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AANA Responds to President Trump's Proposed FY2019 Budget

In response to the release of President Donald Trump’s proposed Fiscal Year 2019 budget, the AANA has grave concerns about its potential far-reaching impact on the nation’s nursing workforce.
The president’s budget proposes significantly cutting the federal healthcare workforce and research programs under Title VIII of the Nurse Workforce Development Program, from $229 million to just $83 million, a decrease of 64 percent.
“For more than 50 years, the programs supported under Title VIII have helped to build the supply and distribution of qualified nurses to meet our nation’s healthcare needs. Title VIII funding has also been critical to educating and training Certified Registered Nurse Anesthetists (CRNAs) who deliver more than 43 million anesthetics to patients each year in the United States, especially those living in rural and other medically underserved areas,” said AANA President Bruce Weiner, DNP, MSNA, CRNA.
“Nurses supported through Title VIII programs go on to provide high-quality, evidence-based healthcare to patients in a variety of settings including hospitals, surgery centers, physicians’ office, long-term care facilities, community centers, state and local health departments, schools, workplaces, patients’ homes, and more.  It is imperative that these programs continue to thrive and provide support for institutions that educate and train our future nursing workforce to meet our nation’s growing demand for healthcare services,” Weiner said.
The AANA is also concerned about the addendum to the president’s budget which recommends cutting the National Institute of Nursing Research (NINR) by approximately $3 million, a decrease of 2 percent.
“While the AANA is pleased to see that the president’s proposed budget includes increased funding for the National Institutes of Health, we are concerned about the proposed cuts to NINR,” Weiner said. “Nursing science is critical to promote and improve the health of individuals, families, and communities. Many of the findings from nursing science can be put directly into practice, changing lives and promoting wellness.”
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Check out the Check-In
CPC Program 2-Year Check-in Window Opens April 3, 2018

CRNAs who recertified or originally certified in 2016 will complete the next step in the CPC Program beginning this April when the 2-year Check-in window opens. Where you used to recertify every two years, now you’ll instead do this quick and easy Check-in requirement at the mid-point in the 4-year CPC Program cycle. And it should only take about 10 minutes (or less) to complete. 
The 2-year Check-in is an important step and requirement, as completing this process continues CPC compliance for the upcoming two years. By checking in, CRNAs will confirm current licensure and practice, update contact information, pay the same fee ($110) as in the past, and check CPC compliance progress (Class A, B, Core Modules). 
Look for regular updates and reminders on the 2-year Check-in. Visit today for more information. 
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Join the AANA and the NICE Network on CDC Webinar Discussing Injection Safety

The Centers for Disease Control (CDC), the American Nurses Association, and the NICE Network invite you to register now for a free webinar with continuing education, "Empowering Nurses to Protect Themselves and Their Patients: Exploring Best Practices in Injection Safety," on Thursday, 2/22 at 1 PM EST. The webinar will feature Chuck Griffis, PhD, CRNA who will discuss the essential balance between meeting immediate or emergent patient safety needs and performing all recommended infection control practices during clinical care. Register here.
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FDA Warns That Kratom Has Opioid Properties

US Food and Drug Administration (FDA) Commissioner Scott Gottlieb, MD, warns the public about the herbal supplement kratom in a recent statement, stating "There is no evidence to indicate that kratom is safe or effective for any medical use" and likening its chemical compounds to opioids.  Learn more about the FDA’s computational analysis and deaths associated with the use of kratom in the full statement
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Providing Culturally Competent Care for African Americans Reduces Health Disparities

Providing Culturally Competent Care for African Americans and reducing health disparities is an important initiative to improve outcomes for patients from diverse backgrounds. 
Many African Americans experience healthcare disparities that result in limited access to healthcare, the underutilization of healthcare services, quality of care received, and having inadequate health insurance coverage. When individuals have these limitations, it is important to be culturally sensitive and competent to ensure the patient receives the best quality of care. When a patient has a positive experience, he or she is more likely to engage in their own healthcare in the future. Read more about this issue and its importance for CRNAs in the AANA Press Release.
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Perfect for Sharing with Patients: MANA Posts Informational Video on CRNAs

Be sure to view and share "CRNAs: Helping Millions Every Day," a new video created by the Michigan Association of Nurse Anesthetists. View the video.
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Air Force CRNA Receives Bronze Star

Lieutenant Colonel Matthew Uber, CRNA, USAF, was among five Special Tactics airmen to receive a Bronze Star from the U.S. Air Force for extraordinary heroism.

Lt. Col. Uber, along with Capt. Cade Reedy, Lt. Col. Ben Mitchell, Maj. Justin Manley, and Maj. Jonathan Chin received the military's fourth-highest medal during a ceremony at the University of Alabama at Birmingham on Feb. 13.

The airmen were part of an elite special operations surgical team that provided quick, life-saving care during an overwhelming surge of casualties while forward-deployed with special operations forces in the fight against the Islamic State. They treated more than 750 patients, managed 19 mass-casualty events, performed 16 life-saving surgeries and cared for partner-force casualties exposed to chemical weapons during the summer of 2016, according to the team's "Portraits in Courage" story.
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Consider Nominating a Colleague for an AANA Award!
Deadline is March 15

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 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. 
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Foundation and Research

AANA Foundation 2018 Award Nominations Deadline Extended to March 1

Each year the AANA Foundation presents awards at the AANA Annual Congress to individuals who have made a difference in the nurse anesthetist community. The extended deadline for Award nominations is March 1.
Nomination/application forms are available online for:
  • Advocate of the Year—presented to an advocate committed to supporting the AANA Foundation and encouraging others to do the same.
  • John F. Garde Researcher of the Year—Presented to an individual who has made a significant contribution to the practice of anesthesia through clinical research.
  • Rita L. LeBlanc Philanthropist of the Year—Presented to an individual who has donated time, talent and direct financial support to the AANA Foundation and other deserving organizations.
  • Janice Drake CRNA Humanitarian Award—Presented to a CRNA who wishes to volunteer and provide anesthesia, education, and training in underserved areas.
Forward the completed form to the AANA Foundation. Email to or mail to 222 S. Prospect Avenue, Park Ridge, IL 60068.
Thank you in advance for recognizing a member of the nurse anesthesia community. If you have any questions, please contact the AANA Foundation at (847) 655-1170 or
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AANA Foundation Student Scholarships Applications Now 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, 2018. Scholarship awards range from $1,000 to $3,000 each. To apply for a scholarship, you must be enrolled in a program for at least six months prior to March 1, 2018.
Don’t delay! Access the Student Scholarship Application webpage on the AANA Foundation website,
Contact the AANA Foundation at (847) 655-1170 or with any questions. 
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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.

Opioid Analgesic Use and Risk for Invasive Pneumococcal Diseases

A team from Vanderbilt University Medical Center carried out a nested case-control study centered around the theory that prescription opioid use is an independent risk factor for invasive pneumococcal disease (IPD). The hypothesis is based on the knowledge that some opioid analgesics possess immunosuppressive traits that inflate the risk for infection in animals. Using administrative and surveillance databases, the researchers identified 1,233 patients at least five years of age who were diagnosed with IPD between 1995 and 2014. A control group was populated by 24,399 patients matched according to age, county of residence, and date of diagnosis. Study participants with IPD were more likely than controls to be current opioid users, with the strongest associations formed for long-acting or highly potent opioids as well as those given at high doses. In light of the findings, the investigators conclude that opioid use correlates to higher risk for IPD and serves as a novel risk factor for the condition.

From "Opioid Analgesic Use and Risk for Invasive Pneumococcal Diseases"
Annals of Internal Medicine (02/13/18) Wiese, Andrew D.; Griffin, Marie R.; Schaffner, William; et al.

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Acupuncture Versus Titrated Morphine in Acute Renal Colic

A study done in Tunisia compared the safety and efficacy of acupuncture, as opposed to intravenous titrated morphine, for emergency department (ED) treatment of renal colic. Researchers randomly allocated 54 study participants to 30 minutes of acupuncture therapy after a prespecified protocol. The other 61 participants were assigned to 0.1 mg/kg of morphine at five-minute intervals until pain score was cut at least in half from baseline levels. Visual analog scale ratings were assessed at baseline and at 10, 20, 30, 45, and 60 minutes after treatment onset. From the first measurement until the end of the intervention, acupuncture delivered a deeper analgesic effect than titrated morphine. Analgesia was also faster in the acupuncture patients, who needed just 14 minutes to achieve the desired 50% reduction in baseline VAS compared to 28 minutes in the morphine group. Only three acupuncture recipients experienced minor side effects, far fewer than the 42 morphine recipients. No major side effects were documented. The study results indicate that, in the ED setting, acupuncture offers faster and deeper analgesic effect and a better tolerance profile than titrated IV morphine in patients presenting with renal colic.

From "Acupuncture Versus Titrated Morphine in Acute Renal Colic"
Journal of Pain Research (02/18) Vol. 11, P. 335 Beltaief, Kaouthar; Grissa, Mohamed Habib; Msolli, Mohamed Amine; et al.

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Risk Factors for Neurodevelopmental Delay in Children Mirror Those for Overall Mortality

With so much research and discussion around the potential for poor neurodevelopmental outcomes after pediatric surgery, one group of investigators questioned how mortality and morbidity are affected by early exposure to anesthesia. Knowing that age younger than three years, exposure to multiple anesthetics, and prolonged exposure to the drugs are all risk factors for neurodevelopmental delays, the team from the Children's Hospital of Wisconsin and Medical College of Wisconsin theorized that the same predictors would apply to morbidity and mortality outcomes. Led by George Hoffman, MD, they reviewed medical records for 61,088 children treated at the hospital between 2013 and 2016. With 400 deaths, the mortality rate was estimated at 0.65 percent. The researchers analyzed outcomes based on a number of variables, including the same risk factors for neurodevelopmental delays as well as ASA physical status score, age, and more. "In summary, exposure to anesthesia and surgery identified children at significantly longer term risk of mortality at 30 days. Age, ASA physical status score and multiple/prolonged exposures all had associations with higher mortality risk in univariable analysis. After controlling for ASA physical status score, multiple exposures and cumulative exposure time had small, incremental effects on mortality," Hoffman reported. "So the risk factors for mortality were similar to those risk factors previously identified for neurodevelopmental delay."

From "Risk Factors for Neurodevelopmental Delay in Children Mirror Those for Overall Mortality"
Anesthesiology News (02/12/18) Vlessides, Michael

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Anesthesia in Parkinson Disease Requires Cautious Care

Research suggests a link between Parkinson disease (PD) and higher rates of unfavorable perioperative and postoperative outcomes, possibly due to negative interaction between anesthetic agents and PD medications. Because of its potent anesthetic properties, for instance, propofol is frequently used for PD patients who require surgery. However, the drug has been shown to trigger dyskinetic activity in individuals with and without PD or other movement disorders. Research published in 2006 indicates that dexmedetomidine might be one strategy for managing this particular complication, especially in individuals in the late stages of disease. As another example, evidence finds that halothane is not an optimal choice of anesthetic for PD patients who take levodopa, due to the heightened cardiac sensitivity it causes. Instead, clinicians are advised to consider sevoflurane, enflurane, and isoflurane. Simon JG Lewis, who co-authored a recent review in the Journal of Clinical Neuroscience, says that for PD patients in general, "special consideration will need to be given to the timing of medications pre- and post-surgery [and] the potential for neuropsychiatric problems such as psychosis and confusion." The Australian professor of neuroscience adds that prospective, multi-site studies examining short- and long-term effects of general anesthesia on motor and non-motor aspects of PD are needed.

From "Anesthesia in Parkinson Disease Requires Cautious Care"
Neurology Advisor (02/09/18) Rodriguez, Tori

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Injections of Corticosteroids vs Local Anesthetic in Rotator Cuff-Related Shoulder Pain

The medical literature suggests that patients treated for rotator cuff-related pain might get more short-term relief from corticosteroids than from local anesthetics. A systematic review, published in the British Journal of Sports Medicine, looked at findings from 13 relevant randomized controlled trials with more than 1,000 participants collectively. Each study compared single or repeat injections of local anesthetic against subacromial corticosteroid injections, with or without local anesthetic. Shoulder pain, function, range of motion, and patient-reported improvements were evaluated at three different intervals: three months, three to 12 months, and longer than one year. Of four studies deemed to carry low risk for bias, three pointed to greater improvement of outcomes in patients treated with corticosteroids rather than local anesthetics only. The effect was evident for only up to eight weeks, however, with no significant difference apparent between patient groups during followup over three to 12 months. The data did not allow for comparison of outcomes beyond one year. "If local anesthetics prove safe and effective in future research, significant cost savings could be achieved," the investigators concluded.

From "Injections of Corticosteroids vs Local Anesthetic in Rotator Cuff-Related Shoulder Pain"
Clinical Pain Advisor (02/08/18) May, Brandon

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One in Five Older Adults Experience Brain Network Weakening Following Knee Replacement Surgery

Researchers report that nearly a quarter of total knee arthroplasty (TKA) patients aged 60 and older sustained a decline in activity in one or more regions of the brain tasked with specific cognitive functions. Moreover, 15 percent of patients declined across all the brain networks studied by the team from the University of Florida. "In essence, normally synchronized parts of the brain appeared more out of sync after surgery," said co-lead author Jared Tanner, PhD. He and colleagues performed cognitive and brain imaging tests pre- and postoperatively on 48 study participants and compared them with images from age-matched controls who also had knee osteoarthritis but who did not undergo TKA. There were no changes in the "before" and "after" scans within the no-surgery group; however, 23 percent of the patients who had knee replacement presented significant declines in connectivity in at least one brain network during 48-hour followup. According to the findings, the greatest effect was observed in TKA patients who were already more cognitively fragile pre-procedure. The investigators emphasize the need for additional research. In the meantime, "we strongly believe clinicians need to consider preoperative memory and attention abilities in their patients," said senior author Catherine Price, PhD. "Across the nation, however, cognition is not routinely assessed prior to surgery." The study results can be found online in the Journal of Alzheimer's Disease.

From "One in Five Older Adults Experience Brain Network Weakening Following Knee Replacement Surgery"
ScienceDaily (02/07/18)

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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.

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February 15, 2018
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