Anesthesia E-ssential

AANA Anesthesia E-ssential, February 13, 2020

Vital Signs

In Memoriam: Goldie Brangman, MEd, MBA, CRNA (1917-2020)

Goldie Brangman, 2009 Annual MeetingFormer AANA President Goldie Brangman, MEd, MBA, CRNA, passed away peacefully on February 9, 2020, at age 102. A visionary and pioneer in nurse anesthesia, Brangman achieved many notable accomplishments throughout her illustrious career, including her term as the first and only African-American president of the AANA.

She began her nursing career at Harlem Hospital in 1940, where she began working after graduating from the hospital's nursing school in 1943. When the hospital’s physician anesthesiologists were called up to serve in WWII, nurses began to train to administer anesthesia. Brangman studied with renowned anesthesiologist Helene Mayer at Harlem Hospital and passed the national certification exam. “The residents and surgeons trained us in all aspects of anesthesia,” Brangman told Minority Nurse magazine in 2013. “I really enjoyed the work. Unlike many nursing jobs, [in nurse anesthesia] you have a beginning and an end – you put the patient to sleep and you later have the satisfaction of seeing them wake up and begin the recovery process.” Learn more.
Share Facebook  LinkedIn  Twitter 

ACS Trauma Verification Program Removes Level III Restrictions on CRNA Practice

After extensive AANA advocacy, the American College of Surgeons Verification, Review, and Consultation Program recently removed the last remaining restriction on CRNA practice in the Level III trauma program. That restriction previously excluded CRNAs who are not licensed to practice independently from serving as the anesthesia liaison to the facility trauma program. (The facility trauma program performs multidisciplinary peer review.)
  • In the past, CRNAs with state supervision requirements could not serve in this role, even if an all-CRNA practice provided anesthesia for the facility. Instead, these facilities would need to retain a physician anesthesiologist solely to serve as anesthesia liaison to the trauma program.
  • With this positive change, CRNAs may serve in this role regardless of whether they work under state physician supervision requirements. Facilities are no longer required to pay/retain a physician anesthesiologist solely to serve in this role.
  • This means there are no remaining restrictions on CRNA practice in the Level III trauma program. For more information about the Level III requirements, see Resources for Optimal Care of the Injured Patient/ Resources Repository, including Verification Change Log 2020 and Clarification Document 2020.
Share Facebook  LinkedIn  Twitter 

Class I Recall of GE Healthcare Anesthesia Systems

GE Healthcare has recalled nearly 3,600 Carestation anesthesia systems in the U.S. due to a problem that could halt patient ventilation, according to the FDA. FDA labeled the recall as Class I, the most serious type of medical device recall. Learn more.
Share Facebook  LinkedIn  Twitter 

CDC Releases Guidance on Coronavirus for Healthcare Providers

The Centers for Disease Control and Prevention (CDC) have created a 2019 Novel Coronavirus (2019-nCoV or COVID-19) information page for healthcare professionals. The webpage includes:
  • Interim Guidance for Healthcare Providers.
  • Infection Control.
  • What Healthcare Professionals Should Know about Caring for Patients with Confirmed or Possible COVID-19 Infection.
  • Preparedness Checklists.
  • A Flowchart to Identify and Assess 2019 Novel Coronavirus, and more.
This is an emerging, rapidly evolving situation and CDC will provide updated information on its website as it becomes available.
Share Facebook  LinkedIn  Twitter 

AANA Celebrates National Salute to Veteran Patients Week, Feb. 9–15, 2020

The American Association of Nurse Anesthetists honors our nation’s veterans during National Salute to Veteran Patients Week, Feb. 9-15. The week pays tribute to the more than 9 million veterans who are proudly cared for in Department of Veterans Affairs (VA) medical centers and other VA facilities. The healthcare professionals who work in the VA system—including nurse anesthetists—also are recognized this week for their important work in caring for veterans. Learn more.
Share Facebook  LinkedIn  Twitter 

Considering Your Own Anesthesia Practice?

Learn the business side of anesthesia from two highly successful group practice owners, Juan Quintana and Larry Hornsby. They’re providing an online 8-week seminar with university-level curriculum covering billing and reimbursement, negotiations, contracts and proposals, and differences in practice models.
AANA Membership Exclusive - Earn 16 CE Credits - Next Session starts April 8, 2020. Get more details here! Spring 2020 Session
Share Facebook  LinkedIn  Twitter 

The Complex Issue of Burnout

A staggering 92% of clinicians call burnout a “public health crisis.” Learn what over 450 clinicians shared by downloading Spok’s Clinician Burnout in Healthcare: A Report for Healthcare Leaders for free! #AANAWellness
Share Facebook  LinkedIn  Twitter 

Hot Topics

ADCE Attendees: Candidate Info Available - Choose Your Delegate to the Education Committee

One delegate to the Education Committee will be elected at the Assembly of Didactic and Clinical Educators in Braselton, Ga. Only CRNA members registered for the meeting are eligible to vote. You will receive a ballot when you pick up your badge. Check out the delegate candidates on the AANA website (login required).
Share Facebook  LinkedIn  Twitter 

Submit MIPS Data for the 2019 Performance Year

CRNAs who were eligible to participate in the merit-based incentive payment system (MIPS) can submit their data for the 2019 performance year until the submission window closes on March 31, 2020 at 8:00 p.m. EDT. To enter your data, sign in to the Quality Payment Program (QPP) website with your access credentials. If you need to create an account to submit MIPS data, the QPP User Guide will show you how to register a Healthcare Quality Information System (HCQIS) Access Role (HARP) account, which is required to login to the QPP website.
Share Facebook  LinkedIn  Twitter 

Last Opportunity! Nomination Deadline for AANA Award for State Government Relations Advocacy is Feb. 15

State Associations: Submit your entry for the Excellence in State Government Relations Advocacy Award, to be presented at the AANA Mid-Year Assembly in April 2020. This annual award is not tied to a specific “victory” in the state legislative or regulatory arena, but is given based on the quality of the state association effort.

Examples of state association efforts include successful lobby days, legislative/regulatory efforts, or increased member participation in grassroots or other efforts. For more information and to submit your state’s application by Feb. 15, 2020, visit the AANA website.
Share Facebook  LinkedIn  Twitter 

Conduct Crucial Conversations: State Leadership Workshop – Newport Beach, California

When: March 7-8, 2020
Location: Hyatt Regency Newport Beach

Join us in Newport Beach, Calif., for a day-and-a-half workshop that will inspire leaders to:
  • Conduct an effective crucial conversation and how to influence change for positive outcomes.
  • Describe the applied skills in emotional intelligence and how this relates to your role as a state leader.
  • Develop strategies for improving association board governance.
Share Facebook  LinkedIn  Twitter 

A New Mobile Journal App Coming Soon – February 2020

Stay current with the latest CRNA research and industry news using the new AANA Journal mobile app! You’ll get the same great AANA Journal content, quickly and conveniently across your mobile devices.

Expanded functionality:
  • Listen to Articles - All articles will include narrated audio.
  • Watch Videos - Video resources can be viewed in the app.
  • Easily navigate - View external resources and pages online directly from the app.
AANA members will be able to download the app for free from Google Play, Apple App Store, or the Amazon App Store.
Share Facebook  LinkedIn  Twitter 

Call for Abstracts: Be a Speaker at 2020 Leadership Summit

Be recognized as a thought leader and share your experience with hundreds of highly engaged CRNAs in various levels of leadership. AANA members are invited to submit an abstract for the new mini-session series, “Leadership in Action.”

Examples of fitting topics:
  • State Association Initiatives Related to Governance, Leadership and Advocacy
  • Innovative Approach to Coalition Building for State Associations
  • Taking Your Grassroots to the Next Level
  • Departmental QI Initiatives
  • Chief CRNA Challenges and Successes
  • Leadership Related DNP Projects
If selected, speakers will receive free registration (travel and hotel accommodations not included) to the 2020 AANA Leadership Summit at the Fort Lauderdale Marriott Harbor Beach Resort & Spa on November 13-15, 2020.

The deadline to submit your abstract(s) for consideration is Friday, Feb. 28. Visit our information page to learn more about submission guidelines, the selection process, and topic suggestions.
Share Facebook  LinkedIn  Twitter 

Celebrate Diversity with the AANA: #IAmMe

Now in its third year, the award-winning I Am Me Campaign celebrates diversity and inclusion within the nurse anesthesia profession. Every April—aka Celebrate Diversity Month—Certified Registered Nurse Anesthetists (CRNAs) and anesthesia students are encouraged to share their "I Am Me" statement with colleagues. Submissions for 2020 will open March 1.

There are more than 54,000 nurse anesthetists in the U.S., and while the same high quality, safe, anesthesia care is administered to patients every day, as individuals we bring a wealth of unique experiences. The AANA recognizes the differences in race, gender, ethnicity, language, cultural and religious beliefs, and socio-economic status that our CRNA and SRNA members bring to the nurse anesthesia profession.

Follow the AANA on Instagram and Facebook for more information about the campaign. We hope to see your submission this year! #IAmMe
Share Facebook  LinkedIn  Twitter 

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.
Share Facebook  LinkedIn  Twitter 

NewsMaker: CRNA Nelson Aquino Running for Board of Health

Nelson J. Aquino, MS, CRNA, is running for a seat on the Winchester, Mass., Board of Health. In a recent issue of Daily Times Chronicle, Aquino says his main goal is to "address public health needs in Winchester and advance resources in the areas of mental health, substance abuse and making healthy decisions."

Aquino has training in "disaster relief efforts, medical missions and crisis management situations. His alma mater, Seton Hall University, bestowed him with their first Humanitarian Award, after spending time in Haiti after the 2010 earthquake." Learn more.
Share Facebook  LinkedIn  Twitter 

NewsMaker: CRNA Charnelle Lewis Profiled on

Charnelle Lewis, DNP, CRNA, was interviewed on about her journey from registered nurse to CRNA. She details how she originally was on track to become a pharmacist and then made the leap to nursing and then to nurse anesthesia. She "had an intense love for pharmacology and hard sciences. I wanted to advance my education and build upon my critical care background. I wanted to be in a position where I could dedicate myself to care for and administer anesthesia for one patient at a time. Therefore, nurse anesthesiology was the best of both worlds," Lewis said. Learn more.
Share Facebook  LinkedIn  Twitter 

NewsMaker: Retired CRNA Liudas Cesnaitis Publishes Political Fiction Novel

According to the Digital Journal, "Liudas Cesnaitis, a retired Certified Registered Nurse Anesthetist, has completed his new book, 'Crisis Coming': a great tale that depicts a nation on the brink of falling apart as political issues arise, people not acting as one, and a crisis beginning to prosper."

In the article, Cesnaitis says the novel presents what could happen. "All of the hatred and resistance for one person, the president and the fact that no matter what was done, the opposing party was not able to attain power again. The scenario presented is one that could possibly occur. Citizens or militia are an integral part of this nation. Many would or will fight to keep this country free from foreign or domestic enemies." Learn more.
Share Facebook  LinkedIn  Twitter 

AANA Meetings: Refresh Your Knowledge and Make New Connections

Come Meet Your Future

Earn Class A CE credits, build your support network, and meet AANA leaders. To view all upcoming live events, visit
Share Facebook  LinkedIn  Twitter 

Ultrasound-Guided Peripheral Nerve Block Workshop

When: March 28-29, 2020
Location: AANA National Headquarters, Park Ridge, Ill.

Earn 12 Class A CE credits and refresh your knowledge of ultrasound-guided peripheral nerve block techniques. This weekend workshop features expert lectures, hands-on instruction, and group discussions of representative clinical cases. Register now for advance registration rates.
Get Details or Register
Share Facebook  LinkedIn  Twitter 

Mid-Year Assembly 2020: Advocate for Your Profession on Capitol Hill

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

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

Register Today!
Share Facebook  LinkedIn  Twitter 

Register Now for the Spinal-Epidural with Obstetric Essentials Workshop

When: April 30-May 2, 2020
AANA National Headquarters, Park Ridge, Ill.

Earn 23.50 Class A CE credits with 4.25 Pharmacology/Therapeutics credits with expert lectures and hands-on instruction. Topics include: normal and abnormal physiology of pregnancy, pharmacology, analgesia/anesthesia techniques, clinical applications of spinal and epidural anesthesia procedures, and introduction to the application of ultrasound using live models.

Get details or Register.
Share Facebook  LinkedIn  Twitter 

AANA Member Benefits

Members, Take Advantage of Free Class A and Pharmacology Credits!

Earn up to 11 Class A CE and two pharmacology credits with exclusive AANA Learn courses, including topics like enhanced recovery, respiratory compromise, and multimodal pain management. Free to AANA members and associate (student) members—just login and add the course(s) to your cart. Get started today!
Share Facebook  LinkedIn  Twitter 

Are You a Member of the "800 Club"?

800 Club Laurel RoadNo, it’s not about your travel rewards—it’s about your credit score. Like those who always chased straight A’s in school to make honor roll, these young, above-800 credit score holders believe it’s the undisputed marker of financial adulthood.

Of course, there are also certain perks for those who fastidiously manage their credit scores. And for those who believe the “800 Club” is a distinct rite of passage to lower rates and better deals: they may be right. Top-tier borrowers stand to reap some benefits unavailable to others— from student loan refinancing, to other lending services such as mortgages and personal loans. A higher credit score can yield long-term savings via lower interest rates on borrowing. Learn more.
Share Facebook  LinkedIn  Twitter 


CRNACareers - What are your next steps?

Whether you’re graduating soon and researching employers, are a seasoned professional interested in advancing your career or looking to supplement your work with locum tenens options, is the place to help get you started:

  • 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!

Share Facebook  LinkedIn  Twitter 

Certified Registered Nurse Anesthetist: Memorial Medical Center, 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 to 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.
  • Newest technology available with standardized equipment throughout the health system.
  • Robust EHR (Cerner).
  • Hospital employed; competitive salary and benefits package.
  • Reimbursement for continuing education with educational leave time.
  • Financial assistance of up to $30,000 available while pursuing anesthesia education.
  • Sign-on bonus of up to $30,000.
  • Relocation assistance available.
Learn more.
Share Facebook  LinkedIn  Twitter 

Cardiac CRNA: Memorial Medical Center, Illinois

Status: Full Time, Non-Exempt.

Schedule: Days, Weekend Call.

Our Cardiac Certified Registered Nurse Anesthetists administer 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.

They 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.

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.
  • Level 1 Trauma Center.
  • Diverse case mix.
  • Newest technology available with standardized equipment throughout the health system.
  • Robust EHR (Cerner).
  • Hospital employed; competitive salary and benefits package.
  • Reimbursement for continuing education with educational leave time.
  • Financial assistance of up to $30,000 available while pursuing anesthesia education.
  • Sign-on bonus of up to $30,000.
  • Relocation assistance available.
Learn more.
Share Facebook  LinkedIn  Twitter 

Certified Registered Nurse Anesthetist: Beaumont Health, Michigan

Currently hiring for our Trenton and Wayne locations only!

We have full time and contingent positions open at our Trenton location and full-time and part-time positions at our Wayne location.


To provide and manage safe, efficient, anesthesia care to the various age populations under the medical direction of the anesthesiologist. Demonstrates the delivery of excellent customer service by exhibiting the hospital’s ten customer service behaviors in every aspect of the job. Learn more.
Share Facebook  LinkedIn  Twitter 

CRNA: Mary Washington Healthcare, Virginia



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

CRNA II: Novant Health, North Carolina

Novant Health in Winston Salem, NC is seeking a CRNA to grow and develop within a professional setting. Team members utilize skills obtained through additional training, education and/or experience in the provision of anesthesia care to patients who present with complex and unique anesthetic requirements. Come join a remarkable team where quality care meets quality service, in every dimension, every time.

Let Novant Health be the destination for your professional growth.

This position includes floating to additional facilities within the Winston-Salem market and includes a variety of shift openings. Sign-on bonus included for experienced and new grads CRNAs in the acute care facilities.

Locations (Facilities in the greater Winston-Salem area):
  • Novant Health Forsyth Medical Center
  • Novant Health Kernersville Medical Center
  • Novant Health Clemmons Medical Center
  • Novant Health Hawthorne Outpatient Surgery Center
  • Novant Health Kernersville Outpatient Surgery Center
  • Novant Health Clemmons Outpatient Surgery Center
  • Novant Health Medical Park Hospital
  • Novant Health Maya Angelou Women’s Health & Wellness Center
  • Competitive compensation.
  • Medical, dental and vision coverage.
  • Sign-on bonus available for new grad and experienced CRNAs.
  • Relocation reimbursement.
  • Excellent work environment with an anesthesia care team (ACT) model.
  • 403b and matching program.
  • Excellent paid time off (PTO).
  • Flexible full-time and part-time schedules; weekender programs.
  • Wellness clinics for team members and covered dependents.
  • On-site child care programs.
  • Affordable medication available through on-site pharmacies and mail-order program.
  • Recognized as one of the 50 best places for women and managers of diverse backgrounds to work by Diversity MBA.
It is the responsibility of every Novant Health team member to deliver the most remarkable patient experience in every dimension, every time.
  • Our team members are part of an environment that fosters teamwork, team member engagement, and community involvement.
  • The successful team member has a commitment to leveraging diversity and inclusion in support of quality care.
  • All Novant Health team members are responsible for fostering a safe patient environment driven by the principles of "First Do No Harm."
  • Education: Bachelor's degree required. BSN required. Graduate from both an accredited school of nursing and school of nurse anesthesia. Listed on the National Board of Certification and Recertification for Nurse Anesthetists as a Certified Registered Nurse Anesthetist and recognized by the state of practice as an Advanced Practitioner. Must meet continuing education per NBCRNA requirements to maintain CRNA certification.
  • Experience: Previous experience is not necessary. Four-to-six week orientation period (working with preceptor) is required. Orientation period will depend on previous experience and clinical skills.
  • Licensure/Certification/Registration: Current RN licensure in appropriate state required. BLS, ACLS, and PALS required. CRNA by NBCRNA required.
  • Additional skills required: Must have extensive knowledge of current anesthetic agents, techniques, drugs and equipment. Has knowledge and skills necessary to modify the anesthetic care suitable to patient age. Must have considerable ability to make independent decisions, sometimes under stress, and to maintain a professional demeanor with patients, coworkers and physicians.
Learn more.
Share Facebook  LinkedIn  Twitter 

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.

Virtual Reality Promising for Turning Down Labor Pains

The benefits of virtual reality (VR) in medical practice continue to emerge, with researchers now reporting on the technology's pain management effects on laboring women. The team from Cedars-Sinai Medical Center in Los Angeles randomly assigned 20 mothers-to-be to engage in up to 30 minutes of VR during labor, with a like number of expectant mothers serving as controls. Patients who saw and heard relaxing images and messages through the VR headset realized a reduction in pain by 0.52 from the onset of labor, while pain levels increased by 0.58 among those who were not exposed to the intervention. In addition, women in the VR group experienced lower heart rates compared with women in the control group. "We have concluded that VR was effective in reducing pain in laboring women," said investigator Melissa Wong, MD. "In addition, our secondary finding of a reduction in heart rate is biologically consistent with a reduction in pain." She acknowledged the study's limitations, however, including the brief duration of the intervention and the decision to use "no intervention" as the control.

From "Virtual Reality Promising for Turning Down Labor Pains"
MedPage Today (02/10/20) D'Ambrosio, Amanda

Share Facebook  LinkedIn  Twitter 

Comparative Evaluation of Epidural Bupivacaine Alone and Bupivacaine Combined with Magnesium Sulfate in Providing Postoperative Analgesia

A meta-analysis done in China asked whether adding magnesium sulfate to epidural bupivacaine provides superior postoperative pain relief compared to epidural bupivacaine alone. The researchers included 11 studies in the review, which ultimately identified a number of advantages with the combined analgesic approach. Supplementing epidural bupivacaine with magnesium sulfate was associated with fewer patients requiring rescue analgesics, more time passing before first demand for rescue analgesia, and a lower requirement for rescue analgesics. Although the results appeared to favor epidural bupivacaine plus magnesium sulfate over bupivacaine only, the investigators rated the evidence as very low in quality. The effects of magnesium sulfate on postoperative analgesia must be validated through large, high-quality trials, they conclude.

From "Comparative Evaluation of Epidural Bupivacaine Alone and Bupivacaine Combined with Magnesium Sulfate in Providing Postoperative Analgesia"
BMC Anesthesiology (02/05/20) Vol. 20, No. 39 Li, Li-Qin; Fang, Mei-Dan; Wang, Cong; et al.

Share Facebook  LinkedIn  Twitter 

Intrathecal Catheterization After Observed Accidental Dural Puncture in Laboring Women

Researchers revisited their earlier work on dural puncture in laboring women, with a different outcome the second time around. Their 2013 conventional meta-analysis found that intrathecal catheter insertion after an observed accidental dural puncture may reduce the incidence of post-dural puncture headache (PDPH) and curtail the need for epidural blood patch in parturients requesting epidural analgesia. The new investigation, however, included a trial-sequential analysis (TSA), which tests for the presence of firm evidence in meta-analyses. The 13 studies included in the TSA, all with low risk of bias, compared intrathecal catheter insertion to epidural catheter re-site or no intervention at all. The TSA revealed that monitoring and futility boundaries were not crossed, indicating insufficient data to exclude potential errors in the statistical analysis. Therefore, the investigators determined, the TSA does not uphold the previous finding that intrathecal catheterization lowers the incidence of PDPH. Although the practice increasingly is used in real life, the team—with representation from Switzerland, Germany, and the Netherlands—points to the need for evidence-based recommendations for clinical practice.

From "Intrathecal Catheterization After Observed Accidental Dural Puncture in Laboring Women"
International Journal of Obstetric Anesthesia (Winter 2020) Vol. 41, P. 71 Heesen, M.; Hilber, N.; Rijs, K.; et al.

Share Facebook  LinkedIn  Twitter 

Effect of Sevoflurane Versus Isoflurane on Emergence Time and Postanesthesia Care Unit Length of Stay

While Cleveland Clinic research has shown that patients receiving isoflurane and sevoflurane experience similar lengths of stay in the hospital, a recent study focused on the outcomes of emergence time and duration of time in the postanesthesia care unit (PACU). The team re-analyzed data from nearly 1,500 adult participants in the earlier trial, who had been randomized to either volatile anesthetic in two-week blocks that alternated over the course of six months. Emergence time took a median 16 minutes with isoflurane compared to 14 minutes with sevoflurane—a difference that was not considered clinically significant—and time to phase 1 recovery in the PACU was comparable between the groups. Given that isoflurane performs on par with sevoflurane, but is more soluble and less expensive, the investigators believe it is a viable alternative to sevoflurane.

From "Effect of Sevoflurane Versus Isoflurane on Emergence Time and Postanesthesia Care Unit Length of Stay"
Anesthesia & Analgesia (02/20) Vol. 130, No. 2, P. 360 Maheshwari, Kamal; Ahuja, Sanchit; Mascha, Edward J.; et al.

Share Facebook  LinkedIn  Twitter 

Systemic Lidocaine Lowers Opioid Use in Non-OR Settings

Administration of systemic lidocaine may provide adequate post-surgical pain relief to outpatients without relying so heavily on opioids, researchers report. Pain, plus postoperative nausea and vomiting (PONV), are the leading reasons that ambulatory patients suffer unplanned admissions or experience prolonged stays in the postoperative care unit (PACU), according to Danielle Lovett-Carter, MD, of Rhode Island Hospital and Brown University. She and her co-investigators undertook a meta-analysis that included five randomized controlled trials with a collective 329 adult participants who underwent ambulatory procedures. All of the studies compared the use of systemic lidocaine with a control group. While the work did not turn up any evidence that systemic lidocaine improves PONV, it did indicate that the approach lowered postoperative opioid demand in the PACU by 4.23 mg I.V. morphine equivalents compared to controls. "We also found that there was no significant difference in pain scores between groups at any time point," Danielle Lovett-Carter, MD, reported at the 2019 annual meeting of the Society of Critical Care Anesthesiologists. "So even though these ambulatory patients used less opioids, their pain scores were not increased." In light of the meta-analysis results, and given lidocaine's status as a safe and cost-effective drug, Lovett-Carter sees little reason not to use it. "I think one of the reasons that clinicians might not use systemic lidocaine in ambulatory patients is that it's simply not common practice, so we don't think about it," she said. "There may be concerns about using lidocaine in patients with specific cardiac conduction defects, but it is safe for the vast majority."

From "Systemic Lidocaine Lowers Opioid Use in Non-OR Settings"
Pain Medicine News (02/05/20) Vlessides, Michael

Share Facebook  LinkedIn  Twitter 

Intraoperative Hyperglycemia Associated with Post-op Delirium

Outcomes from a German study shed light on the role of intraoperative hyperglycemia in postoperative delirium and postoperative cognitive function. Gunnar Lachmann and study co-authors at Charité – Universitätsmedizin Berlin launched a subproject of the prospective BioCog study. Working with 87 older adults scheduled for elective surgery, they measured intraoperative blood glucose levels every 20 minutes via arterial blood gas analyses. The team also conducted twice-daily screenings for postoperative delirium until postoperative day seven and evaluated participants for postoperative cognitive decline at three-month followup. Researchers determined that postoperative delirium affected about 47 percent of the patients; however, the rate of postoperative cognitive dysfunction was only about 15 percent. Further investigation revealed a significant association between intraoperative hyperglycemia and postoperative delirium, with an odds ratio of 3.86, although the same correlation could not be drawn between hyperglycemia and postoperative cognitive impairment. The results also suggested that time spent in hyperglycemia may matter, with postdelirium patients having longer exposure than nondelirium patients. Based on the findings, Lachmann recommends that anesthesia providers avoid intraoperative hyperglycemia if at all possible.

From "Intraoperative Hyperglycemia Associated with Post-op Delirium"
Anesthesiology News (02/05/20) Vlessides, Michael

Share Facebook  LinkedIn  Twitter 

News summaries © copyright 2020 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:

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

Attn: Cathy Hodson
E–ssential Editor
February 13, 2020