Anesthesia E-ssential

AANA Anesthesia E-ssential, February 20, 2020
AANA Member Advantage Program

Vital Signs

AANA Secures Provider Nondiscrimination Amendment During Markup

Last Tuesday, the House Education & Labor Committee marked up a bill to address surprise billing. The bill, which closely mirrors a bill drafted up by the House Energy & Commerce Committee last year, would take patients out of the middle of out-of-network bills. Reimbursement for out-of-network services would be based on a regional in-network median rate, which would be set by the Secretary of Health and Human Services (HHS).

During the markup, the AANA managed to secure the introduction and unanimous approval of a resolution on provider nondiscrimination. The resolution, introduced by Rep. Donna Shalala (D-FL), would require the Secretary of HHS to finalize rulemaking on provider nondiscrimination language.

Nondiscrimination language is a key issue in surprise billing, as advanced providers such as CRNAs and nurse practitioners face discrimination from private insurers, leading to issues with network adequacy and increasing the likelihood of out-of-network bills.

In speaking on the importance of her amendment, Rep. Shalala stated, "It's very important to us that a patient's choice in provider, or access to a provider, is not unintentionally limited by our efforts. I've always believed that all providers in our healthcare system should be able to engage in their full scope of practice allowed by their states. Many nonphysicians, particularly advanced practice nurses, play a primary role in providing the highest quality care and filling gaps in access to care across our country... Our healthcare system will not work efficiently until everyone is working up to their full licensure allowed by their states."

Additionally, Shalala stated, "Inadequate networks stifle access and increase costs. We have to work to ensure that we are promoting competition and consumer choice and avoiding anything that might restrict access to necessary care."

Upon offering the amendment, a voice vote was taken, in which no member was heard opposing the amendment. It was successfully added to the bill, which was later passed by the committee. This bill will still need to be reconciled with bills from the Energy & Commerce Committee as well as a bill passed by the Ways & Means Committee.

Watch Congresswoman Shalala's Remarks
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New – American Society of Addiction Medicine (ASAM) Public Policy Statement on Physicians and Other Healthcare Professionals with Addiction (2020)

The American Society of Addiction Medicine (ASAM)'s recommendations are in line with the AANA’s Addressing Substance Use Disorder in Anesthesia Professionals, calling for education on addiction and awareness of healthcare professionals with impaired practice for early identification and a non-disciplinary confidential process of intervention, evaluation, treatment, and requiring monitoring for return to practice.

Both documents are found here:
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Last Day to Register! 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.
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AANA Journal App: Simpler, Easier, More Functionality at Your Fingertips

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.
  • 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 – Download the App Today:
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War Stories: Recording the Contributions of CRNAs In Service of Our Country

The American Association of Nurse Anesthetists (AANA) seeks to record the histories of our Certified Registered Nurse Anesthetists (CRNAs) who served in any of the United States' military operations and maneuvers of the 20th or 21st centuries (World War I, World War II, Korean War, Vietnam, The Invasion of Grenada, Gulf War, Iraq War). The AANA is interested in preserving your experiences as a matter of historical record. The AANA hopes to share these experiences with our membership, legislators, and the general public as a means of enlightening, healing, and reaching back into history so that the many accomplishments and sacrifices of CRNAs, soldiers, brothers, sisters, friends and loved ones, are not forgotten.

Submission guidelines are provided on the War Stories and Vietnam Voices pages. If you have any questions, or would like assistance in crafting your narrative, please contact Cathy Hodson, managing editor, digital publications and public relations.
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Hot Topics

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.
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Exploring the February 2020 AANA Journal Issue

The February 2020 AANA Journal features articles on education, opioids, vaping, turnover/burnout and many other fascinating topics. Below, Editor-in-Chief Chuck Biddle, PhD, CRNA, introduces each article in the latest issue.

Development of a Common Clinical Assessment Tool for Evaluation in Nurse Anesthesia Education
The authors deal with a perplexing and long standing problem—the lack of standardization in evaluating the SRNA. The authors describe and detail the efforts by our professional organization to develop and validate a common tool. Those who are involved in the education of nurse anesthetists will find this work of particular interest.

Association of Prescription Opioid Exposure and Patient Factors with Prolonged Postoperative Opioid Use in Opioid-Naïve Patients
This article identifies patient modifiers that may be associated with chronic opiod use in the wake of surgery with an emphasis on those who are opioid-naïve patients. Examining both potentially modifiable and non-modifiable influences,the article suggests strategies in the perioperative period that we can actively pursue as yet another way of influencing what has become a national crisis of drug misuse and mismanagement.

Vaping: Anesthesia Considerations for Patients Using Electronic Cigarettes
The authors illuminate terrain that is high on the lay- and healthcare-professionals’ radar: vaping. Their work provides a broad overview of a social phenomenon that deserves our careful consideration, given its current widespread use in the U.S. and globally.

Anesthesia Challenges in the Management of Freeman-Sheldon Syndrome: Report of Two Cases and Literature Review
Two cases report on Freeman-Sheldon syndrome, a very rare but challenging anomaly with very important anesthetic considerations. Case reports/case series such as these provide us with a flexible template for managing challenging patients who may present to us needing anesthesia care.

Turnover, Burnout, and Job Satisfaction of Certified Registered Nurse Anesthetists in the United States: Role of Job Characteristics and Personality
Through researching and utilizing data archived with the AANA, the authors examine the important domain job dynamics, especially those that related to recruitment and retention in workplace settings. All readers will find this work of great interest with a sense of vicariousness being experienced by all who read it with care.

Damage Control Resuscitation of a Patient with Traumatic Aortic Rupture: A Case Report
The management of a true surgical/anesthetic emergency is detailed…rupture, in this case a traumatic one of an aortic rupture. The setting of the injury was rural, complicating the management even further. A page turner!

Effect of Simulation Training on Cognitive Performance Using Transesophageal Echocardiography
The authors take a deep dive into the role of simulation in the education and training of the nurse anesthetist, here related to TEE skills. As other authors have done in other domains of care, the authors compared web-based (online) knowledge and skill acquisition to that obtained by simulator training. Read on to see what was observed!

Sustained Value of Implementation of a Flexibility-Based Compensation Structure for Nurse Anesthetists in a Large Multihospital Healthcare System
The author explores the ability of the CRNA to creatively and adaptively model their financial management skills. With the author's financial background (MBA), the strengths of this paper reside in an astute and systematic analysis and strategy that will benefit all readers. This unique paper and the author’s skillset set this up as a potential exemplar in the domain.

AANA Journal Course: Update for Nurse Anesthetists—Enterohepatic Recirculation: From Death by Mushroom to Perioperative Pharmacokinetics
This course explores, in a novel manner, enterohepatic recirculation, a physiological process that can have significant clinical implications for the drugs being used by, and administered to, the patients we take care of during anesthetic care. This installment of the Journal’s CEU offering is heavily vested in pharmacology and has implications for patient safety.

And look for our exclusive online content:

Practice News reviews new and updated professional practice documents that have application and merit to all practicing CRNAs, as well as three informative Letters to the Editor.
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Accepting Applications for Post-Graduate Advanced Pain Management Fellowship

The Advanced Pain Management Fellowship at the Texas Christian University School of Nurse Anesthesia, in partnership with AANA, is now accepting applications. The post-graduate CRNA fellowship in advanced pain management takes a holistic and multimodal approach in individualizing treatment plans to manage pain, optimize functional ability, and reduce suffering. The program includes online courses and hands-on clinical practice. The deadline is April 1 to apply for the cohort beginning Fall 2020. Learn more.
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FY2021 CRNA-PAC Committee - Application Deadline is April 30, 2020!

CRNAs and SRNAs interested in serving on the CRNA-PAC Committee beginning in the AANA 2021 fiscal year are encouraged to submit an application through the AANA online committee submission form located on the 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 or call (202) 741-9087.

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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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 student registered nurse anesthetists (SRNAs) 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
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NewsMaker: CRNA Mary Neff Serves on Opioid Intervention Panel at Interdisciplinary Workshop

At Oakland University's Fourth Annual Interprofessional Workshop on Opioid Abuse in Michigan, Mary Neff, MSN, CRNA, served on a panel discussion that highlighted multidisciplinary intervention options to limit the use of prescription opioids. The panel discussion followed a student activity that involved a case study of a typical patient in a clinical setting for which students were tasked with coming up with an intervention plan. Each group was led by a faculty facilitator who asked questions and guided discussion. The case study then was discussed by the panel who offered their solutions. More than 300 students and faculty attended. Learn more.
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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
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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!
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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
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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.
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AANA 2020 Annual Congress: The Power of the Past. The Force of the Future.

When: August 14-18, 2020
Location: San Diego Convention Center, San Diego, Calif.

Get details
Sign up for updates
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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 log in and add the course(s) to your cart. Get started today!
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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!

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Seeking CRNAs: University of Rochester Health System, New York

Looking for an exciting career w/ excellent work-life balance and supportive mentors/colleagues? Come and join our expanding team of CRNAs at the University of Rochester! We offer competitive salary, generous benefits including retention/loan forgiveness, opportunities for continuing education or participating in Grand Rounds, and excellent work-life balance w/ no weekends and no call requirements!

Our CRNAs see a broad spectrum of patient cases - including Orthopedics, OB/GYN, Ambulatory Surgery, GI, General Surgery, Neurosurgery, and more - enjoy supportive, respectful working relationships w/ Anesthesiology providers.

Other Highlights
  • Flexible shift length (dependent on OR cases for the shift).
  • Large team of Anesthesia MDs, CRNA providers, and Anesthesia Techs.
  • Optional afternoon/evening or weekend shifts available, if desired.
Learn more.
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CRNA: Banner Health, California

Banner Health, a Top 5 Large Health System and one of the country's premier non-profit healthcare networks is expanding its team of advanced practice providers and is seeking an experienced CRNA to join our highly trained surgical team where you’ll enjoy a smaller hospital setting and become part of the fabric of the community.

Banner Lassen Medical Center (BLMC), built in 2004, in Susanville, California, has a growing younger population with four seasons and a short winter and is located just 90 minutes from Reno, Nevada. With proximity to Eagle Lake and the mountains, the area offers many outdoor recreational opportunities including hiking, biking, golfing, fishing and hunting. Susanville and Lassen County is an outdoor paradise where the beautiful Sierra Nevada and Cascade mountains meet the desert of the Great Basin. The unique and diverse terrain offers something for everyone with an ideal year-round climate with an average summer high of 89 degrees and daytime temps of 40 degrees during the winter months.

This represents an excellent opportunity for a passionate and energetic CRNA to join a well-respected surgical team providing Orthopaedic, General Surgery and Scopes.
  • CRNA-only practice model.
  • Responsible for performing general, regional, and monitored anesthesia services including Ultrasound-guided block, and OB.
  • 3 years’ experience preferred.
  • 2 weeks on, 1 weeks off.
Learn more.
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CRNA: MEDNAX/American Anesthesiology, Tennessee

MEDNAX is currently seeking CRNAs to join our well-established group practice in Knoxville, Tennessee.
  • Our practice is the exclusive provider of anesthesia services at Parkwest Medical Center, Ft. Sanders Medical Center as well as the Tennova Health Systems.
  • Collectively, we provide services at five tertiary hospitals and seven ambulatory surgery centers, all of which are located in close proximity.
  • We do all types of general cases including general surgery, GI, cardiac, eye cases and only simple pediatric cases.
  • Experienced providers, as well as new graduates, are welcome to apply.
Knoxville was recently ranked as one of “10 Best Value Cities for 2011” by Kiplinger. Founded in 1791, the city has long been the focal point of East Tennessee. Conveniently located off three of the nation’s major interstates, Knoxville is within a one day’s drive of half of the country’s population. Home to the main campus of the University of Tennessee, Knoxville is also home to 17 additional colleges which provide ample cultural and educational opportunities. Knoxville is less than an hour’s drive from The Great Smoky Mountains National Park, the most visited park in America. A rich quality of life, outstanding schools, affordable housing and a low cost of living makes Knoxville a great place to live and work. Whether you’re a history buff, a sports enthusiast, an admirer of arts or an adventure seeker, Knoxville has something for every interest.

Our clinicians enjoy a competitive compensation package with many locations offering sign-on bonuses, relocation and tuition reimbursement.

*Our benefits include:
  • Health (various options), life, vision, dental and disability insurance.
  • 401(k) with annual matching program.
  • Advanced and continuing medical education.
  • Leadership training and advancement opportunities.
  • Employee stock purchase plan at a 15% discount.
  • Professional liability insurance.
  • Support and payment for mandatory license/s and hospital credentialing.

*These benefits are for full-time employees, employees in other types of employment classifications may be eligible for some of these benefits. Learn more.
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Assistant Program Director, University of New England, Maine

This is a full-time faculty/administrative position with the School of Nurse Anesthesia. Under the general supervision of the Director of the School of Nurse Anesthesia, the Assistant Director provides assistance to the Director in all phases of the administration of the School. In the absence of the Director, this individual will perform the Director’s duties. The incumbent also performs duties and tasks in accordance with the performance standards established for the position, while adhering to financial targets for revenue and expense. Didactic teaching is required.

This is an on-site position. The position may be negotiated as a half-time position. On-site presence is required. 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.

Association of Surgical Jacket and Bouffant Use with Surgical Site Infection Risk

Researchers at the University of Alabama at Birmingham questioned whether surgical site infections (SSIs) would drop if operating room staff were made to wear both surgical jackets and bouffant head covers. The retrospective, single-site cohort study examined more than 34,000 inpatient cases during three consecutive time segments over a 22-month period. The first segment included eight months during which neither surgical jackets nor bouffants were required, while the second covered the next six months, when only surgical jackets were mandated. SSI rates during these time frames were compared with those during the final eight months of the study, when operating room staff were compelled to don both types of apparel. The risk of SSIs—which are associated with greater morbidity and mortality—was 1.01 percent when the attire was not required versus 0.99 percent with mandatory surgical jackets and 0.83 percent with mandatory bouffants and surgical jackets. Although the surgical jackets alone cost more than $300,000 a year, they did not provide any meaningful reduction in SSIs, leading investigators to conclude that mandating the jackets and bouffants is neither beneficial nor cost-effective.

From "Association of Surgical Jacket and Bouffant Use with Surgical Site Infection Risk"
JAMA Surgery (02/12/20) Wills, Bradley W.; Smith, Walter R.; Arguello, Alexandra M.; et al.

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Nonsedation or Light Sedation in Critically Ill, Mechanically Ventilated Patients

Scandinavian researchers compared outcomes in ICU patients on mechanical ventilation, based on their exposure to two different sedation protocols. The NONSEDA randomized controlled trial included 700 patients, half receiving light sedation with daily interruption and half receiving no sedation at all. The primary endpoint was 90-day mortality, which occurred at a rate of 37 percent in the sedation group and 42.4 percent in the nonsedation group. Secondary outcomes—including duration of mechanical ventilation, time in the ICU, length of hospital stay, and number of days free from coma or delirium—were not significantly different between the two treatment arms. While previous research has demonstrated that lighter sedation translates to less time on mechanical ventilation and reduced length of stay in the ICU or hospital, the NONSEDA results found that these outcomes did not differ significantly between the trial groups.

From "Nonsedation or Light Sedation in Critically Ill, Mechanically Ventilated Patients"
New England Journal of Medicine (02/16/20) Olsen, Hanne T.; Nedergaard, Helene K.; Strøm, Thomas; et al.

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Sedation Monitors Required for Off-Pump CABG Surgery

Failure to employ sedation monitors during off-pump coronary artery bypass graft surgery could result in patients receiving too much anesthesia, researchers warn. Their prospective, observational study involved 40 adults who underwent the procedure at a single institution during a one-year span. All patients received standardized anesthetic care that included induction with propofol, midazolam, fentanyl, and pancuronium followed by maintenance with isoflurane. Standard monitoring, including use of the bispectral index (BIS) and core temperatures, was in place for all participants. "These patients tend to get cold during surgery, but not many clinicians reduce the anesthetic at lower temperatures," noted Kumar Belani, MD, of the University of Minnesota and Masonic Children's Hospital in Minneapolis and the Narayana Institute of Cardiac Sciences in India, where the trial took place. "So we wanted to see if they have less need for general anesthetic agents when they cool." The team found that isoflurane requirements, adjusted as needed to maintain BIS levels of 40-60, decreased linearly as core body temperature fell. For each degree that body temperature dropped, 0.1303 percent less end-tidal anesthetic concentration was required. Belani said that declining to adjust the anesthetic flow rate in patients with a lower body temperature could promote unfavorable outcomes, such as delayed wake-up time, cardiorespiratory depression, or other complications of anesthesia, whereas optimal anesthetic dosing could reduce emergence agitation and emergence delirium.

From "Sedation Monitors Required for Off-Pump CABG Surgery"
Anesthesiology News (02/14/20) Vlessides, Michael

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Another Round of Research Shows Ketamine May Help Alcoholism

The body of research is growing to support ketamine as a way to control drinking in people with alcohol dependency. The latest evidence comes from a randomized pilot study out of Columbia University Medical Center in New York, which has been published in the American Journal of Psychiatry. All 40 participants underwent motivational enhancement therapy on an outpatient basis, supplemented by either intravenous ketamine or by midazolam. Higher abstinence rates, longer time to relapse, and fewer heavy drinking days were observed in patients in the ketamine group compared with those in the midazolam group. The results dovetail with a 2019 U.K. study involving 90 participants who were heavy drinkers but had not been diagnosed with alcohol use disorder. Those findings indicated that a single infusion of I.V. ketamine, when coupled with therapy, curbed drinking urges and alcohol intake more than did ketamine alone or placebo. Despite the promising data, Elias Dakwar, MD, who led the more recent research effort, says small scale and other study limitations warrant larger trials to validate his team's results.

From "Another Round of Research Shows Ketamine May Help Alcoholism"
Medscape (02/13/20) Brauser, Deborah

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Anesthetic Management Using Multiple Closed-Loop Systems and Delayed Neurocognitive Recovery

A superiority study evaluated the performance of closed-loop, automated management of anesthesia/analgesia, fluid, and ventilation parameters versus manual adjustment. The sample population consisted of 90 older adults undergoing noncardiac surgery. Among 87 who were included in the final analysis, 44 were randomly assigned to closed-loop, automated management using three independent controllers. Anesthetic depth, cardiac blood flow, and protective lung ventilation were adjusted manually, meanwhile, for the other 43 patients. Compared with the controls, trial participants in the closed-loop group spent less time during surgery with a Bispectral Index below 40, experienced less end-tidal hypocapnia, and had a lower fluid balance. Investigators had predicted that the closed-loop, automated technique would outperform the manual approach, and they were right. Moreover, superior management with closed-loop, automated control may be associated with neuroprotective benefits. Montreal Cognitive Assessment scores changed from baseline to one week after surgery for the control patients, suggesting delayed neurocognitive recovery, but the same was not true for the intervention group.

From "Anesthetic Management Using Multiple Closed-Loop Systems and Delayed Neurocognitive Recovery"
Anesthesiology (Winter 2020) Vol. 132, No. 2, P. 253 Joosten, Alexandre; Rinehart, Joseph; Bardaji, Aurélie; et al.

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The Effect of the IPACK Block on Pain After Primary TKA

Investigators assessed the value of local anesthetic infiltration between the interspace between the popliteal artery and capsule of the knee (IPACK) for patients undergoing total knee replacement. The randomized trial included 35 patients who received continuous adductor canal block with IPACK block and 34 who received continuous adductor canal block with sham subcutaneous saline injection. Between the two groups, there were no significant differences in pain scores on postoperative day one or during physical therapy, in opioid use in the postanesthesia care unit (PACU) or at 24 hours after surgery, in walking distance, or in duration of stay in the PACU or in the hospital. IPACK was associated with statistically lower pain scores at rest in the PACU: however, the finding likely bears little clinical significance. Therefore, the researchers do not recommend routine use of the IPACK—although it may be helpful as a rescue block or in patients who are poor candidates for standard multimodal treatment regimen or who have chronic pain or opioid dependence.

From "The Effect of the IPACK Block on Pain After Primary TKA"
Docwire News (02/07/20)

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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:

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Park Ridge, IL 60068
Phone: (855) 526-2262 (toll-free)/(847) 692-7050
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Attn: Cathy Hodson
E–ssential Editor
February 20, 2020