AANA Anesthesia E-ssential, December 13, 2018
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Guidelines for Core Clinical Privileges Out for Open Comment

The Guidelines for Core Clinical Privileges for Certified Registered Nurse Anesthetists are available for open comments through January 7, 2019. Please submit your comments to practice@aana.com. More information is available at www.aana.com/OpenComment. We appreciate your time, expertise, and feedback in the review of this document.
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New Guidance Outlines Recommendations for Infection Control in Anesthesiology

A writing panel consisting of experts in anesthesiology and infection prevention has developed new guidance on how hospitals and healthcare providers may reduce infections associated with anesthesiology procedures and equipment in the operating room. The guidance, published in Infection Control & Healthcare Epidemiology, looks to improve patient outcomes through increased hand hygiene, environmental disinfection, and continuous improvement plans.

The key recommendations include:

  • Hand hygiene should be performed, at a minimum, before aseptic tasks, after removing gloves, when hands are soiled, before touching the anesthesia cart, and upon room entry and exit. The authors also suggest strategic placement of alcohol-based hand sanitizer dispensers.
  • During airway management, the authors suggest the use of double gloves so one layer can be removed when contamination is likely, and the procedure moves too quickly to perform hand hygiene. The report also recommends high-level disinfection of reusable laryngoscope handles or adoption of single-use laryngoscopes.
  • For environmental disinfection, the guidance recommends disinfecting high-touch surfaces on the anesthesia machines, as well as keyboards, monitors, and other items in work areas between surgeries, while also exploring the use of disposable covers and re-engineering of the work surfaces to facilitate quick decontamination in what is often a short window of time.
  • IV drug injection recommendations include using syringes and vials for only one patient, and that injection ports and vial stoppers only be accessed after disinfection.

The guidance was endorsed by the Society for Healthcare Epidemiology of America (SHEA), the American Association of Nurse Anesthetists (AANA), the Anesthesia Patient Safety Foundation (APSF), the Association for periOperative Registered Nurses (AORN), and the American Academy of Anesthesiologist Assistants (AAAA), with a letter of support from the American Society of Anesthesiologists (ASA).

Access the expert guidance for free at https://doi.org/10.1017/ice.2018.303.

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Health Insurance Enrollment Ends Soon!

The health insurance open enrollment deadline for Affordable Care Act (ACA) plans is Dec. 15th and non-ACA plans is Dec. 31st. AANA Member Advantage partner, AHiX is available to help you better understand the health insurance marketplace and options available. Learn more.
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AANA Foundation: Award Nominations
Nominations due by January 1

Honor a CRNA who has made an outstanding contribution by nominating them for a prestigious AANA Foundation award. Award nominations due by January 1, 2019 are listed below. Visit the AANA Foundation Applications and Program Information webpage to learn more and access the applications.
  • John F. Garde Researcher of the Year Award
  • Rita L. LeBlanc Philanthropist of the Year Award
  • Advocate of the Year Award
  • Janice Drake Humanitarian Award
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Hot Topics


Assessing Respiratory Compromise Risk Through New Tool

An article in the Journal of Critical Care, "Respiratory Depression in Low Acuity Hospital Settings - Seeking Answers from the PRODIGY Trial" reviews the problem of respiratory compromised in adult patients receiving opioids on the general care floor, and the methodology used in the ongoing PRODIGY (PRediction of Opioid-induced Respiratory Depression In Patients Monitored by capnoGraphY) trial. The trial was designed to create and validate a novel respiratory compromise risk prediction tool to identify medical and surgical patients at increased respiratory compromise danger while receiving opioids on the general care floor. See study.
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Earn One Free CE Watching the Goldie Brangman Lecture on Diversity and Inclusion on AANALearn

The inaugural Goldie Brangman lecture on diversity and inclusion is now available on AANALearn. The lecture was given by Courtney Brown, PhD, CRNA, on the topic of “Crafting a Diversity and Inclusion Strategic Plan at a Nurse Anesthesia Program: A Journey, Not a Destination.” Dr. Brown is the associate director of didactic education at the Wake Forest Baptist Health Nurse Anesthesia Program.

Goldie Brangman, MEd, MBA, CRNAGoldie Brangman, MEd, MBA, CRNA, was the 1973-74 president, and the first and only African-American president of the AANA. This lecture will be an annual event at the AANA Nurse Anesthesia Annual Congress.

View the lecture here.

Decades before diversity and inclusion was a much talked about business principle, or a core value of the AANA, Goldie Brangman saw the value in including nurse anesthesia professionals from all demographics and cultural backgrounds.
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AANA Submits Joint Comments with ASA, APSF, and AAAA on Proposed Revisions to USP <797>

On November 30, 2018, the AANA submitted joint comments to the United States Pharmacopeial (USP) Convention regarding proposed revisions to USP <797>, the standards for preparing compounded sterile preparations (CSPs) in pharmacy and nonpharmacy areas, including in hospitals, ambulatory surgical centers, and office-based locations. The joint recommendations to USP from the AANA, American Society of Anesthesiologists, Anesthesia Patient Safety Foundation, and American Academy of Anesthesiologist Assistants include:
  • Carving out operating and procedure room settings from USP <797> requirements.
  • Working with the U.S. Food and Drug Administration (FDA) to address discrepancies in terms and definitions.
  • Considering impact on drug shortages.
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Be Safe and Well this Holiday Season!

AANA, AANA Peer Assistance Advisors and Health & Wellness committees wish you and your families all the best this holiday season! Take this time to catch up on sleep, be physically active, avoid germs, help those in need, and celebrate in moderation.

This time of the year may not be a joyous occasion for everyone and can increase stress and create emotional unbalance. Maintaining wellness and proper self-care is vital. The holiday season, and winter in general, is especially difficult for anyone facing seasonal depression, emotional crisis, or recent loss; challenging to those in recovery to maintain sobriety; perilous for those contemplating suicide and battling active addictions. Seek help and support - talk to a loved one, your healthcare professional or clergy. Other available options may include access to a workplace employee assistance program or university counseling services.

Remember, there is always help available:
  • Drugs or alcohol concerns, call the AANA Peer Assistance Helpline for 24/7 confidential live support and resources 800-654-5167
  • Suicidal thoughts, American Foundation for Suicide Prevention Hotline 800-273-TALK
  • Sexual assault, RAINN National Sexual Assault Hotline 800-656-4673
  • When life threatening or potential for immediate risk or harm to self or others, call 911
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Gain a Basic Understanding of Malpractice Insurance with Understanding CRNA Malpractice 101

Malpractice insurance can be confusing. Our CRNA malpractice 101 document addresses key topics related to your malpractice insurance coverage. Learn more.
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Seeking Candidates for Delegate to the Education Committee

The AANA Education Committee is seeking candidates who are interested in serving on the committee as a Delegate. The deadline for receiving completed candidate packets is January 7, 2019. 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 2019.

Delegates must be CRNAs who spend at least 50 percent 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 education@aana.com.
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NewsMaker: SRNA India Johnson Interviewed About Community Service

India Johnson, BSN, CCRN, was interviewed about a homeless outreach program she is active in for a segment of "The Pulse of St. Louis." Read more.
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NewsMakers: Wheeling Hospital CRNAs Donate to Shelter, Receive Gift in Exchange

Teen girls living at Youth Services System's Helinski Shelter in Wheeling, W.Va., have enjoyed learning from the shelter's staff how to crochet borders around fleece blankets. After having received donated items from Wheeling Hospital's CRNAs several times this year, the girls decided to use their new skills to give back to the hospital by making blankets for the babies born there. Read more.
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Meetings and Workshops


Assembly of Didactic and Clinical Educators (ADCE)
Formerly the Assembly of School Faculty (ASF)

The ADCE takes place February 13-16, 2019, in Houston, Texas. Clinical preceptors, didactic educators, and program administration are encouraged to join your peers and refresh your knowledge at the only forum designed for nurse anesthesia programs. This year will feature a focus on simulation. Other topics include educating millennials, health and wellness, diversity, research, and technology. Learn more.
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Ultrasound-Guided Peripheral Nerve Block Workshop
Formerly the Upper and Lower Extremity Nerve Block Workshop

The Ultrasound-Guided Peripheral Nerve Block Workshop takes place March 16-17, 2019, at the AANA National Headquarters building in Park Ridge, Illinois.

The Upper and Lower Extremity Nerve Block Workshop is designed to enhance your knowledge in the clinical sciences related to upper and lower block anesthesia. Featuring didactic and hands-on training, this program will expand the CRNA's skills and expertise in upper and lower extremity nerve block anesthesia. Learn more.
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State Leadership Workshop

The State Leadership Workshop takes place March 23-24, 2019, in San Diego, California.

This day-and-a-half workshop will inspire state leaders to lead and influence through crucial conversations and emotional intelligence. Other topics include state board orientation, governance principles, and sharing best practices and success stories with other state association leaders.
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Mid-Year Assembly – Registration Now Open!

The Mid-Year Assembly takes place April 6-10, 2019, in Washington, D.C.

Are you prepared to advocate effectively on Capitol Hill for protecting and advancing nurse anesthesia practice? At the AANA Mid-Year Assembly, you'll gain professional advocacy skills and healthcare policy understanding that promotes leadership at the national level and in professional practice. As one 2018 Mid-Year Assembly attendee commented in their meeting evaluation, "You can't truly understand the importance of advocacy unless you are physically there, seeing it in action. CRNAs need to be there!" Learn more.
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Foundation and Research


AANA Foundation: Call for Committee Members
Respond by January 7, 2019

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

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

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

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

If you are interested, please submit a statement of interest along with your CV to foundation@aana.com by January 7, 2019. Any questions, please contact the Foundation at (847) 655-1170.
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AANA Foundation: Support Nurse Anesthesia Research and Education
Make Your Tax-Deductible Year-End Donation Today!

It’s the season of giving. Help us strengthen the nurse anesthesia profession by supporting the AANA Foundation’s Annual Fund and the RISE Above campaign. Make your gift today by visiting the Foundation’s secure donation page. To maximize your 2018 tax benefits, please submit your gift no later than December 31, 2018.

The Foundation is grateful for your support this year and would like to wish you and yours a very happy holiday season!
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Federal Government Affairs


Interested in Serving on the CRNA-PAC Committee? Applications are due January 31

CRNAs and SRNAs interested in serving on the CRNA-PAC Committee beginning in the 2020 AANA fiscal year are encouraged to submit an application by January 31. 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 August/September and Mid-Year Assembly in April) and conference calls on an as-needed basis. Read the full job description.

Applications should be submitted to Mary Scheuermann at committees@aana.com by January 31, 2019 (Students, please see specific criteria and instructions here). The full slate of candidates will be approved for nomination by the AANA Board of Directors at the Assembly of Didactic and Clinical Educators in February, and new members will be elected by the CRNA-PAC Committee at Mid-Year Assembly.

If you have any questions, please contact Catharine Harris, AANA Associate Director of Political Affairs, at charris@aanadc.com or (202) 741.9087.
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AANA Member Benefits


Nationwide
Safety Tips for the Holidays

From candles to candy and trees to toys, nearly every joyful holiday tradition also carries the potential for accidents and injuries. See these safety tips from Nationwide to help keep the season merry and bright!


December Holiday Safety Tips
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Jobs


Assistant Professor, Nurse Anesthetist Specialty: University of Maryland Baltimore, School of Nursing, Baltimore, Maryland

The University of Maryland School of Nursing (UMSON) Nurse Anesthesia Program is currently recruiting for a full-time non-tenure Assistant Professor to participate in the clinical and didactic education of Nurse Anesthesia students. Learn more.
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$30k Start Bonus with NEW comp; $150k-$165k base PLUS Opportunity for Additional Comp: Envision Physician Services, Sarasota, Florida

Envision Physician Services has a full-time CRNA opportunity available with our Coral Anesthesia Associates division in Sarasota, FL. This team provides a full range of anesthesia services at Sarasota Physicians Surgical Center, Doctor’s Hospital of Sarasota and Doctor’s Same Day Surgery Center. Learn more.
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Hospital-Employed CRNA Opportunity at Level I Trauma Center: Carle Physician Group, Urbana, Illinois

Carle Physician Group is seeking an additional CRNA to join our team of 50 CRNAs at our main campus in Urbana, Illinois. Learn more.
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Certified Registered Nurse Anesthetists: Surgery Partners – Lubbock, Texas

Surgery Partners, a Nashville-based publicly traded company with over 200 locations nationwide, is seeking (2) experienced Certified Registered Nurse Anesthetists (CRNA) for Lubbock Heart Hospital, our hospital location in Lubbock, Texas. Reporting directly to the Director of Surgical Services, the CRNAs will administer anesthesia, monitor patients' vital signs, and oversee patient recovery from anesthesia. May assist anesthesiologists, surgeons, other physicians. Learn more.
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CRNACareers

Looking to Grow Your Career?

Visit CRNA Careers today, the official career center of the AANA. Job searching that is catered to meet your needs. Here's what we offer:

  • The Best CRNA Jobs: Connecting you to top employers in anesthesia.
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  • Post Your Resume Anonymously: You're in control. Make your profile confidential and respond to employers with the best opportunities.

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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.

Adductor Canal Block Analgesia Unaffected by Injection Site

Adductor canal block for anterior cruciate ligament (ACL) delivers the same level of analgesia no matter which part of the thigh receives the injection, researchers say. The finding comes after Canadian researchers compared postoperative analgesia and motor function in 108 patients who took the injection of lidocaine and ropivacaine in the proximal thigh, midthigh, or distal thigh. Both opioid consumption and time to first reported pain were comparable across the three groups—which included 34, 38, and 36 patients, respectively. There also was no significant between-group difference in quadriceps muscle strength 30 minutes post-block. "The analgesic efficacy of the block and quadriceps motor strength [are] consistent with previous reports of the adductor canal block," according to Jorge Mejia, MD, a fellow in anesthesia at Toronto's Women's College Hospital. "We also saw that pain scores increased at six, 12 and 24 hours, which is also in accordance with previous studies of lower extremity blocks." The research results were presented at the 2018 Joint World Congress on Regional Anesthesia and Pain Medicine and annual meeting of the American Society of Regional Anesthesia and Pain Medicine.

From "Adductor Canal Block Analgesia Unaffected by Injection Site"
Anesthesiology News (12/06/18) Vlessides, Michael

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Effect of Total Intravenous Anesthesia vs Volatile Induction with Maintenance Anesthesia on Emergence Agitation After Nasal Surgery

New evidence suggests that substituting total intravenous anesthesia (TIVA) for inhalation anesthesia during nasal surgery may curtail emergence agitation. The complication is not uncommon in this setting and can result in patient injury or pain, hemorrhage, or removal of the breathing tube. University researchers in Seoul, South Korea, assembled a sample population of patients undergoing rhinoplasty, septoplasty, turbinoplasty, or sinus surgery under general anesthesia. They randomized 40 participants to TIVA with remifentanil hydrochloride and propofol and 40 others to volatile induction and maintenance of anesthesia (VIMA) with sevoflurane and nitrous oxide. Based on two separate agitation-sedation scores assessed immediately following extubation, the incidence of emergence agitation was lower among the TIVA recipients.

From "Effect of Total Intravenous Anesthesia vs Volatile Induction with Maintenance Anesthesia on Emergence Agitation After Nasal Surgery"
JAMA Otolaryngology–Head & Neck Surgery (11/29/18) Jo, Jun-Young; Jung, Kyeo-Woon; Kim, Ha-Jung; et al.

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Hospital-, Anesthesiologist-, and Patient-Level Variation in Primary Anesthesia Type for Hip Fracture Surgery

Considering that low institutional takeup of neuraxial anesthesia for hip fracture surgery is associated with higher patient mortality, researchers broke down the factors that contribute to uneven patterns of use. Team members from three Ontario hospitals examined administrative data for 107,317 older patients who underwent a hip fracture operation from April 2002 to March 2014. Of that number, 57,080—or about 53 percent—received neuraxial anesthetic. Analysis revealed that roughly 60 percent of the variation in neuraxial use is due to patient factors, including lack of preoperative anticoagulant or antiplatelet agents, absence of obesity, and presence of pulmonary disease. Factors related to the anesthesia provider accounted for another 20 percent of the variation in use, with the remaining 20 percent attributed to the facility where the surgery was performed. To address that combined 40 percent variation in choice of anesthesia type, policymakers will need to look at hospital-level processes as well as the behaviors and intent of anesthesia providers, the researchers conclude.

From "Hospital-, Anesthesiologist-, and Patient-Level Variation in Primary Anesthesia Type for Hip Fracture Surgery"
Anesthesiology (Fall 2018) Vol. 129, No. 12, P. 1121 McIsaac, Daniel I.; Wijeysundera, Duminda N.; Bryson, Gregory L.; et al.

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Intranasal Ketamine for Acute Pain in Children

Intranasal delivery of medication is often preferred for pediatric patients, which two recent studies address with respect to ketamine and fentanyl. In the first trial, conducted in Australia, boys and girls presenting to the emergency room with limb injuries were randomized to either intranasal ketamine or intranasal fentanyl. The primary endpoint—median reduction in pain score 30 minutes after administration—was not meaningfully different between the 36 children in the ketamine group and the 37 in the fentanyl group. However, adverse events—including bad taste, drowsiness, dizziness, itchy nose, and hallucinations—occurred far more often in the ketamine recipients, although they were less likely than the fentanyl recipients to require rescue analgesia. A U.S.-based study, meanwhile, randomly assigned 43 young patients to intranasal ketamine for suspected extremity fractures and 44 to intranasal fentanyl. The primary outcome for this trial was incidence of adverse events and side effects within one hour of drug administration. Adverse events, evaluated periodically for six hours, affected 61 percent of fentanyl patients and all ketamine patients but were minor overall. In summary, ketamine was associated with more frequent adverse events in both trials; but neither detected a statistically significantly disparity in pain reduction with either technique. While the correlation to adverse effects will likely keep intranasal ketamine in the background, it could possibly serve as an alternative analgesic in cases of a contraindication or a drug shortage.

From "Intranasal Ketamine for Acute Pain in Children"
Practical Pain Management (12/18) Vol. 18, No. 9, P. 27 Vahlkamp, Danielle; Ferguson, McKenzie C.

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Para-Cervical Block as a Strategy to Reduce Postoperative Pain After Laparoscopic Hysterectomy

Researchers set up a study to determine if administering para-cervical block preoperatively would reduce pain after laparoscopic hysterectomy. The team from the University of Tennessee College of Medicine compared visual analogue scale scores in 41 adult patients post-surgery. The readings were significantly lower 30 and 60 minutes after having the procedure in the 21 women who received para-cervical block with 0.5 percent lidocaine after general anesthesia induction. Additionally, successful pain control—defined as an average pain score of four or less—was achieved by 71.4 percent of patients in the treatment group versus only 25 percent of the control patients. The trial results indicate that para-cervical block, administered before laparoscopic hysterectomy, produces a meaningful reduction in pain immediately after surgery.

From "Para-Cervical Block as a Strategy to Reduce Postoperative Pain After Laparoscopic Hysterectomy"
Journal of Minimally Invasive Gynecology (12/07/18) Radtke, Steven; Boren, Todd; Depasquale, Stephen

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Ultrarestrictive Opioid Prescription Protocol for Pain Management After Gynecologic and Abdominal Surgery

Researchers say they have developed an ultrarestrictive opioid prescription protocol (UROPP) that can safely and effectively manage pain after gynecologic oncology or abdominal surgery. Roswell Park Comprehensive Cancer Care in New York adopted the plan in June 2017. Under it, laparotomy patients were sent home with only a three-day supply of opioids. Patients having minimally invasive or ambulatory procedures, meanwhile, received none at all unless they required more than five doses of oral or intravenous opioids during their stay. All gynecologic oncology surgeries performed during the year after implementation were included in a case-control cohort study to evaluate the effect of the new protocol. Among an estimated 1,230 patients, the UROPP significantly reduced the number of opioids dispensed at discharge compared with a similar cohort of women who underwent the same kinds of surgeries at the center 12 months before the plan went live. The effect was also true during the entire perioperative period for opioid-naive patients. Importantly, the reduction did not come at the expense of a jump in the number of refill requests, a rise in pain scores, or an increase in the number of complications. Considering the evidence, the researchers say the UROPP appears to be a safe and viable option.

From "Ultrarestrictive Opioid Prescription Protocol for Pain Management After Gynecologic and Abdominal Surgery"
JAMA Network Open (12/07/18) Vol. 1, No. 8 Mark, Jaron; Argentieri, Deanna M.; Gutierrez, Camille A.; et al.

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News summaries © copyright 2018 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
chodson@aana.com
December 13, 2018
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