Anesthesia E-ssential

AANA Anesthesia E-ssential, December 19, 2019
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Vital Signs


Scope of Nurse Anesthesia Practice Available for Open Comments Through Jan. 12, 2020

The draft Scope of Nurse Anesthesia Practice is available for member review and open comment through Jan. 12, 2020. Visit www.aana.com/OpenComment (login required).

The updated Scope of Nurse Anesthesia Practice broadly defines the CRNA’s professional role; education, licensure, certification, and accountability; anesthesia practice; leadership; and engagement in advocacy and policymaking. Please send feedback directly to practice@aana.com.
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The Top 10 Anesthesia E-ssential Articles of 2019

In case you missed them on their first run, here are the Top 10 Anesthesia E-ssential stories from 2019 (January 10-December 12 issues). The stories are tabulated by what our members click on in each issue.
  1. AANA Ends Monetary Donations to APSF (March 21, 2019)
     
  2. Ketamine Infusion Therapy for Psychiatric Disorders Position Statement Issued by American Association of Nurse Anesthetists and American Psychiatric Nurses Association (August 29, 2019)
     
  3. CPC Program Next Step is Two-Year Check-in: Are You Due? (May 2, 2019)
     
  4. The Disruption of Anesthesia Care Delivery: Six Predictions About What is Coming Our Way (February 28, 2019)
     
  5. FDA Approves Esketamine Nasal Spray to Fight Intractable Depression (March 7, 2019)
     
  6. Now Open - CPC Program 2019 Two-Year Check-in (April 4, 2019)
     
  7. CALL TO ACTION: YOUR RESPONSE NEEDED to Change.org Petition; Executive Order: Protect and Promote Nursing's Role in Providing Care for Patients (October 10, 2019)
     
  8. Oregon Governor Signs Two Bills Removing Practice Barriers for CRNAs (May 30, 2019)
     
  9. CRNAdvocacy Alert: Tell CMS You Support its Proposal to Allow CRNAs to Perform the Pre-anesthetic Assessment in ASCs (September 5, 2019)
     
  10. Did You Complete Your CPC Two-Year Check-in Yet? Deadline for Many: July 31 (July 11, 2019)
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Holiday Wellness Tips

We wish you the best this holiday season! If this time of year is difficult due to seasonal depression, emotional crisis, recent loss, addiction, or suicidal thoughts, please seek help as needed. For information, resources, and help, see www.aana.com/depression and www.aana.com/gettinghelp
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Closing Out 2019 and Anticipating a Great 2020!

December often holds the best of what humanity can be. As we wind down the year and look inward to celebrate our hopes and our aspirations for a better world, we often see the best of what people can be. Kindness is more prominent. We give freely of our good fortune to others who need it.

The AANA staff and Board of Directors extend their best wishes to our members for a holiday season filled with life, laughter, love and peace. If you need help, get it. If you are able to help, do so. Rest, relax, replenish, renew. 2020 is going to be a banner year for CRNAs, and we want you all along for the ride!

The Anesthesia E-ssential will be on hiatus through the New Year, returning on January 9 with more good stories of importance to our members. Thank you for being an AANA member. We appreciate you. See you in 2020!
 

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AANA Insurance Services Holiday Hours

In the spirit of the season, AANA Insurance Services will be closed:
  • Tuesday, December 24 through Thursday, December 26, and
  • Tuesday, December 31 and Wednesday, January 1.
At any time, you can view your individual policy or download and print a copy of your certificate of insurance by visiting www.AANA.com/Malpractice and navigating to the My Policy Tab. On behalf of AANA Insurance Services, Happy Holidays!
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Hot Topics


Final 2019 MIPS Eligibility Status Information Now Available

CRNAs can now check their final Merit-based Incentive Payment System (MIPS) eligibility status for 2019. Your eligibility is based on review of Medicare Part B claims and Provider Enrollment, Chain and Ownership System (PECOS) data from October 1, 2018 to September 30, 2019. It is important to check the QPP Participation Status Tool, because your eligibility status could have changed during the year. If you need more information, you can access the MIPS Participation website, contact QPP@cms.hhs.gov or call 866-288-8292.
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The Joint Commission Issues FAQ Regarding Operating Room Attire

The Joint Commission’s response to a frequently asked question concerning OR attire states that it will not prescribe OR attire. Instead, The Joint Commission (TJC) will survey to facility policy, which must address the following in a hierarchical approach to infection control standards:
  1. State rules or regulations.
  2. Centers for Medicare & Medicaid Services (CMS) requirements if the facility is accredited under The Joint Commission’s deemed status program. (TJC quotes from the CMS Infection Control Worksheet as an example: “Surgical attire (e.g., scrubs) and surgical caps/hoods covering all head and facial hair are worn by all personnel and visitors in semi restricted and restricted areas.” In addition, the worksheet states, “Surgical masks are worn fully covering mouth and nose by all personnel in restricted areas where open sterile supplies or scrubbed personnel are located.”)
  3. Manufacturer Instructions for Use. (Medical equipment/device instructions may include attire instructions.)
  4. Evidence-based guidelines and consensus statements. (These can be selected based on the facility’s evaluation process.)
CRNAs may consider the AANA Infection Prevention and Control Guidelines for Anesthesia Care as they work with their facilities to develop appropriate policies.

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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 aana.com 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 charris@aanadc.com or call (202) 741-9087.

Disclaimer
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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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 Anesthesia 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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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 aana.com. The application deadline is April 30, 2020.
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Get Your CRNA Week Gear On!

Get ready to celebrate! National CRNA Week is right around the corner. You can help educate the general population about the important work that CRNAs do every day. The 2020 theme emphasizes the high level of care that CRNAs give each and every patient – CRNAs: Your Comfort. Your Care. WE ARE THERE.

Share your professional pride with 2020 National CRNA Week themed shirts, hats, travel mugs, and more. Some items (like pens, buttons, and posters) are available to AANA members for just the cost of shipping. HURRY—quantities are limited. Order today!
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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 education@aana.com.
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NewsMaker: CRNA Louise Hershkowitz Appointed to the Virginia Board of Health Professions

Louise Hershkowitz, MSHA, CRNA,has been appointed by the Governor of Virginia to serve as a member of the Virginia Board of Health Professions. This position is in addition to her current service as President of the Virginia Board of Nursing, and in it she represents the Board of Nursing, along with representatives from 13 boards (along with five Citizen members) within the Department of Health Professions.

The Board of Health Professions oversees a number of issues concerning the licensure and regulation of health professionals, including studying and making recommendations to the Department, the General Assembly and the Governor regarding whether or to what degree a particular profession should be regulated.
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NewsMaker: CRNA Dan Lovinaria Named NAP Distinguished Fellow

Dan Lovinaria, DNAP, MBA, CRNA, APRN, CHSE, has been selected a Distinguished Fellow for National Academies of Practice (FNAP). He will be inducted in March 2020 in San Diego. Other CRNAs who are distinguished fellows of the NAP include: James Walker, DNP, CRNA, FAAN, FNAP; Lynne Reede, DNP, MBA, CRNA, FNAP; Marjorie Geisz-Everson, PhD, CRNA, APRN, FNAP; and Mike Neft, DNP, MHA, CRNA, FAAN, FNAP, LTC(ret).

A Distinguished Practitioner Fellow within NAP is a very high honor that acknowledges a fellow's outstanding achievements. Fellows are recognized leaders in the profession and colleagues to other academies of the NAP, acknowledging the ability to help establish and lead the Academy in the days to come. 

Lovinaria is currently the program director for the University of Minnesota Nurse Anesthesia Program with clinical practice at the Minneapolis Veterans Affairs Healthcare System. He's been a practicing CRNA for more than 17 years. He has served as Minnesota Association of Nurse Anesthetists (MANA) President, and AANA Communications Committee Chair for four years. He's currently the AANA representative to the Nurses On Boards Coalition.

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Meetings and Workshops


Last Day: Sign-up Deadline! 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: Be the Voice of the CRNA

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

The voices of CRNAs are making a positive and significant impact on U.S. healthcare, and this year will be a pivotal moment for Nurse Anesthetists as reforms to the Medicare program are being examined. Join us on Capitol Hill so we can work together to advance the profession, and increase access to safe and effective anesthesia care for every patient.

Early Registration Savings: Save up to $100

Register Today!
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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 foundation@aana.com 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


Important Member Benefits Announcement

We are excited to announce the beginning of a relationship with Caprock Insurance Partners. It is important to the AANA that we continue to serve our members to the best of our ability. To make the best member benefits available to you, we have decided to affiliate with Caprock through the Member Advantage Program. Caprock brings to the table a suite of individual Disability Income Insurance options for CRNAs. We find it important to introduce an experienced, trusted insurance provider to help you facilitate your proper income protection planning. After completing extensive due diligence on this subject, we have concluded that Caprock Insurance Partners is a seasoned, capable resource to assist CRNAs with their Disability Income protection planning.

The Caprock Team can help you plan for your financial future by providing the following benefits:
  • Top-Tier Disability Insurance Carriers
  • Guaranteed Level Premium Structure to Age 65 & No premium increases
  • Customizable policy rider options like:
  • “True Own Occupation” policy language
  • Extended Partial Disability Benefit
  • Future Insurability Option
  • Cost of Living Adjustment
  • Catastrophic Disability Benefit
  • A service model that reflects many years of experience working exclusively with CRNAs
  • An Exclusive Discount Program for AANA Members
We are thrilled to welcome Caprock Insurance Partners to the AANA Member Advantage Program. If you would like additional information on how Caprock can help you with your insurance planning needs, please contact them through their website: caprock-insurance.com.
Learn more.

Caprock Insurance Partners
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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 AANAcpc.com.

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Jobs



CRNACareers

CRNACareers.com - 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 CRNACareers.com!

  • 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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Assistant Director/Clinical Coordinator: University of Evansville, Indiana

The University of Evansville invites applicants for a 12-month Assistant Professor and Assistant Director position in the Nurse Anesthesia Program. Responsibilities include teaching and course coordination within the program; managing the clinical education component of the curriculum, including site development, student assignment, orientation of preceptors, student supervision, and assessment; maintaining records; advising; providing service to the program, including meeting with prospective students, families, recruitment events, and representing the program to the University and community as required. Minimum requirements for the position include a DNP, PhD, or DNAP, current certification by the NBCRNA, and three years of clinical practice as a CRNA. Prior teaching and student supervision are preferred but not required. Opportunities exist to participate in clinical practice in the community and to be involved in interprofessional education activities.

The Nurse Anesthesia Program is housed on the UE campus, and classes are also offered at the Stone Family Center for Health Sciences in downtown Evansville. This state-of-the-art multi-institutional campus will provide unique opportunities for interprofessional experiences among faculty, as well as collaborative learning and research opportunities. Additional information is available about the UE Nurse Anesthesia program. Learn more.
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Cardiac CRNA: Memorial Health System, Illinois

Status: Full Time, Non-Exempt
Schedule: Days, Weekend Call

Basic Functions:
  • Administration of anesthesia for all cardiac and vascular procedures employing a variety of techniques to render persons insensible to pain during a variety of surgical, dental, obstetric, and diagnostic procedures.
  • Evaluating the effectiveness of interventions and assist in identification of alternative strategies.
  • Demonstrate knowledge of the principles of growth and development for patients of adult age through geriatrics.
  • Assess and interpret data reflective of the patient's status and provide care relative to their age-specific needs in accordance with the department's policies, procedures, and standards of care.
CRNAs are directed by an Anesthesiologist and work in a collaborative team approach to improve quality, safety, and control costs. Serve as clinical mentor for Student Registered Nurse Anesthetists. Learn more.
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Certified Registered Nurse Anesthetist: Memorial Health System, Illinois

Status: Full-Time, Hospital employed
Schedule: Convenient flexible schedule with 8-, 10- and 12-hour shift options available

Basic Functions:
Our CRNAs administer general, regional, and MAC anesthesia to patients of all ages and any ASA status. The CRNAs work in a collaborative team environment with 50 CRNAs, 21 Anesthesiologists, and 12 Anesthesia Techs who assist with room turnover and stocking. The CRNAs serve as Clinical Instructors for SIUE and Millikin/Decatur Nurse Anesthesia programs.

Due to our continued growth, Memorial Medical Center has multiple needs for Certified Registered Nurse Anesthetists. Positions are available full time in the Main OR, CVOR or as a split 50/50 between Main OR and CVOR.
  • Deliver more than 29,000 anesthetics annually across 23 Main ORs, 4 CVORs, 6 Ambulatory surgery ORs, and multiple off-site locations including OB, ECT, GI, IR, and Cath Lab.
  • Level 1 Trauma Center
  • Diverse case mix
Learn more.
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Faculty (Full-time) – Doctor of Nurse Anesthesia Practice Program: AdventHealth University, Florida

AdventHealth University (AHU) is seeking a highly motivated and qualified CRNA for the position of full-time Faculty for the Doctor of Nurse Anesthesia Practice Program. The CRNA Faculty are responsible for classroom, simulation, and clinical instruction and evaluation of students, as well as student advising and other departmental responsibilities. AHU specializes in healthcare education with a focus on whole-person care (body, mind, and spirit), with the mission of, “Developing Skilled Professionals Who Live the Healing Values of Christ.” This faith-based institution seeks qualified candidates who align with its mission.

Duties: Classroom, simulation, and clinical instruction and evaluation of students; clinical site visits, committee membership, and other assigned responsibilities as needed.

Qualifications: Doctoral degree in Nurse Anesthesia, Nursing, Education, or a related field required.  Minimum of three (3) years of recent clinical practice as a CRNA with current NBCRNA Certification and eligibility to obtain Florida APRN licensure. Prefer recent experience in nurse anesthesia education, to include simulation education and organizational skills.

Required Education:   Minimum of Doctoral degree
Learn more.
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Certified Registered Nurse Anesthetist: NYU Langone Hospitals (Bellevue), New York

Position Summary:
We have an exciting opportunity to join our team as a Certified RN Anesthetist.
In this role, the successful candidate responsible for administering anesthesia under the supervision of the Attending Anesthesiologist, administering local, inhalation, intravenous and other anesthetics prescribed during surgery, deliveries or other medical procedures. Institutes resuscitative procedures throughout the hospital, including the recovery room, and is available at all times while on duty.

Minimum Qualifications:
To qualify you must have a Current NYS RN License, CRNA Certification or GRNA certificate with letter qualifying to sit for the national boards.

Required Licenses: CRNA-Certified RN Anesthetist, Registered Nurse License-NY.

NYU School of Medicine is one of the nation’s top-ranked medical schools. For 175 years, NYU School of Medicine has trained thousands of physicians and scientists who have helped to shape the course of medical history and enrich the lives of countless people. An integral part of NYU Langone Health, the School of Medicine at its core is committed to improving the human condition through medical education, scientific research, and direct patient care. For more information, go to med.nyu.edu, and interact with us on Facebook, Twitter and Instagram. Learn more.
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CRNA: Banner University Medical Group, Arizona

BANNER UNIVERSITY MEDICAL GROUP (BUMG) is seeking a CRNA to join our team at Banner University Medical Center – Tucson. BUMC-T values patient-centered care and healthcare innovation. We were named a U.S. News and World Report Best Hospital and ranked No. 3 Hospital in Arizona.

Details and requirements include:
  • Current Board, CPR, BLS, and ACLS certifications
  • Current Arizona License
  • Critical Care training and experience
  • Responsible for performing general, regional, and monitored anesthesia services across a broad scope of the health continuum in a Directed Program
  • Some weekends may be required
Banner Health and University of Arizona Health Network have come together to form Banner – University Medicine, a health system anchored in Phoenix and Tucson that makes the highest level of care accessible to Arizona residents. At the heart of this partnership is academic medicine – research, teaching and patient care – across three academic medical centers.
Learn more.
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Anesthesiologist and CRNA: Geisinger, Pennsylvania

At Geisinger, we’re committed to doing things differently to improve lives and give our people the best to deliver excellent care. Our anesthesiologists and CRNAs have opportunities to practice in a variety of exceptional clinical settings – from Level 1 and 2 trauma centers to ambulatory surgery centers, we treat a variety of complex cases including transplants, adult and pediatric cardiac, and robotics with state-of-the-art technology. When you join Geisinger you’ll be a part of an organization that’s leading healthcare change.

We take pride in the support we provide:
  • Flexible scheduling, including minimal on call and weekend/holiday shifts
  • Excellent compensation and benefits package, including recruitment loans, relocation, malpractice and tail coverage
  • Overtime opportunities
  • Teaching and mentoring opportunities in our anesthesia residency and SRNA programs
We offer several convenient locations that are just a short drive from New York City and Philadelphia, and in areas with excellent locally and nationally recognized school systems. Develop a career with lasting impact while enjoying a balanced lifestyle. Learn more.
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CRNA: Atrium Health, North Carolina

Our mission remains the same: to improve health, elevate hope and advance healing - for all. The name Atrium Health allows us to grow beyond our current walls and geographical borders to impact as many lives as possible and deliver solutions that help communities thrive. For more information, please visit www.joinatriumhealth.org.

Job Summary: Looking for FT and PRN This position provides professional, competent anesthesia care to a wide variety of patients from neonatal through lifespan population, requiring surgical, obstetrical and other anesthesia services. The CRNA I possesses additional training, education and/or experience in the provision of anesthesia care to patients with complex and unique anesthetic requirements. Supports and contributes to the patient-centered care philosophy that every team member is a caregiver, who cares about the needs of each patient.

Essential Functions:
  • Provides anesthesia care to patients with complicated, pre-existing disease and advanced disease states.
  • Provides care to trauma victims requiring resuscitative, diagnostic and surgical restoration; adult patients that undergo cardiothoracic procedures requiring cardio-pulmonary bypass; and patients that require intensive monitoring so the surgical procedure can be completed.
  • Coordinates anesthetic patient care with anesthesia team mates.
  • Participates clinically with Student Registered Nurse Anesthetists.
  • Accepts additional departmental duties as determined by management.
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.

Preliminary Study Faults Opioid-Free Anesthesia for Bariatric Surgery

A preliminary chart review assessed the value of opioid-free anesthesia in the setting of bariatric surgery. Obstructive sleep apnea and/or other comorbidities are common in this patient population, putting them at risk for the respiratory depressive effects of opioids. For the study, researchers analyzed the records of 22 morbidly obese individuals who underwent minimally invasive vertical sleeve gastrectomy at a single facility between May and December 2018. An opioid-based approach that included sevoflurane with fentanyl was used for intraoperative pain management in 12 cases, while an opioid-free method that included propofol with ketamine or dexmedetomidine infusions was used in the other 10. All patients were subjected, meanwhile, to the hospital's enhanced recovery protocol for bariatric surgery, which calls for the use of narcotic analgesics postoperatively as a last resort only. Upon review, the investigators found that the opioid-free group required significantly more postoperative opioids; took significantly longer to reach an Aldrete score of 9, signaling readiness for discharge; and needed more antiemetic rescue medication for breakthrough postoperative nausea and vomiting in the first 24 hours after surgery. The preliminary study suggests that despite the growing popularity of opioid-free anesthesia for various procedures, it may not be the best option in the bariatric setting. However, owing to its small size, the researchers emphasize the importance of large-scale trials to validate the findings.

From "Preliminary Study Faults Opioid-Free Anesthesia for Bariatric Surgery"
Anesthesiology News (12/11/19) Vlessides, Michael

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Analgosedation During Flexible Fiberoptic Bronchoscopy: Comparing the Clinical Effectiveness and Safety of Remifentanil Versus Midazolam/Propofol

Remifentanil is an alternative to traditional sedative agents used for diagnostic bronchoscopy; however, safety and efficacy data on its performance are scarce. For a better look, researchers in Korea compared outcomes in 111 patients who had the procedure with reminfentanil and 75 who underwent it with midazolam/propofol. They found no significant differences in terms of safety events like desaturation, arrhythmia, and hypotension. Patients in the remifentanil group, however, recovered more quickly than those in the control group. The findings surfaced despite the fact that a greater share of patients in the remifentanil group underwent more invasive procedures—including biopsy or bronchoalveolar lavage—whereas the majority of patients in the traditional group received bronchoscopy for the exclusive purpose of endobronchial inspection.

From "Analgosedation During Flexible Fiberoptic Bronchoscopy: Comparing the Clinical Effectiveness and Safety of Remifentanil Versus Midazolam/Propofol"
BMC Pulmonary Medicine (12/19) Vol. 240, No. 19 Lee, Hyun; Choe, Yeong Hun; Park, Seungyong

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Exposure to Surgery Under General Anesthesia and Brain Magnetic Resonance Imaging Changes in Older Adults

A Mayo Clinic study explored the potential role of general anesthesia (GA) in the development of neurodegeneration similar to that seen in patients with Alzheimer's disease (AD). Operating under the theory that surgery with GA would correlate to more cortical thinning and increased frequency of white matter lesions, researchers used magnetic resonance imaging (MRI) to look at structural changes in the brains of participants. The study population was drawn from the Mayo Clinic Study of Aging and ultimately included 1,410 patients between the ages of 70 and 91 years who had a baseline MRI on record. Of that number, 932 had surgery under GA within 20 years prior to the first MRI performed after enrollment. Although the analysis found no association between prior GA exposure and white matter hypersensitivities, it did show a connection between surgical anesthesia and thinning in the cortical regions of the brain implicated in AD. Further study is warranted, according to the study authors.

From "Exposure to Surgery Under General Anesthesia and Brain Magnetic Resonance Imaging Changes in Older Adults"
British Journal of Anaesthesia (12/19) Vol. 123, No. 6, P. 808 Sprung, Juraj; Kruthiventi, S. Chandralekha; Warner, David O.; et al.

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Diagnosing OSA with Airway, Nonairway Parameters Identified with Ultrasound

Researchers undertook a meta-analysis of published studies reporting on the diagnosis of obstructive sleep apnea (OSA) using noninvasive ultrasound. Ultimately, they included 21 studies—seven that assessed airway parameters for OSA with ultrasound and 14 that evaluated nonairway parameters. The team then evaluated the association between ultrasound parameters and OSA diagnosis determined as a result of traditional sleep studies. The airway parameters that successfully identified moderate-to-severe OSA included distance between lingual arteries, mean resting tongue thickness, tongue base thickness during Muller maneuver, and a combination of neck girth and retropalatal diameter shortening during Muller maneuver. The nonairway parameters that correlated to OSA, meanwhile, included carotid intimal thickness and presence of plaque. "This is a new exciting area of investigation, and future studies should build on this work to determine whether a perioperative [point-of-care ultrasound] can further improve diagnostic accuracy of OSA questionnaire-based tools," said the researchers, who reported their work in Anesthesia & Analgesia.

From "Diagnosing OSA with Airway, Nonairway Parameters Identified with Ultrasound"
Pulmonology Advisor (12/13/19) Moeller, Bryant

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Thermochromic Nail Polish as a Novel Indicator to Predict Infraclavicular Brachial Plexus Block Success

Change in skin temperature is a simple and objective sign of peripheral nerve block success, and researchers in Hungary report that nail polish is an effective medium for confirming that change. They designed a prospective cohort study and enrolled 50 patients—all of whom underwent infraclavicular brachial plexus block (IBPB) for surgeries of the forearm, wrist, or hand. Thermochromic nail polish, which changes color as the wearer's skin temperature fluctuates, was applied to the nails of both hands of all patients prior to block administration. Digital photos taken immediately after the polish was applied were compared with images snapped 30 minutes after the block. The positive predictive value for color change in thermochromic nail polish predicting successful IBPB was 96 percent, according to the investigators, demonstrating the approach as a valid and reliable marker of block success.

From "Thermochromic Nail Polish as a Novel Indicator to Predict Infraclavicular Brachial Plexus Block Success"
European Journal of Anaesthesiology (12/01/2019) Vol. 36, No. 12, P. 911 Kavakli, Ali S.; Enginar, Ferhat; Arslan, Ulku; et al.

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More Than a Party Drug, Ketamine Finds New Life as IV Treatment at Miami Clinics

Despite its reputation as a club drug, the powerful anesthetic ketamine has continued to reach into new corners of clinical usage. The very latest data, for example, suggests that a single dose of ketamine, when paired with mental interventions, can curb an alcoholic's desire to drink. Meanwhile, patients are already flocking to special clinics in Miami and elsewhere, where they can receive therapeutic infusions meant to manage everything from depression, post-traumatic stress disorder, and drug dependency. Patients generally undergo screening to determine if ketamine is an appropriate alternative for them, and approved treatments are then administered in controlled amounts in a monitored setting. Experts also recommend that infusion recipients also work with a psychologist, counselor, or life coach in order to maximize the benefits of treatment.

From "More Than a Party Drug, Ketamine Finds New Life as IV Treatment at Miami Clinics"
Miami New Times (12/09/19) Tellez, Dave

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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.

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December 19, 2019