Anesthesia E-ssential

AANA Anesthesia E-ssential
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AANA Election Slate Announced

The AANA Nominating Committee, after reviewing the nominations for elected positions for the upcoming election at its February meeting, has announced the slate of candidates for the 2017 election of the AANA Board of Directors, Nominating and Resolutions Committee members. See the AANA website for the complete slate of candidates and further information about the upcoming elections. (Member login and password required.) The order of names was determined randomly on the ballot by the Nominating Committee. Those elected will begin their fiscal year 2018 terms of office at the conclusion of the AANA 2017 Nurse Anesthesia Annual Congress in Seattle, Wash.
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AANA – NBCRNA Working Together: NBCRNA Reviewing Future Alternatives to CPC Program Exam

The following is a joint message from AANA President Cheryl Nimmo, DNP, MSHSA, CRNA, and NBCRNA President Steve Wooden, DNP, CRNA, NSPM-C.

The AANA and NBCRNA Boards of Directors and staff continue to work together and provide input on joint and other projects. AANA has provided valuable feedback about the Continued Professional Certification (CPC) Program—specifically regarding the exam component—and NBCRNA is listening. We want to further strengthen the credential and are working together to build more choice and convenience into a certification process that is based on standards that everyone can trust.

NBCRNA, with input from the AANA Board of Directors, continues to evaluate the CPC Program and is open to, and currently looking into, alternative methods to the CPC Exam that meet the same goals and rigor of a traditional summative assessment. NBCRNA is currently evaluating the effectiveness and ability to operationalize several future alternatives including:
  1. The MOCA-Minute concept
  2. Self-assessment followed by additional CE
  3. Simulation
With the MOCA-Minute, NBCRNA is closely monitoring this American Board of Anesthesiology (ABA) pilot project, and are following their efforts to address the unanswered questions with regard to validity, reliability, long term costs, and establishing a passing standard.

Regarding the self-assessment concept, NBCRNA is aware of programs that are using self-assessment in conjunction with focused continuing education. The CPC Program has a built-in self-assessment in the Class A component, and as the AANA collects and reports data on the self-assessment of Class A, evaluation can be made regarding the relationship between self-selected continuing education and incorporation of knowledge into practice. How this will translate into future alternatives for the Continued Professional Certification (CPC) Exam is yet to be determined.

Simulation is also being considered as a future alternative method of summative evaluation. Cost, access, and reliability are all factors that will need to be considered. Simulation is included in the NBCRNA Reentry program which will provide an opportunity to evaluate its usefulness in the CPC Program as well.

As other options come to the attention of NBCRNA and AANA through internal investigation or external recommendations, their value to the overall program will be considered as future alternatives to any of the components, including the CPC Exam. The CPC Program is designed to be modified based on evidence. NBCRNA is not set on any one method or vehicle to meet the program goals.

In addition, NBCRNA is in the process of developing a formal research project that will compare multiple assessment formats including an open resource format, a closed book format, and other options suggested by the literature and CRNAs throughout the country. The research will additionally include a review of remote and live proctoring. The results of this study will inform not only the NBCRNA, but the entire community of healthcare educators, of the best assessment methods—whatever those may prove to be—to achieve the goals of the CPC Program.

The CPC Program will evolve greatly over time as new and improved technologies and new research become available. AANA and NBCRNA will also continue to work together to further strengthen the credential and pave the way for a solid future for the profession.
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Advanced Pain Management Fellowship Program

The need for pain management is growing. How can you keep up with demand? TCU School of Nurse Anesthesia, in partnership with American Association of Nurse Anesthetists (AANA), provides CRNAs with a convenient and innovative approach to advance their career in pain management. We can help you stay on top of this increasing demand while earning the credentials you need to become an expert in the field.
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AANA Student Mentoring Program at Mid-Year Assembly

Program Administrators - do you have a standout student registered nurse anesthetist in your program who would be interested in participating in the Student Mentoring Program, sponsored by the AANA Communications Committee, during the Mid-Year Assembly (MYA) in Washington, DC? If so, be sure to recommend your student for this popular annual event! This year’s mentoring program will take place on Saturday, April 8, with a wine and cheese reception for all participants the evening prior. Please nominate a student before the March 3 deadline! Due to the popularity of the program we are increasing the number of students to 50 this year. Spots are filling fast so don’t delay.

Students – do you want to be an involved member of the AANA and learn from a leader in the association? If so, please let your program administrator know that you are interested in being recommended for the Student Mentoring Program during the MYA.

The purpose of the program is to provide a positive, welcoming, motivational and educational experience for students who’ve exhibited the potential, or expressed a desire, to become involved members of the AANA.

If you have any questions please contact Karen L. Sutkus, Administrative Associate, at or 847-655-1140.
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PQRSwizard Extends Data Submission Deadlines

CRNAs using PQRSwizard for their 2016 PQRS reporting please note: PQRSwizard has extended their data submission deadlines from February 28 to March 10, 5 pm EST. There are a variety of February webcasts to walk you through the PQRSwizard upload and validation process. Please visit the PQRSwizard Video Library for more information. If you have specific questions about data reporting or measures found in PQRSwizard call 1-877-509-7774.
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February 2017 AANA Journal Overview

CRNAs: Stay current in the profession with the February 2017 issue of the AANA Journal. Here is a brief overview of the articles, including our new online content.

Social Media in Nurse Anesthesia: A Model of a Reproducible Educational Podcast
The authors explore the current use, and potential for exploitation, of social media in the education of nurse anesthetists, calling for research to illuminate what has become a widespread cultural phenomenon.

Postoperative Cognitive Dysfunction After Noncardiac and Nonneurologic Surgery: An Integrative Review
In a review of the literature on postoperative cognitive dysfunction (POCD), the author found major methodological flaws in much of the literature, making definitive conclusions suspect. She suggests a role for bispectral-index monitoring and biomarkers as tools in better elucidating real from perceived modifiers.

Simple Cost-Effective Alternative to Fluid and Blood Warming System to Prevent Intraoperative Hypothermia
The authors describe a simple, low-cost approach to warming fluids before administration using existing equipment. Although their approach is feasible at face value, the authors urge research to determine clinical efficacy.

Instruments to Measure Preoperative Acute Situational Anxiety: An Integrative Review
In this critique of instrumentation available to clinicians and researchers who aim to quantify anxiety levels in patients, the authors raise concerns about validity and reliability of currently available tools.

Anesthetic Management and Intraoperative Implications for Surgical Resection of a Recurring Primary Cardiac Rhabdomyosarcoma: A Case Report
The authors report a rare case of initially successful anesthetic and surgical management of a cardiac tumor and explore the challenges in caring for such a patient.

Implementation of an Obstructive Sleep Apnea Screening Program at an Overseas Military Hospital
Education, training and use of a preoperative screening program were successful in markedly increasing the identification of patients with obstructive sleep apnea at a US Naval facility in Japan, the authors report.

Usefulness of Cerebral Oximetry in Preventing Postoperative Cognitive Dysfunction in Patients Undergoing Coronary Artery Bypass Grafting
The authors explore the role that noninvasive cerebral tissue oxygen tools have in assessing the risk of POCD in cardiac surgical patients. The authors suggest that early recognition of declining cerebral oximetry values might provide a preventive opportunity but recognize the shortcomings of current research in the domain.

Point-of-Contact Assessment of Nurse Anesthetists’ Knowledge and Perceptions of Management of Anesthesia-Related Critical Incidents
The impact of critical incidents on CRNAs can be profound and long-term, according to the authors. Policies and protocols for managing the effects on providers are sorely needed, and the authors call for better understanding and intervention.

AANA Journal Course: Update for Nurse Anesthetists—Part 6—The Other Side of the Difficult Airway: A Disciplined, Evidence-Based Approach to Emergence and Extubation
The author notes the attention and detail given to airway management at the start of a case in patients with a challenging airway, and cites concerns—and offers evidence-based guidelines—regarding the equally complex time when extubation occurs.


Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery
The authors provide us with strategies to help prevent surgical site infections in a highly vulnerable patient population. The authorship is cross-disciplinary, and strong clinical evidence is provided in support of their recommendations. This article is also published in the January 2017 issue (Vol. 129, No. 1) of Obstetrics & Gynecology, the January 2017 issue (Vol. 124, No. 1) of Anesthesia & Analgesia, and the January/February 2017 issue (Vol. 46, No. 1) of Journal of Obstetric, Gynecologic, & Neonatal Nursing.
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New Sponsored Courses on AANA Learn: Complimentary CE for AANA Members

Be sure to take advantage of two new complimentary AANA Learn CE courses available to AANA members through an educational grant by Medtronic.
  1. Respiratory Compromise, Moving Patients from Surgery to the PACU
  2. Perioperative Delirium: The Latest Science in Anesthesia Management
Visit AANA Learn to access these and other member exclusive courses.
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Member Exclusive! Online Courses Addressing the Opioid Crisis on AANA Learn®

Do you understand your roles and responsibilities in regards to the opioid crisis? Four new courses will arm you with the knowledge you need to help navigate CDC guidelines and be ready to educate others. Each course has been prior approved for 1 Class A CE credit.
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Meetings and Workshops

Mid-Year Assembly Early Bird Registration Deadline

Join your CRNA colleagues in the heart of D.C. during the National Cherry Blossom season for the most productive and exciting meeting of the year. Learn to advance CRNA policy interests on Capitol Hill and develop the skills needed to effectively advocate for your profession. Register before March 5 for early bird rates. It is strongly recommended that you make travel and hotel arrangements early. Discounted hotel rates include April 5-12 dates.
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Foundation and Research

Call for Foundation Board Members: Application Deadline - April 1

The Foundation is currently looking for candidates interested in playing an active role in supporting these important aspects of the CRNA profession by participating on the AANA Foundation Board of Trustees. The ideal candidate enjoys fundraising and possesses expertise in research.
Criteria for Board Members:
  • Current CRNA and AANA member in good standing
  • Must be a supporter of the AANA Foundation of time, talent and treasure
  • Must be willing to advocate for the AANA Foundation
  • Must have a Foundation giving history
  • Must have a history of volunteerism
  • Term is for two years (September – August)
If you are interested in applying, access the application and nominee profile form at Board Nomination Application.

If you have any questions, please contact the Foundation at (847) 655-1170 or
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Student Rep Position on Foundation Board of Trustees Available for 2018-2019

Attention Students: The AANA Foundation would like to encourage energetic and highly motivated students to apply for the student representative position on the AANA Foundation Board of Trustees. The student representative serves a two year term as a full board member with equal voting privileges and represents an integral role as the voice for students across the country. The student representative is a valued and essential board member for accomplishing the AANA Foundation’s mission. The student application for the AANA Foundation Board of Trustees is now available. The application deadline is April 1, 2017.

Questions? Call (847) 655-1170 or
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Foundation Student Scholarships Applications Available Online: Deadline March 1

The AANA Foundation is pleased to continue its long history of funding nurse anesthesia education. Applications for nurse anesthesia student scholarships are available online and the application deadline is March 1, 2017. Scholarship awards range from $1,000 to $3,000 each. In order to apply for a scholarship, you must be enrolled in a program for at least six months prior to March 1, 2017.

Please contact the AANA Foundation at (847) 655-1170 or with any questions.
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Foundation Post-Doctoral and Doctoral Fellowship Applications Available: Extended Deadline – May 1

Post-Doctoral and Doctoral Fellowship applications are currently available on the AANA Foundation website. Visit AANA Foundation. The deadline for submission has been extended to May 1. If you have any questions, please contact the AANA Foundation at (847) 655-1170 or
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Foundation “State of the Science” Oral and General Poster Presentation Applications Available

“State of the Science” offers an opportunity for CRNAs and SRNAs to present their research findings and innovative educational approaches at the AANA Nurse Anesthesia Annual Congress in Seattle, WA, September 8-12, 2017. Research, literature reviews, and innovative, creative techniques in anesthesia are appropriate topics.
  • Oral Poster Presentation – April 1 Deadline – An award of up to $1,000 accompanies oral presentation
  • General Poster Presentation – May 1 Deadline
If you have any questions, please contact the AANA Foundation at (847) 655-1170 or
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to view or place job postings
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Featured Career Opportunity

CRNA Opportunity – Anesthesia Associates of Southern Illinois
Southern Illinois

Anesthesia Associates of Southern Illinois is expanding to new locations and we are seeking additional CRNAs for our growing group. Our locations are eligible for Federal Student Loan Repayment!

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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.

Ropivacaine: Less Pain, Hemorrhage Risk During Vitrectomy

New research shows that ropivacaine is a safer and more effective peribulbar anesthetic during retinal surgery than bupivacaine, lidocaine, or a cocktail of the two. The Chinese study, published online in the British Journal of Ophthalmology, included 140 patients undergoing pars plana vitrectomy to treat conditions like macular degeneration, retinal detachment, and diabetic retinopathy. Participants were equally randomized into one of the four treatment arms, with no meaningful difference observed between them in terms of achieving grade 5 anesthesia. None of the patients who received ropivacaine, however, complained of intraoperative pain while 11.4 percent of the bupivacaine patients and 14.3 percent of the lidocaine and combination patients did. The ropivacaine cohort also reported significantly less postoperative pain than the other three groups, and these participants were less affected by postoperative subconjunctival hemorrhage. "This study suggests that 1% ropivacaine alone is a suitable choice when administering peribulbar anesthesia for patients undergoing pars plana vitrectomy because it produces an adequate quality of intraoperative anesthesia and better postoperative anesthesia and also improves patient comfort" compared with bupivacaine or with lidocaine alone or paired with bupivacaine, the investigators summarize.

From "Ropivacaine: Less Pain, Hemorrhage Risk During Vitrectomy"
Medscape (02/09/17) Haelle, Tara

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Johns Hopkins to Roll Out Surgical Recovery Protocol to 750 Hospitals

The Johns Hopkins Armstrong Institute for Patient Safety and Quality will train anesthesia providers, doctors, and nurses at 750 U.S. hospitals on ERAS (enhanced recovery after surgery). The approach has been shown to reduce surgical complications and expedite recovery while saving costs. Under the protocol, preoperative fasting is limited; opioid-sparing pain management techniques are applied; and the patient and family are kept in the loop about their role in driving successful outcomes. Johns Hopkins will pair the ERAS protocol with its own Comprehensive Unit-Based Safety Program for implementation at participating institutions. The method shortened length of hospital stay by 1.5 days, cut surgical-site infections in half, and saved $1,500 in hospital costs after implementation at Johns Hopkins, which limited the protocol to patients undergoing colon surgery. While the nationwide rollout will target this same patient population, ERAS eventually also will be used in bariatric, orthopedic, gynecological, and emergency general surgeries.  

From "Johns Hopkins to Roll Out Surgical Recovery Protocol to 750 Hospitals"
Health Leaders Media (02/09/2017)

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Study Shows Ketamine May Prevent PTSD Symptoms

A dose of ketamine a week before a stressful event can help fend off symptoms of post-traumatic stress disorder (PTSD), according to Columbia University Medical Center researchers. They intravenously administered the powerful anesthetic to one group of mice while giving a placebo to controls, and then delivered a series of small shocks to the animals either one hour or one week later. After eventually returning the mice to the test environment, which the rodents associated with the shocks, investigators were able to observe their fear response and freezing behavior. The mice that received ketamine a full week before the shock treatment exhibited less freezing when returned to the test environment. And while administering ketamine after a stressful event did not impact the fear response, providing a dose one hour after a second shock reduced it. The findings, published in Neuropsychopharmacology, suggest that timing of ketamine delivery is key to suppressing fear. The researchers believe that using the drug this way could be helpful in specific circumstances rather than as a broad application. "If our results in mice translate to humans, giving a single dose of ketamine in a vaccine-like fashion could have great benefit for people who are highly likely to experience significant stressors, such as members of the military or aid workers going into conflict zones," explained assistant professor of clinical neurobiology and lead study author Christine Denny, PhD.

From "Study Shows Ketamine May Prevent PTSD Symptoms"
United Press International (02/08/17) Wallace, Amy

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1 in 10 Women Filled Opioid Scrip After Vaginal Delivery

University of Pittsburgh researchers report that many women fill opioid prescriptions after delivering their babies, even if they did not have a cesarean section or present a "pain-inducing" condition. Looking a state-level Medicaid data, they identified 164,720 mothers who had live vaginal births from 2008 to 2013. Of that number, only about 28 percent had tubal ligation, severe lacerations, episiotomy, or other conditions that would indicate narcotic painkillers; yet 12 percent still filled opioid orders within five days of returning home. Moreover, 14 percent of those women filled a second opioid prescription six to 60 days later. Writing in Obstetrics and Gynecology, the investigators pointed out that "little is known about opioid prescribing after obstetric delivery." The publication's editor-in-chief, Nancy Chescheir, MD, noted the importance of the study in a separate online interview, suggesting that perhaps it is time for OB-GYN experts and anesthesiology groups to put their heads together on U.S. recommendations.

From "1 in 10 Women Filled Opioid Scrip After Vaginal Delivery"
MedPage Today (02/08/17) Walker, Molly

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Anesthesia and Developing Brains—Implications of the FDA Warning

The Food and Drug Administration's (FDA) December 2016 warning on the use of general anesthesia and sedation agents in early life or near the end of pregnancy prompted fresh debate on an already contentious subject. With no human data to support adverse fetal outcomes following exposure to anesthetics and the most recent evidence on children indicating lack of harm from single exposures, the FDA safety communication was somewhat of a bombshell for the medical community. Dean B. Andropoulos, MD, of Texas Children's Hospital and Michael F. Greene, MD, of Massachusetts General Hospital are concerned that patients, parents, and providers will postpone some operations and diagnostic procedures in light of the safety alert. The problem, they explain, is that most procedures indicated for expecting mothers and young children are medically necessary and could produce unfavorable outcomes if put off. While they worry that FDA's communication could spook the public away from necessary care, anesthesia provider Andropoulos and obstetrician Greene do support the agency's call for "additional high quality research to investigate the effects of repeated and prolonged anesthesia exposures in children," including studies specifically focused on fetal exposure to general anesthetics and sedatives.

From "Anesthesia and Developing Brains—Implications of the FDA Warning"
New England Journal of Medicine (02/08/17) Andropoulos, Dean B.; Greene, Michael F.

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Liposomal Bupivacaine Infiltration Likely Reduces Opioid Use After TKA

New research suggests that a local infiltration of liposomal bupivacaine curbs opioid requirements after knee replacement surgery. The retrospective study involved 199 total knee arthroplasties performed at the Veterans Affairs Medical Center, with roughly half of the patients having received a periarticular injection of liposomal bupivacaine. Median opioid consumption, patient-controlled analgesia, and use of anti-emetics all were lower during the first 24 hours postoperatively in patients who were given the injection versus those who were not. However, while more of the liposomal bupivacaine recipients saw greater improvements in pain levels or were pain-free in the post-anesthesia care unit, they had higher median pain scores at 48, 72, and 96 hours after surgery.

From "Liposomal Bupivacaine Infiltration Likely Reduces Opioid Use After TKA"
Healio (02/07/2017) Jaramillo, Monica

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The Benefits of Prefilled Syringes

In anesthesia practice, ditching the vial-and-syringe technique of preparing medication doses in favor of prefilled syringes promises to save money and boost patient safety. At Mt. Sinai in New York City, for example, buying prefilled syringes of neostigmine and ephedrine—two of the anesthetics that are among both the most expensive and the most likely to not be completely used—has almost certainly reduced waste at the facility, even if some of those savings have been eroded by the higher cost of prefilled syringes. At Boston's Brigham and Women's Hospital, meanwhile, prefilled syringes have "reduced our in-house compounding workload and also reduced our purchases from outsourced compounders, which can be expensive," confirms director of pharmacy, business, and finance John Fanikos, RPh. "We've been trying to make life easier for our OR nurses and physicians by providing them with prefilled syringes for odansetron, metoclopramide, dexamethasone, midazolam, and diphenhydramine, rather than have these drugs prepared from vials." The syringes are also used in inpatient units, he notes. Ethan Bryson, associate anesthesiology professor at Icahn School of Medicine at Mt. Sinai, agrees that prefilled syringes are a time-saver, citing a simulation study published online last June in the Journal of Patient Safety. Preparation time using vials took twice as long as with prefilled syringes, according to the research, which also found that medication error rates as high as 75 percent fell to the single digits when nurses used prefilled syringes versus vial-and-syringe methods. "Having the medication predrawn in a prelabeled syringe goes a long way to reducing the chance that someone will make a mistake," Bryson remarked.

From "The Benefits of Prefilled Syringes"
Pharmacy Practice News (02/07/17) Wild, David

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Mixing Opioids and Alcohol May Increase Likelihood of Dangerous Respiratory Complication

Researchers are warning that simultaneous intake of alcohol and prescription opioids elevates the risk of respiratory depression, a potentially lethal complication. Dutch investigators observed breathing patterns in 12 healthy young people and 12 elderly volunteers who each received a 20 mg oral dose of oxycodone along with an intravenous infusion of ethanol. Respiratory measurements were recorded before and after administering the drugs. Baseline minute ventilation, or the amount of air breathed per minute, fell 47 percent after drug consumption—28 percent with the oxycodone tablet and another 19 percent with 1 g/L of ethanol added, the equivalent of about three alcoholic beverages for women or five for men. The opioid/alcohol mix also had a significant impact on how often participants—especially the seniors, aged 66 to 77 years old—temporarily stopped breathing. The episodes occurred 0 to 3 times with no ethanol and 0 to 11 times with 1 g/L of ethanol. "We hope to increase awareness regarding the dangers of prescription opioids, the increased danger of the simultaneous use of opioids and alcohol, and that elderly people are at an even greater increased risk of this potentially life-threatening side effect," said study author Prof. Albert Dahan, head of the Anesthesia and Pain Research Unit at Leiden University Medical Center. The findings are reported in the Online First edition of Anesthesiology.

From "Mixing Opioids and Alcohol May Increase Likelihood of Dangerous Respiratory Complication"
Medical Xpress (02/07/17)

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Efficacy Data for IV Ibuprofen Use in Children Published

Newly published data support the use of intravenous ibuprofen in febrile children who are prevented from taking an oral dose because of surgery or other reasons. In a sample population of 103 hospitalized minors at least six months old who presented with fever of 101 degrees or higher, 10 mg/kg of I.V. ibuprofen significantly lowered temperature. The randomized, open-label study was reported in BMC Pediatrics.

From "Efficacy Data for IV Ibuprofen Use in Children Published"
Monthly Prescribing Reference (02/17) Han, Da Hee

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Protocol Lacking for Post-Op Delirium

Postoperative delirium is a common complication, especially among seniors, yet research indicates that more than 75 percent of anesthesia practices have no system for identifying at-risk patients. Nearly 90 percent of providers with no screening process would be receptive to adopting one, however. The findings are based on poll responses provided by an estimated 3,000 professionals who registered to attend the 16th World Congress of Anaesthesiologists in Hong Kong last year. According to other survey results, 84 percent of respondents admitted their hospital or clinic lacked protocols to prevent postop delirium; and 73 percent said their facility had no management plan to handle delirium when it does present. The study was commissioned by POND (postoperative neurobehavioral disturbance) Awareness.

From "Protocol Lacking for Post-Op Delirium"
Anesthesiology News (02/06/17) Agres, Ted

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Study: Surgeons Prescribed More Opioids Than Required to Patients for Upper Extremity Surgery

According to new data, patients are being given more opioids than they need following surgeries of the hand and wrist. A prospective study tracked patient characteristics, surgical details, anesthesia type, and painkiller prescription and consumption activity in more than 1,400 patients undergoing procedures on an upper extremity. In general, a mean 24 pills were prescribed afterwards—or three times the 8.1 pills patients actually used. Specifically, opioid use was tied to procedure type, anatomic location, type of anesthesia administered, patient age, and type of health coverage. "To avoid overprescribing opioids and to limit potential abuse, surgeons should consider the patient's preoperative opioid experience and should establish prescribing standards on a case-by-case basis depending on the nature and location of the surgical procedure, the type of anesthesia and the age of the patient," the authors write in the Journal of Bone & Joint Surgery.

From "Study: Surgeons Prescribed More Opioids Than Required to Patients for Upper Extremity Surgery"
Healio (02/06/2017) Jaramillo, Monica

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Scientists Find Evidence That Aspirin and Ibuprofen Don't Actually Help Spinal Pain

Taking nonsteroidal anti-inflammatory drugs (NSAIDs) is a popular—but ineffective—treatment for backache, report researchers from Australia's George Institute for Global Health. They reviewed 35 randomized, placebo-controlled studies involving more than 6,000 patients with spinal pain. For each participant who experienced clinically significant relief after two weeks on aspirin, ibuprofen, or another NSAID, six others did not achieve a clinically meaningful decrease in pain. Moreover, the investigators explained in the Annals of the Rheumatic Diseases, NSAIDs more than double the risk of gastrointestinal bleeding and also may trigger poor cardiovascular outcomes. Similar reviews for acetaminophen (paracetamol) and for opiates like codeine and OxyContin produced equally dismal conclusions about their benefits as they relate to back pain. According to the study paper, "it is now clear that the three most widely used, and guideline-recommended medicines for spinal pain do not provide clinically important effects over placebo."

From "Scientists Find Evidence That Aspirin and Ibuprofen Don't Actually Help Spinal Pain"
ScienceAlert (Australia) (02/04/17) McRae, Mike

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Anesthesia E-ssential is an executive summary of noteworthy articles of interest to nurse anesthetists. It is distributed bimonthly to AANA members.

Anesthesia E-ssential is for informational purposes, and its contents should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

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February 15, 2017
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