AANA Anesthesia E-ssential
Anesthesia E-ssential

December 15, 2014


Vital Signs

CRNA Week: Here Before You Know It!
Don't Forget to Order Your Promotional Materials
National CRNA Week, slated for Jan. 25-31, 2015, is right around the corner.
Are you making plans to join the thousands of CRNAs across the country who will be taking part in CRNA Week to educate our key audiences about the role and value of CRNAs in today’s—and tomorrow’s—healthcare environment? Don't forget to order your CRNA Week promotional items at www.aana.com/crnaweek. You’ll find posters, pens, buttons, magnets, T-shirts, mugs and other popular items. Ordering deadline: Jan. 20, 2015.
The theme of this year’s annual event is “CRNAs: The Future of Anesthesia Care Today,” which mirrors the theme of AANA’s national public education campaign launched in September 2014. In addition, you can find other resources to help you promote your profession in the PR Tools area on the AANA website. Member login and password required.
And don’t forget to inform your facility administrators, healthcare colleagues, key contacts at your state house and in Washington, patients, and others with a keen interest in nurse anesthesia about the information-packed new website www.future-of-anesthesia-care-today.com.


The Pulse

  • Happy Holidays—And See You Next Year!
  • Simon Sinek to by Keynote Speaker at Nurse Anesthesia Annual Congress
  • The Joint Commission Seeks Feedback on Proposed Standards for Integrated Care Certification
  • AANA Hits Social Media Milestone
  • Have a Safe and Well Holiday Season!
  • APSF Announces the Procedure for Submitting Grant Applications
  • Make Your Year-End Donation to the AANA Foundation Today
  • Register Today for Fun in the French Quarter at ASF
  • AANA Foundation Award Applications Due February 1, 2015
  • Open Sessions at COA Meetings
  • Call for Comments - Additional Standards for Entry into Practice Research Doctoral Degrees
  • 2022 Is Closer Than You Think
    Transition to the Doctoral Degree – Workshop
  • CRNA Educator Director Nominations Sought
  • Early Registration for the Assembly of School Faculty Now Open
  • Save the Date for the Mid-Year Assembly
  • Mark Your Calendars Now for the AANA 2015 Nurse Anesthesia Annual Congress

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.

Inside the Association
Happy Holidays—And See You Next Year!
Due to the holidays, Anesthesia E-ssential will not come out on Dec. 30, 2014, and will resume publication with the Jan. 15, 2015, issue. The E-ssential staff wishes all of our readers a joyous holiday season, and we look forward to serving you in 2015.
Simon Sinek to be Keynote Speaker at Nurse Anesthesia Annual Congress
Simon Sinek, renowned leadership expert, will be the keynote speaker at the AANA 2015 Nurse Anesthesia Annual Congress, Aug. 29 to Sept. 1, in Salt Lake City, Utah. 
Described as “a visionary thinker with a rare intellect,” Sinek teaches leaders and organizations how to inspire people. With a goal to help build a world in which the vast majority of people go home every day feeling fulfilled by their work, Sinek is leading a movement to inspire people to do the things that inspire them.
He is the author of two books, “Start With Why: How Great Leaders Inspire Everyone to Take Action” and “Leaders Eat Last: Why Some Teams Pull Together and Others Don’t.” Sinek is perhaps best known for popularizing the concept of Why and for the talk he gave on the subject that became the second-most-watched talk of all time on TED.com. He has met and consulted with an array of leaders and organizations, including 3M, Disney, KPMG, Pfizer, NBC/Universal, jetBlue, the U.S. military, multiple government agencies, and entrepreneurs.
We hope to see you in Salt Lake City. For more information on the Annual Congress, click here.
The Joint Commission Seeks Feedback on Proposed Standards for Integrated Care Certification
The Joint Commission is seeking feedback on standards for an Integrated Care voluntary certification option for Hospitals, Critical Access Hospitals, and Ambulatory Health Care accredited organizations. This certification program is being developed to provide a pathway for hospitals and ambulatory care settings to demonstrate that they can come together to deliver clinically coordinated care, treatment and services. Comments will be gathered through January 16, 2015. Read the proposed requirements and submit comments here
AANA Hit Social Media Milestone
The AANA Facebook page reached an impressive milestone in late November: 10,000 likes! If you haven't already "liked" us, click that link to get the latest news about your profession and professional association on your timeline.

Have a Safe and Well Holiday Season!
AANA Health & Wellness wishes you and your families the best during this time of year. Some basic tips to keeping healthy – eat well, get enough sleep, avoid germs, drink wisely in moderation, make time to be physically active, reach out to help the needy in your community, and savor your family, friends, and holiday traditions. See our collection of Wellness Milestones articles (www.AANA.com/WellnessMilestones) on Seasons and Holidays and maintaining your well-being.
The holidays, and the winter season in general, can unfortunately challenge emotional wellness and may not be a joyous time for everyone. This time of year 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. Remember, there is always help available — reach out to a loved one and your doctor, or your workplace might have an employee assistance program with available resources. If you need help with chemical dependency ohttp://www.aana.com/GettingHelpr addiction, contact AANA Peer Assistance (see www.AANA.com/GettingHelp for additional information).
APSF Announces the Procedure for Submitting Grant Applications
The deadline to submit a Letter of Intent (LOI) for an Anesthesia Patient Safety Foundation (APSF) Grant Award to begin Jan. 1, 2016, is March 2, 2015 (5 p.m. EST). The grant application website will be open on Jan. 21, 2015. The maximum award is $150,000 for a study conducted over a maximum of two years to begin Jan. 1, 2016. Based on the APSF’s Scientific Evaluation Committee’s evaluation of these LOIs, a limited number of applicants will be invited to submit a full proposal. Investigators will be notified of the status of their LOI electronically on Thursday, May 15, 2015. See the website at http://www.apsf.org/grants.php for further information.

Make Your Year-End Donation to the AANA Foundation Today
Your donation to the AANA Foundation supports important research that advances the nurse anesthesia profession. Evidence provides proof, and proof is power!
Take a moment today to make your year-end, tax-deductible gift to AANA Foundation’sProof is Power campaign—click here to access the Foundation’s secure donation page. To maximize your opportunity for 2014 tax benefits, please submit your gift before 11:59 p.m. Wednesday, Dec. 31, 2014.
Thank you for your support!
Register Today for Fun in the French Quarter at ASF
If you’re planning to attend the AANA Assembly of School Faculty (ASF) in February, you won’t want to miss the AANA Foundation’s Fun in the French Quarter event at Acme Oyster House.Click here to visit the AANA ASF registration page to learn more and purchase tickets for this event. We hope to see you there!
AANA Foundation Award Applications Due February 1, 2015
Nominate Someone Special Today
The AANA Foundation presents annual awards to individuals who have made a difference in the nurse anesthetist community. The following awards will be presented at the 2015 Nurse Anesthesia Annual Congress in Salt Lake City, Utah.
  • John F. Garde Researcher of the Year
  • Rita L. LeBlanc Philanthropist of the Year
  • Advocate of the Year
  • Janice Drake CRNA Humanitarian
Please take the time to nominate and recognize someone special for the work they do on behalf of nurse anesthesia. It is truly an honor to be considered for one of these prestigious awards. The deadline for nominations is Feb. 1, 2015. Click here for more information and to access the nomination forms.
Thank you in advance for helping the Foundation honor a member of the nurse anesthesia community.

Open Sessions at COA Meetings
January meeting dates: January 21-23, 2015
The business portion of Council on Accreditation of Nurse Anesthesia Educational Programs (COA) meeting is open to the public. The meetings are open to program representatives and others who are interested in observing the proceedings, however, the meeting will be closed to observers while the COA deliberates on accreditation decisions.
The meetings are held at the AANA Headquarters, 222 S. Prospect Avenue, Park Ridge, IL 60068. Please notify the COA of your proposed attendance. Call the COA office (847/ 655-1161) for further information, specific times, and directions if needed.
Call for Comments - Additional Standards for Entry into Practice Research Doctoral Degrees
At its October 2014 meeting, the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) approved the draft Additional Standards for Entry into Practice Research Doctoral Degrees to be distributed for comment by the community of interest. The Additional Standards for Entry into Practice Research Doctoral Degrees will be included in the back of the Practice Doctorate Standards (PDS) manual. Programs developing research doctoral degree programs for entry into nurse anesthesia practice will need to meet these Standards in addition to the Practice Doctorate Standards.
The COA is seeking your feedback. Please review the draft Standards and provide comments to help inform the COA’s implementation of its Additional Standards for Entry into Practice Research Doctoral Degrees. The survey will remain open until Jan. 2, 2015. Contact Jennifer Varhalla at 847-939-3536 or by email at jvarhalla@coa.us.com with any questions about the survey.
2022 Is Closer Than You Think
Transition to the Doctoral Degree – Workshop
A joint COA/AANA Education Committee workshop is scheduled on Feb. 24-25, 2015. This workshop is designed to assist nurse anesthesia programs in their successful transition to award entry-level doctoral degrees. Topics include planning, resources, curriculum design, development, and tips for success. Programs starting students on Jan. 1, 2022, and thereafter must graduate with doctoral degrees. Program administrators, faculty and deans are encouraged to attend. CE credits available. Register on the Assembly of School Faculty webpage.
CRNA Educator Director Nominations Sought
The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is seeking nominations for a CRNA Educator Director. Candidates must be available to attend three-day COA meetings, typically held in January, May and October. The term of office is for three years, beginning fall 2015 through fall 2018. The individual then would be eligible to be considered for reelection for an additional term. For more information on the position criteria and application process, please visit the COA website at http://home.coa.us.com.

Early Registration for the Assembly of School Faculty Now Open
Early registration for the Assembly of School Faculty (Feb. 26-28) in New Orleans is now open!Sign up now to receive $50 off of your registration fee!
Save the Date for the Mid-Year Assembly
April 18-22, 2015
The Mid-Year Assembly, to be held this spring in Arlington, Va., is for all CRNAs and student registered nurse anesthetists interested in issues, trends and influences related to practice and professional advocacy. Registration opens soon: Click here to learn more.
Mark Your Calendars Now for the AANA 2015 Nurse Anesthesia Annual Congress
This is the AANA’s largest professional, social and educational event of the year, where more than 3,000 CRNAs and student registered nurse anesthetists will come for the education and stay for the experience. There's so much to do in Salt Lake City,find out more!

Certified Registered Nurse Anesthetists – NewYork -Presbyterian
Lower Manhattan, NY
Be a part of creating a new team of CRNA’s at New York-Presbyterian. Explore this career-making opportunity to become a valued member of the first NYP/Lower Manhattan Hospital CRNA team. Apply today. Read more about this position.
Visit the CRNA Career Center

Laughing Gas Could Treat Depression
Much like ketamine, Washington University researchers believe nitrous oxide—also an anesthetic—could effectively treat depression. In a small pilot study, published in Biological Psychiatry, the team compared patients who received a placebo against patients who received a combination of oxygen and nitrous oxide, also known as laughing gas. Two-thirds of the patients who received the gas, which is commonly used in dentist offices, reported marked improvement in their depressive symptoms; but only one-third of the patients in the placebo group benefited in similar fashion. "The nitrous oxide improved it above and beyond the placebo," confirmed Washington University assistant professor of anesthesiology Dr. Peter Nagele. "This was fairly rapid, so at two hours. But our primary endpoint when we measured everybody—we asked the patients to come back the next day—was sustained to a day." Because the researchers followed up with the 20 patients just twice in the 24 hours following nitrous oxide administration, he acknowledged that more study is warranted. While laughing gas is a much milder anesthetic than ketamine, Nagele said both affect receptors in the brain that control memory and cognitive function. Nitrous oxide, while less potent than ketamine, could prove to be the better application, however, because of its inhaled delivery method compared to ketamine's intravenous administration.
From "Laughing Gas Could Treat Depression"
CBS News (12/09/14) Firger, Jessica
Patients Prescribed Narcotic Painkillers Use More of Them for Longer, Study Finds
According to an Express Scripts report, nearly 60 percent of 6.8 million Americans filling at least one prescription for an opioid between 2009 and 2013 also were prescribed muscle relaxants or anti-anxiety drugs, which could lead to dangerous reactions. Moreover, the report found that nearly 50 percent of the people taking opioids for more than 30 days in the study's first year were still using them three years later, which could signal abuse. "Not only are more people using these medications chronically, they are using them at higher doses than we would necessarily expect," said Glen Stettin, MD, a senior vice president at Express Scripts. The Centers for Disease Control and Prevention found that opioid painkillers have played a role in about 70 percent of prescription drug overdoses leading to accidental deaths, with opioid overdoses leading to 16,000 deaths in 2012. Two-thirds were being prescribed the drugs by two or more doctors and nearly 40 percent filled their prescriptions at more than one pharmacy. Stettin says, "It begs for the use of active monitoring and also for better coordination of care."
From "Patients Prescribed Narcotic Painkillers Use More of Them for Longer, Study Finds"
New York Times (12/09/14) P. B3 Thomas, Katie; Meier, Barry
Study Suggests Nasal Applicator Provides Effective Nerve Block in Seconds
New research suggests the Tx360 nasal applicator can quickly, safely, and effectively produce sphenopalatine ganglion (SPG) nerve block for head and facial pain without the use of a needle. The pilot study recruited four female patients suffering from chronic migraines, neuralgia, and other conditions. Investigators in Chicago treated them, using the Tx360 to deliver ropivicaine and dexamethasone to the nasal cavity. All of the patients indicated that their symptoms were significantly alleviated 15 minutes after the initial nerve block, and three of the four reported sustained pain relief in the first 28 days following the procedure. After that period, patients were permitted to receive more SPG blocks, as needed, for up to one year; and the researchers concluded that doing so offered even greater levels of improvement and pain relief. Study author Raheleh Rahimi Darabad, MD, said the single-use Tx360, which can achieve SPG block in as little as 10 seconds, is minimally invasive and user-friendly. "This device overcomes the inaccuracy and patient discomfort that's associated with the long-standing corrective application of the local anesthetic for SPG block," she said, noting that larger, controlled, double-blinded trials are needed.
From "Study Suggests Nasal Applicator Provides Effective Nerve Block in Seconds"
Pain Medicine News (12/09/2014) Leung, Martin
Surgical Site Anesthetic Infusion May Enhance Analgesia After Mastectomy
A number of studies have examined the role of local anesthetic infusion in breast cancer surgery, but only recently have researchers applied this focus specifically to patients undergoing modified radical mastectomy. The double-blind trial involved 80 women, some of whom were randomly assigned to receive levobupivicaine through a catheter placed in the surgical wound. These patients experienced substantially less postoperative pain than members of the control group—who had received only a saline solution through their catheters—and they also required fewer analgesics. Additionally, the findings revealed high levels of patient satisfaction among the levobupivicaine group. However, the results also indicated that the anesthetic infusion did not provide any further relief from nausea and vomiting, which remained the same.
From "Surgical Site Anesthetic Infusion May Enhance Analgesia After Mastectomy"
2 Minute Medicine (12/05/14) Hong, Chris; Carrier, Charles
Pediatric Critical Events Checklist Is an Easy to Use App for Emergency Situations
The Society for Pediatric Anesthesia Quality and Safety Committee has created checklists for key management steps in 18 "critical event" situations and put them in the form of an Apple iOS app. The app, also called "Pediatric Critical Events Checklist" or "Pedi Crisis," allows users to choose from 18 situations, such as anaphylaxis or venous air embolism. Users input the patient's weight in kilograms and will receive either background information, such as ECG signs of myocardial ischemia, or be taken directly to the clinical pathway. As soon as the pathway is selected, the app begins a clock that may prompt the user to check pulses every 2 minutes, and prevents the phone from going into sleep or lock mode. The app also calculates the correct weight-based dose for medications. At the end of the pathway, the app reviews next steps and provides for the user to email or save the logs.
From "Pediatric Critical Events Checklist Is an Easy to Use App for Emergency Situations"
iMedicalApps.com (12/04/2014) Sprecher, Eli
Coordinated Care Beneficial to Kids With Complex Respiratory, Gastrointestinal Disorders
When children with complex respiratory and gastrointestinal disorders receive coordinated care by specialists, it can help reduce clinic visits and anesthesia-related procedures, researchers report in JAMA Otolaryngology-Head & Neck Surgery. Children with these aerodigestive disorders may experience a variety of diagnoses that may include sleep apnea, asthma, feeding disorders, and gastroesophageal reflux. Several pediatric tertiary care hospitals have established interdisciplinary clinics to coordinate care for these children. In a small, single-center study, researchers looked at the first 125 children seen by a pediatric aerodigestive center between June 2010 and August 2013. During the initial visit, each patient received an average of 2.9 of four possible consulting services. Physicians recommended evaluation under anesthesia for 68 percent of patients, which led to 267 operations that required a total of 158 episodes of general anesthesia. Combining procedures led to 109 fewer episodes of general anesthesia, reducing the risks of anesthesia as well as the related costs of $1,985 per avoided episode. Coordination of care also may have provided faster diagnoses and treatment and better communication between clinicians, the authors write.
From "Coordinated Care Beneficial to Kids With Complex Respiratory, Gastrointestinal Disorders"
Science Codex (12/04/14)
Music Is an Established Form of Therapy
Music therapy is an evidenced-based form of therapy that can address the physical, emotional, cognitive, and social needs of patients and families in an interactive, entertaining way. At the Golisano Children's Hospital of Southwest Florida, physicians and nurses may bring in a music therapist to help decrease postoperative pain, calm children who wake up with a mechanical ventilator, distract kids from the pain and stress of needle insertion, and reduce the length of hospitalization. Both patients and parents have reported decreased stress and perception of pain with music therapy intervention. Musical toys can help a frightened child by masking hospital sounds during a medical procedure. Golisano Children's Hospital has a Prescribed Pediatric Extended Care center that provides music-therapy sessions to children with special needs. These sessions can help increase language acquisition, positive social skills, and cognitive skills.
From "Music Is an Established Form of Therapy"
News-Press (FL) (12/02/14) Avirett, Julie E.
Low-Pressure Epidural Gravity Saline Technique May Reduce Cesarean Complications
Findings from Rutgers-Robert Wood Johnson University Hospital suggest that method matters when it comes to epidural saline delivery for laboring women who receive a combined spinal epidural (CSE). Specifically, using a low-pressure gravity technique for this purpose reduces the probability of complications during cesarean section compared to using an epidural catheter alone. In a randomized study of 229 women, 115 patients received CSE only; and 114 were given epidural saline by gravity both after the spinal solution was injected and before a closed-end catheter was inserted epidurally. The results indicated fewer cases of blood vessel punctures and paresthesias in the gravity cohort. In addition, these patients required less analgesia after their procedures than the CSE-only patients. "We think the saline helps by lubricating the structures in the epidural space," speculates researcher Antonio Chiricolo, MD. The failure rate for achieving spinal block, however, was 14.8 percent for the gravity patients and 20.2 percent for control group.
From "Low-Pressure Epidural Gravity Saline Technique May Reduce Cesarean Complications"
Anesthesiology News (12/01/14) Vol. 40, No. 12 Firth, Shannon
Widespread Chronic Pain Seen in Study of U.S. Military
A survey of nearly 2,600 troops deployed to hot zones in Iraq or Afghanistan in 2011 uncovered, not surprisingly, a high rate of combat injuries and chronic pain among this subset of soldiers. The level of opioid usage among them, however, was alarmingly steep, with about 15 percent saying they had followed an opioid-based pain management regimen. And while U.S. military guidelines discourage use of the narcotics for a prolonged period of time, nearly a quarter of that 15 percent reported taking them the month before participating in the survey, suggesting long-term consumption. In response to the Walter Reed Army Institute research, which appeared in JAMA Internal Medicine, pain specialist Lynn Webster, MD, cautioned against generalizing the results to the civilian population. "But, I think [the study] does suggest that opioids may be used in the military as a first-line therapy," added Webster, immediate past president of the American Academy of Pain Medicine. "Alternatively, the soldiers could be using opioids to medicate other comorbid conditions. If true, it would be disturbing and could explain why the military is experiencing a crisis with prescription drug abuse." Lead researcher Robin Toblin, PhD, said she hoped the military would be more tuned in to the pain assessment, management, and treatment needs of its enlistees and increase the scope of services available to them for this purpose.
From "Widespread Chronic Pain Seen in Study of U.S. Military"
Anesthesiology News (12/01/14) Vol. 40, No. 12 Dunleavy, Brian
FDA Experts OK Steroid Shots for Back Pain
A Food and Drug Administration (FDA) advisory board has agreed with pain management specialists that steroid injections are a viable treatment option for patients suffering from chronic back pain. In the wake of a 2012 outbreak of contaminated steroids that killed 60 people and made 700 ill, FDA tasked the panel with weighing the benefits of the shots against the risks. The experts concluded that the risks exceeded the benefits for neck injections, but not for back injections, and decided not to recommend a strong federal warning against the treatment. The FDA is not obliged to follow the advisory board's decision, but millions of Americans with chronic back pain will be able to continue receiving the shots if it does.
From "FDA Experts OK Steroid Shots for Back Pain"
Outpatient Surgery (12/01/14) Gapinski, Kendal
Longer Surgery Linked to Higher Blood Clot Risk
A large, multi-site study confirms anecdotal evidence of a correlation between longer surgeries and elevated risk of blood clots. Based on review of data for 1.4 million patients having surgery between 2005 and 2011 at more than 300 different U.S. hospitals, the researchers calculated that 0.96 percent of patients developed venous thromboembolisms (VTE), 0.71 percent had deep vein thrombosis, and 0.33 percent suffered pulmonary embolism within 30 days of their procedures. Patients undergoing the longest operations were more likely to develop VTE than those whose surgeries took an average length of time. Surgical time was a risk factor for three of the most commonplace operations: gallbladder removal, appendectomy, and gastric bypass. Writing in JAMA Surgery, the researchers conclude that understanding the risks presented by lengthy surgeries could help providers make better preoperative and postoperative decisions and also encourage approaches that could shorten the process.
From "Longer Surgery Linked to Higher Blood Clot Risk"
Medscape (12/05/14) Putre, Laura
Acetaminophen, Asthma Link 'Overstated'
There is not enough evidence to establish a connection between the exposure to acetaminophen and the development of asthma in young children, researchers write in the Archives of Diseases of Childhood. Their systematic review and meta-analysis found variable associations between asthma and acetaminophen exposure in early pregnancy. The study authors reviewed 11 studies on the association between acetaminophen exposure during pregnancy and the development of childhood asthma at age five years or older. Some studies found that the use of acetaminophen during the first trimester was associated with increased risk for childhood asthma, but only one study adjusted for maternal respiratory-tract infections. Three studies showed that a higher frequency of acetaminophen use during infancy was linked to greater odds of childhood asthma, but adjustment for respiratory-tract infections reduced the association. So far, the researchers write, the evidence that early-life exposure to acetaminophen contributes to asthma is often overstated.
From "Acetaminophen, Asthma Link 'Overstated'"
Medscape (11/26/14) Barclay, Laurie
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