Anesthesia E-ssential

AANA Anesthesia E-ssential, February 21, 2019

Vital Signs

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 2019 election of the AANA Board of Directors, Nominating and Resolutions Committee members. Visit the Election Center 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 2020 terms of office at the conclusion of the AANA 2019 Nurse Anesthesia Annual Congress in Chicago, Illinois.
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Participate in the Fifth Cycle of the ACOG Council's National Improvement Challenge

The American Congress of Obstetricians and Gynecologists (ACOG) Council on Patient Safety in Women's Health Care is pleased to announce the launch of the fifth cycle of the National Improvement Challenge which is focused on the implementation of the Reduction of Peripartum Racial / Ethnic Disparities and Any Other Clinical Patient Safety Bundle. 

Application Objectives
  • To encourage patient safety and quality improvement projects related to peripartum racial/ethnic disparities in any clinical area covered by a bundle.
  • To increase widespread implementation of the Reduction of Peripartum Racial/Ethnic Disparities Patient Safety Bundle in conjunction with other bundles.
  • To foster a culture of collaboration, teamwork, patient safety, and communication between clinicians and patients to promote the Council’s mission: safe healthcare for every woman.

Any individual (including a CRNA or SRNA) or team in the U.S., not just residency or educational programs, is eligible to participate. Health systems are encouraged to submit a joint project across programs.

Four awards will be given. The first-place award will include $3,000, two paid registrations to a national meeting of a selected clinical professional organization, and the opportunity to present a project on a Safety Action Series teleconference.
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Hot Topics

Call for Health and Wellness and Peer Assistance Related Articles

Interested authors invited! Join the Health & Wellness and Peer Assistance Advisors Committees in supporting CRNAs and SRNAs by submitting wellness or substance use disorder-related articles to the AANA NewsBulletin. Learn more at or
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Want to Serve on an AANA Committee?

Positions are available on AANA committees for CRNAs and student registered nurse anesthetists. Check out the committee page on the AANA website to read about the various opportunities. Deadline for committee request submissions is April 1, 2019. Please note: If you currently serve on a fiscal year 2019 committee, you must reapply for fiscal year 2020.
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CRNAs in VA: Renew AVANA Membership

The Association of Veterans Affairs Nurse Anesthetist (AVANA), the only professional association devoted solely to CRNAs who work in the Veterans Administration (VA), is currently in the membership renewal process for all CRNAs who work in the VA. Learn more about member benefits. Renewal can be done online, via paper form, or through a payroll deduction. Learn more.

Questions? Contact AVANA.
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Can You Trust Your Employer-provided Malpractice Insurance Coverage?

Did you know that your employer can settle a claim on your behalf without your knowledge or consent? If you have concerns about your current coverage, or would like to learn more about coverage that supplements the policy your employer provides, visit AANA Insurance Services’ Employed CRNA Toolkit.
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Consider Nominating a Colleague for an AANA Award!

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 15th.
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Council on Accreditation (COA) Seeks Nominations for Two CRNA Director Openings

The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is seeking nominations for one CRNA Educator director and one CRNA Practitioner director. Candidates must be available to attend three-day COA meetings, typically held in January, May and October. The term of office is three years, beginning Fall 2019 through Fall 2022.

The elected candidates then would be eligible to be considered for reelection to a second three-year term. The deadline to apply is March 15, 2019. For position criteria and application requirements, please visit
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AANA Journal February 2019 Issue Highlights

Editor in Chief Chuck Biddle, PhD, CRNA, presents what you need to know about the February 2019 AANA Journal issue:

Online Content: Drug Diversion in the Anesthesia Profession: How Can Anesthesia Patient Safety Foundation Help Everyone Be Safe? Report of a Meeting Sponsored by the Anesthesia Patient Safety Foundation
The authors, in a paper reprinted from Anesthesia & Analgesia, report on issues related to drug diversion by anesthesia providers. Though reprints of previously published works are rare In the AANA Journal, this paper, a synthesis of work from a multi-authored Anesthesia Patient Safety Foundation panel, thoughtfully discusses obstacles and strategies associated with this pressing national problem.

Placing Central Catheters Via a Peripheral Vein (PICC): An Accelerated Strategy
A novel training program is described for placing peripherally inserted central catheters involving a combination of simulation strategies that permit skill acquisition in a remarkably short period of time.

REBOA: A Minimally Invasive Approach to the Management of Severe Hemorrhage in Select Patients
The authors detail their experience using an endovascular balloon that occludes the aorta in the management of hemorrhagic shock. This extraordinary report describes the management of this novel, lifesaving approach in a best-evidence manner.

Urine Color Change During Surgery: Reason for Concern?
This case report reviews both serious and benign causes of intraoperative urine color change. In the particular case under consideration the appearance of green urine during general anesthesia after the administration of methylene blue.

Certification in Nonsurgical Pain Management: Worth the Effort?
Findings are reviewed involving the perceptions of 474 CRNAs who identified themselves as having a subspecialty practice of nonsurgical pain management, regarding the value of certification in the domain. Given the expanding role of the CRNA in this domain, and an uptick in programs that provide education and training, this work provides some needed science to the value of certification, work that will likely be expanded upon in the near future by other researchers.

Blindness in the Wake of Extensive Spine Surgery
Events are detailed of a case resulting in the catastrophic loss of vision while caring for a patient undergoing a procedure known to be associated with this complication. A unique feature of the patient’s course was moderate improvement from an injury that is usually considered progressive and irreversible. This is essential patient safety reading that all will find valuable.

Telehealth: Does it Have a Place in Pre-anesthetic Assessment
An extensive review of the literature examined the role of a pre-anesthetic assessment performed using video conferencing technology. The use and value of this technology may surprise readers who may otherwise be unfamiliar with its role.

Analgesia for Total Knee Arthroplasty: A Side-by-Side Comparison of Management Approaches
The authors describe their experiences in managing postoperative pain using either a femoral nerve block or a periarticular injection of bupivacaine liposome injectable suspension. Their outcome analysis examined patient pain perception, opioid consumption, and the possible role that the surgeon has on measured outcomes.

Unplanned Reintubation in the PACU
Analysis of cases are described that were found in medical records of reintubations performed in the PACU over the period of 2010-2017. The authors’ work describes associated risk factors that will be of value to all of us in helping to assess the potential of this important patient safety metric and prevent its occurrence.

The Use of Gravity IV Infusion in an Austere Setting: Evaluation of a Low-Tech Device
This report is based on work during the U.S. military activity in Syria. The author evaluated the functionality of the ‘DripAssist Infusion Rate Monitor’ during its use on three trauma patients cared for in a mobile combat care unit for an extensive period of time. The results have significant implications for use in select domestic settings as described by the author.

The AANA Journal Course: CEU offering
The benefits and drawbacks of epidural corticosteroid injections in this state-of-the-science offering are reviewed that provide the reader the opportunity to gain essential knowledge and add to their CEU base as a Journal benefit.

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NewsMakers: CRNAs Emma To and Cheyne Robinson Represent in Article on Top Jobs

One of the two jobs listed at #5 in USA Today's Top Jobs for 2019 is nurse anesthetist (it tied with orthodontist). Emma To and Cheyne Robinson are two of the 91 CRNAs who work at the University of Mississippi Medical Center, Jackson, Miss., and were featured in an article about the top jobs by local TV station WLBT.

"This is you," says To about being a nurse anesthetist. "You're educated on advanced pharmacology. And you know for your patient's situation what drug to give to them for them to have a safe surgery."

"It's the top of our job. It's the top nursing field in my opinion that there is," says Robinson, UMMC Chief CRNA. Learn more
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NewsMaker: CRNA Dave Tonry Demonstrates Intubation at Hands-On Health Program

From The Telegraph (Alton, Ill.): "Dave Tonry, a Certified Registered Nurse Anesthetist at Passavant Area Hospital, and registered nurse Allie Long demonstrate a procedure known as tracheal intubation on a dummy Monday during Passavant’s Hands-on Health program that introduces different career options in the healthcare field." See photo.
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Director of the School of Nurse Anesthesia: Texas Christian University, Ft. Worth, Texas

Texas Christian University, Harris College of Nursing and Health Sciences, seeks an innovative leader and clinical scholar for our next Director of the School of Nurse Anesthesia (professional practice faculty, associate/full professor). The director is the senior leader of the academic unit and serves as liaison between the school and the dean of the college. Learn more.
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Chief Nurse Anesthetist: WellSpan Health, Lebanon, Pennsylvania

WellSpan Ephrata Community Hospital, part of WellSpan Health’s eight-hospital health system, is seeking a full-time Chief Nurse Anesthetist. WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization is comprised of a multispecialty medical group of more than 1,500 physicians and advanced practice clinicians, a regional behavioral health organization, a home care organization, eight respected hospitals, more than 19,000 employees, and 170 patient care locations. Learn more.
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Kick-start the new year and give your career a reboot with updates and new resources via the AANA official career center, CRNA Careers. Here are the top three features to check out:

  1. Career Resources: The turn of the year is the perfect time to catch up on industry news or read tips about advancing your career. The AANA Career Center is a great resource, whether you're looking for industry updates or available positions.
  2. Location Radius Job Search: Searching for a job can be time-consuming. Now when entering a job search location, you will be presented with matching locations to autocomplete your search. You can also choose a specified mile radius from which to pull open jobs.
  3. Job Alert Quick Create: When searching for a job on CRNA Careers, you can also create a job alert. In one easy step, you can search for a job and be alerted when a job you're interested in becomes available.

Wishing you career success and a happy 2019! Get started today!


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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.

Neurodevelopmental Outcome at 5 Years of Age After General Anesthesia or Awake-Regional Anesthesia in Infancy

In light of inconsistent findings to date, researchers in several countries teamed up for a new study on general anesthesia use in babies and later neurodevelopmental outcomes. The international team focused on infants with a postmenstrual age of no more than 60 weeks who were born at least at 26 weeks' gestation. More than 700 babies meeting this profile and undergoing inguinal herniorrhaphy, without previous exposure to general anesthesia or risk factors for neurological injury, were randomized to either awake-regional anesthetic or sevoflurane-based general anesthetic. Data from 205 infants in the former treatment arm and 242 in the latter were included in the primary outcome data for the per-protocol analysis. Full-scale intelligence quotient on the Wechsler Preschool and Primary Scale of Intelligence third edition—the primary outcome—was 99.08 at age five years in the regional anesthesia group and 98.97 in the general anesthesia group. Based on the findings, the researchers concluded that just under one hour of general anesthesia in early infancy alters neurodevelopment progress at age five no more than does regional anesthesia.

From "Neurodevelopmental Outcome at 5 Years of Age After General Anesthesia or Awake-Regional Anesthesia in Infancy"
The Lancet (02/16/19) McCann, Mary Ellen; de Graaff, Jurgen C.; Dorris, Liam; et al.

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Evaluation of Association Factors for Labor Episodic Pain During Epidural Analgesia

Researchers sought to pinpoint the factors that contribute to labor episodic pain in expecting mothers despite having received epidural analgesia. The team examined four years of demographic, clinical, and anesthetic data from the labor delivery records of about 20,800 parturients at a single hospital in Singapore. Labor episodic pain, which requires top-ups and can lower patient satisfaction, occurred at a rate of 14.2 percent within the study population. Using univariate and multivariate logistic regression analyses, the investigators identified several predictors associated with labor episodic pain, including the need for epidural resiting, higher pain scores intrapartum, the need for instrumental or cesarean delivery, and the presence of venous or dural puncture. Other conditions associated with labor episodic pain include the presence of high block, the need for a urinary catheter, higher Bromage scores, use of larger volumes of local anesthetics, higher body mass index, and decreased maternal satisfaction. This insight could lead to future interventions to head off labor episodic pain, according to the researchers, although they concede that more study is needed to validate their results.

From "Evaluation of Association Factors for Labor Episodic Pain During Epidural Analgesia"
Journal of Pain Research (02/19) Vol. 12, P. 679 Chan, Jason Ju In; Gan, Yuan Ying; Dabas, Rajive; et al.

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Evidence Basis for Regional Anesthesia in Ambulatory Arthroscopic Knee Surgery and Anterior Cruciate Ligament Reconstruction

Research out of Ontario, Canada, examined the analgesic effects of adductor canal block (ACB) for ambulatory knee surgery. The motor-sparing properties associated with the technique suggest that it would be an appropriate choice for these procedures, but the evidence is inconsistent. For a deeper look, the investigators scrutinized 10 randomized controlled trials comparing ACB with femoral nerve block (FNB) or with placebo in the setting of minor arthroscopic surgery or anterior cruciate ligament reconstruction (ACLR). They found that ACB delivered improved pain relief at rest and other modest analgesic benefits after minor ambulatory arthroscopic knee operations. For ambulatory ACLR, meanwhile, ACB was no more effective than FNB or placebo for any of the prespecified outcomes—which also included time to first analgesic request, opioid demand, quadriceps strength, and patient satisfaction, among others. The finding supports a limited role for both types of block in ambulatory ACLR surgery, while the results for ambulatory knee surgery must be interpreted in light of the overall dearth of evidence.

From "Evidence Basis for Regional Anesthesia in Ambulatory Arthroscopic Knee Surgery and Anterior Cruciate Ligament Reconstruction"
Anesthesia & Analgesia (02/19) Vol. 128, No. 2, P. 223 Sehmbi, Herman; Brull, Richard; Shah, Ushma Jitendra; et al.

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Low-Dose Methoxyflurane Analgesia in Adolescent Patients with Moderate-to-Severe Trauma Pain

Using data from earlier published research, U.K. investigators examined the viability of low-dose methoxyflurane analgesia for moderate-to-severe trauma pain in adolescents. The post hoc subgroup analysis included 96 adolescents, who were randomly assigned at triage to either low-dose inhaled methoxyflurane or placebo. Visual analog scale pain scores improved at 5, 10, 15, and 20 minutes from baseline with both groups, but to a greater extent with methoxyflurane. The analgesic approach also delivered pain relief within one minute of administration, while patients receiving placebo waited about 2 minutes longer to start feeling better. Although more of the methoxyflurane patients experienced adverse events, mostly mild/transient dizziness and headache, the results indicate that low-dose inhaled methoxyflurane is a fast-acting and effective analgesic in young patients suffering from moderate-to-severe trauma pain. More than 95 percent of the patients, doctors, and nurses rated it as excellent, very good, or good.

From "Low-Dose Methoxyflurane Analgesia in Adolescent Patients with Moderate-to-Severe Trauma Pain"
Journal of Pain Research (02/19) Vol. 12, P. 689 Hartshorn, Stuart; Dissmann, Patrick; Coffey, Frank; et al.

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Does General Anesthesia Pose an Alzheimer's Risk?

South Korean scientists say the results of their systematic review and meta-analysis suggest a possible correlation between general anesthesia and Alzheimer's disease. A total of 16 studies, including a collective 255,618 patients who did not have Alzheimer's at the time that they were exposed to general anesthesia, were the basis for the investigation. Led by Hyun Kang, MD, PhD, a professor of anesthesiology and pain medicine at Chung-Ang University Hospital in Seoul, the team identified a markedly higher risk of Alzheimer's with previous exposure to general anesthesia. However, the findings were somewhat muted by study limitations. "Considering the heterogeneity and publication bias that we observed, we urge caution when interpreting this analysis," Kang reported at the 2018 annual meeting of the American Society of Anesthesiologists. "Furthermore, it may be impossible to discriminate between the influence of surgery and anesthesia. Therefore, further large-scale studies are needed to reduce the risk of bias.”

From "Does General Anesthesia Pose an Alzheimer's Risk?"
Anesthesiology News (02/13/19) Vlessides, Michael

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Combination of Paracetamol and Ibuprofen vs Either Alone on Patient-Controlled Morphine Consumption in the First 24 Hours After THA

Research shows that the combination of paracetamol and ibuprofen led to substantial reductions in morphine consumption compared with paracetamol alone in the first 24 hours following hip replacement. Data for the PANSAID randomized clinical trial, which involved more than 500 individuals undergoing total hip arthroplasty, found no statistically significant rise in serious adverse events in the pooled groups that received only ibuprofen compared with those receiving only paracetamol. The researchers noted, however, that the combination of the two drugs did not demonstrate a clinically important improvement compared with only ibuprofen. That finding suggests that using "ibuprofen alone may be a reasonable option for early postoperative oral analgesia," the authors concluded.

From "Combination of Paracetamol and Ibuprofen vs Either Alone on Patient-Controlled Morphine Consumption in the First 24 Hours After THA"
Journal of the American Medical Association (02/12/19) Vol. 321, No. 6, P. 562 Thybo, Kasper Højgaard; Hägi-Pedersen, Daniel; Dahl, Jørgen Berg; et al.

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News summaries © copyright 2019 SmithBucklin

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

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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For more information on AANA and Anesthesia E-ssential, contact:

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Attn: Cathy Hodson
E–ssential Editor
February 21, 2019
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