen human cadavers, and live-model scanning are included.

When: Jan. 25, 2020, 8:30 a.m. - 1:30 p.m.
Where: Embassy Suites hotel, Grapevine, Texas

Objectives include:
  • Describe the opioid epidemic as it specifically relates to the women's health arena.
  • Review legislative movement toward opioid minimization.
  • Outline society guidelines addressing a multimodal approach for postsurgical care in obstetrics and gynecological procedures.
  • Analyze the scientific literature that supports opioid avoidance.
  • Build out an interactive multimodal and enhanced recovery pathway.
  • Use a cadaveric model focused on surgical techniques applicable to addressing pain management in C-section as well as vaginal, open and minimally invasive surgeries.
  • Demonstrate skill in ultrasound-guided transversus abdominis plane blocks, including live model scanning and cadaveric real-time application.
Register and learn more.
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It Pays to be Prepared: Preorder 2020 CPC Core Modules and Save!

SAVE UP TO 25% on the innovative microlearning series being released in the fall of 2020. You'll have peace of mind knowing you're all set to meet CPC requirements through all four required knowledge domains. Offer expires December 31, 2019.

Be prepared. Preview modules and sign up today at

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Don't Forget! Open Enrollment Closes December 15, 2019

Open Enrollment: November 1 - December 15, 2019
Healthcare plans are now available through the Affiliate Health Insurance Exchange (AHIX), including long term major medical, group medical and the Affordable Care Act ("ObamaCare") or ACA. The long-term major medical coverage offers a new three-year rate and plan design guarantee. It covers pre-existing conditions after 1 year, doctor office co-pays, wellness benefits, a prescription discount program, and more. The group medical program covers all preexisting conditions from Day 1, and it offers unlimited lifetime maximums. ACA coverage also offers pre-existing coverage from Day 1 with unlimited lifetime maximums. Learn more.

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CRNACareers - A New Year is Coming - What Will 2020 Bring for Your Career?

Maybe you need a change of scenery or a new challenge. 2020 is out there with new opportunities and goals to keep your career stimulated, and jobs for which you are uniquely qualified. Find the new you on!

  • Search and apply to locum tenens or permanent positions at industry-leading facilities.
  • Upload your resume anonymously and allow employers to contact you.
  • Set up job alerts to receive notifications on new openings.
  • Access free career resources to assist with resume and interview preparation.

Learn more today!

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CRNA: Mary Washington Healthcare, Fredericksburg, Virginia

CRNAs – bring your talents to Mary Washington Healthcare at Fredericksburg Ambulatory Surgery Center (FASC), the only tertiary-level outpatient surgery facility in the region providing care for:
  • Ear, nose, and throat (ENT)
  • Orthopedics
  • Gynecology
  • Urology
  • Podiatry
  • Pain management procedures
  • Ophthalmology
  • Dental
Ideal candidates will have a valid VA Nursing license, valid VA licensure as a Nurse Practitioner in Anesthesia and current certification as a Nurse Anesthetist by the American Association of Nurse Anesthetists. If pending initial certification, evidence of graduation from an accredited nurse anesthesia program and of eligibility for board exam is required. Learn more.
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Reno CRNA: LifeLinc, Reno, Nevada

LifeLinc is currently accepting applications for CRNAs to work full time and PRN at a vascular ASC in Reno, NV.

Schedule: Monday – Friday (No call, no nights, no weekends)

  • CME Reimbursement
  • PTO
  • Health Insurance
  • 401k
Professional Liability will be covered by LifeLinc.

LifeLinc Anesthesia has emerged as one of the top, comprehensive anesthesia management providers in the country. Since 2003, LifeLinc has centered its mission on "Changing the Status Quo" of healthcare through innovative solutions and excellent clinical quality. We recognize that an exceptional anesthesia team enhances patient safety and experience. This is why we enable our providers to serve as leaders in the perioperative setting, maximizing their potential and fostering long-term employment relationships. Come join a team committed to provider growth and continuing innovation in anesthesia! Learn more.
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CRNA: Merritt Hawkins, Charleston, South Carolina

Private Practice—Enjoy Complete Autonomy In a High-Quality Practice
  • Large 55+ provider private group practice in Charleston’s desirable suburbs.
  • Monday through Friday, always home by 5 p.m.
  • Some days sent home by 2 p.m. but still paid for full day.
  • Autonomy, excellent physician relationships, and respect.
  • Three days of call per month, rarely come back due to low hospital acuity.
  • Base fee paid to be on call and hourly minimum if you come in on call.
  • Flexible schedule with 8-, 10-, or 12-hour shifts—you can decide.
  • Never forced to work late but paid for every minute if you do.
  • 6 weeks of PTO.
  • Generous base pay, benefits, and annual profit sharing.
Learn more.
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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.

One Step Closer to Pathogen Containment by Anesthesia Providers in the Operating Room

Alcohol-based hand rub on gloves may help anesthesia providers curtail the spread of bacteria at critical surgery times—such as during induction or extubation—when it may not be feasible to change gloves or wash their hands. University of Miami researchers demonstrated the potential of this approach in an experiment that recruited volunteers to wear nitrile examination gloves and apply alcohol-based rub to them every 15 minutes for two hours. Perforation rates in those 50 gloves were compared with perforation rates in 50 new gloves not exposed to the hand rub. While investigators discovered a microperforation in one of the unexposed gloves, none were detected among the gloves that were repeatedly subjected to alcohol-based rub. Not only does the study indicate that alcohol-based rub on gloves does not compromise their integrity, a test requiring volunteers to pick up a coin from a table top illustrated that the method also does not prevent anesthesia providers from safely providing routine care. The researchers did find, however, that gloves felt increasingly sticky with each new application of hand rub.

From "One Step Closer to Pathogen Containment by Anesthesia Providers in the Operating Room"
Anesthesia & Analgesia (12/19) Vol. 129, No. 6, P. 1557 Birnbach, David J.; Thiesen, Taylor C.; McKenty, Nathan T.; et al.

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Prevention of Hypotension After Spinal Anesthesia for Cesarean Section

U.S. and Canadian researchers questioned which techniques work best to prevent hypotension in laboring women who undergo spinal anesthesia for cesarean section. The collaborators consulted the literature, identifying 109 relevant randomized clinical trials published through 2018. The studies, which collectively evaluated about a dozen different methods for avoiding hypotension in this patient population, involved 8,561 participants in all. Based on the evidence, metaraminol was the most effective intervention examined. It was followed—in order—by norepinephrine, phenylephrine, leg compression, ephedrine, colloid administered before anesthesia induction, angiotensin, colloid given after anesthesia induction, mephentermine, crystalloid administered after induction of anesthesia, and crystalloid given before anesthesia induction. The authors of the meta-analysis and systematic review conclude that healthy women should be given vasopressors as prophylaxis against hypotension during cesarean section with spinal anesthesia.

From "Prevention of Hypotension After Spinal Anesthesia for Cesarean Section"
Anaesthesia (01/01/20) Vol. 75, No. 1 Fitzgerald, J.P.; Fedoruk, K.A.; Jadin, S.M.; et al.

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Benefits Seen with Use of Regional Blocks for Bilateral Mastectomy with Reconstruction

The jury is still out on the benefit of regional anesthesia in patients having bilateral mastectomy with immediate reconstruction, but findings from a new study add to evidence in favor of this approach. Led by Memorial Sloan Kettering's Hanae Tokita, MD, researchers performed a retrospective review of women who underwent the procedure at the facility between April 2017 and December 2018. Of 713 patients, 639 received regional anesthesia—most often in the form of a paravertebral block. All, however, underwent general endotracheal anesthesia and were managed via standardized enhanced recovery pathways. Regional block was associated with significantly less intraoperative fentanyl requirement, lower postoperative opioid use, faster return to ambulation, lower maximum postoperative pain scores, and 30-minute earlier discharge. There were no significant between-group differences, meanwhile, in terms of acetaminophen or ketorolac consumption, rate of adverse outcomes, hospital admissions, trips to urgent care, or 30-day readmission rates. Through the use of a novel electronic tool, moreover, the researchers were able to collect data on post-discharge symptoms for 10 days post-surgery. Of the 559 participants who completed at least one survey, responses suggested a lasting effect from regional anesthesia. The likelihood of moderate or worse pain was 0.58 times lower for those 10 days in the women who underwent a block.

From "Benefits Seen with Use of Regional Blocks for Bilateral Mastectomy with Reconstruction"
Clinical Oncology News (12/10/19) Vlessides, Michael

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Analgesic Effect of Repeated Quadratus Lumborum Block Versus Continuous Epidural Analgesia Following Laparoscopic Nephrectomy

Researchers in Indonesia investigated how quadratus lumborum block (QLB) stands up to the analgesic efficacy of epidural anesthesia for abdominal surgeries. For the purpose of this prospective trial, they worked with a sample of 62 patients undergoing transperitoneal laparascopic nephrectomy. Based on randomized assignment, half received bilateral QLB and half received continuous epidural for intraoperative analgesia. For postoperative pain relief, bilateral QLB was repeated at the same dose for the QLB treatment group; while the epidural group's dosage was stepped down from 0.25% bupivacaine to 0.125%. The primary endpoint was total morphine requirement in the 24 hours post-surgery, which was found to be similar for both sets of patients. Postoperative pain scores—the secondary outcome—also was comparable between the study groups. While QLB closely mimicked continuous epidural on cumulative morphine requirement, pain scores, sensory blockade, and incidence of postoperative nausea and vomiting and paresthesia, it also was associated with higher mean arterial pressure postoperatively and shorter urinary catheter usage.

From "Analgesic Effect of Repeated Quadratus Lumborum Block Versus Continuous Epidural Analgesia Following Laparoscopic Nephrectomy"
BMC Anesthesiology (12/05/19) Vol. 19, No. 221 Aditianingsih, Dita; Anasy, Naufal; Tantri, Aida Rosita; et al.

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Quadratus Lumborum Block Ineffective for Colorectal Surgeries

New evidence has found that quadratus lumborum block (QLB) is not effective for colorectal surgeries, despite its earlier documented success in abdominal operations. A research team at Laval University in Quebec randomly assigned 31 patients to QLB and a like number of controls to sham injection, with all participants receiving multimodal analgesic care. Not only did the abdominal wall block fail to reduce postoperative opioid demand, the study authors report, patients who received it actually had higher postoperative pain scores than patients who did not. “These results contrast with most previous studies, although those studies were mostly performed in gynecological and C-section procedures,” remarked lead investigator Pamela Paquet, MD. “There was, however, one randomized controlled trial published last November that had results similar to ours and in a similar study population. So, I think maybe it's possible that there is a specific surgical context that might explain why the quadratus lumborum blocks don't seem to be as good for colorectal surgery as they are for other abdominal surgeries." She also noted that there are three different types of QLBs, so one might work better than the others. For now, though, Paquet says her team's findings “do not support the inclusion of the quadratus lumborum block as the standard of care in colorectal surgical patients.”

From "Quadratus Lumborum Block Ineffective for Colorectal Surgeries"
Anesthesiology News (12/06/19) vles; Vlessides, Michael

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Comparison of Spinal Anesthesia Quality Between Patients Addicted and Not Addicted to Opium

A case-control study explored whether the quality of spinal anesthesia differs in patients with no past exposure to opium versus those with an opium-based abuse problem. Researchers recruited 30 opium-naive and 30 opium-dependent participants, all of whom received spinal anesthesia with bupivacaine. Based on anesthesia levels and motor block documented at several intervals over three hours, the study authors determined that addiction does indeed make a difference. Although the mean onset of sensory block was similar between the two patient populations, spinal anesthesia lasted for a notably shorter period of time in the opium-dependent group than in the opium-naive group, they found. Based on their findings, the investigators recommend using intravenous medications or higher doses of spinal marcaine for patients struggling with opium dependency.

From "Comparison of Spinal Anesthesia Quality Between Patients Addicted and Not Addicted to Opium"
Journal of PeriAnesthesia Nursing (12/01/19) Vol. 34, No. 6, P. 1169 Razavi, Majid; Bameshki, Alireza; Jahari, Lida; 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.

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Park Ridge, IL 60068
Phone: (855) 526-2262 (toll-free)/(847) 692-7050
Fax: (847) 692-6968

Attn: Cathy Hodson
E–ssential Editor
December 12, 2019