Anesthesia E-ssential

AANA Anesthesia E-ssential, February 27, 2020
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Vital Signs

Patients in South Dakota Will Have Access to Affordable Quality Care, Thanks to a Law that Extends Authority of Nurse Anesthetists

Marking a huge victory for patients across South Dakota, Governor Kristi Noem signed SB 50, which grants nurse anesthetists the ability to collaborate with healthcare providers in chronic pain practice, expands collaboration in anesthesia care to include podiatrists, dentists and other providers, and grants prescriptive authority. Learn more
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AANA Board of Directors Approve “Scope of Nurse Anesthesia Practice”

Meeting the demands of an ever-changing healthcare environment, the AANA Board of Directors approved the updated “Scope of Nurse Anesthesia Practice.” This document reflects the professional scope of practice of Certified Registered Nurse Anesthetists (CRNAs), including the full range of anesthesia services, and describes CRNAs’ professional, educational, clinical, and leadership roles. The board met in advance of the Assembly of Didactic and Clinical Educators meeting Feb. 19-22. Learn more.
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AANA Reminds VA of CRNA Staffing Shortages in VA Facilities in Response to Rule

In response to a rule proposed by the U.S. Department of Veterans Affairs (VA) to amend its regulations that govern scholarship programs to certain healthcare professionals, the AANA reminded the agency that there are CRNA staffing shortages in VA facilities.

This rulemaking would implement the mandates of the VA MISSION Act of 2018 by establishing a Specialty Education Loan Repayment Program, which would assist the VA in meeting the staffing needs of VA physicians in medical specialties for which the VA has determined that recruitment or retention of qualified personnel is difficult. The AANA's comments state that while we agree that establishing a loan repayment program would be helpful in attracting providers to work for VA facilities, we have concerns that the proposed rule implies there is a staffing shortage of only physicians. The result is that the proposed loan repayment program is geared towards recruiting only physicians to work in VA facilities. We understand there is underutilization and staffing shortages of other types of providers, including Certified Registered Nurse Anesthetists (CRNAs), and we ask that this loan repayment program be broadened to include incentives for recruitment and retention of advanced practice registered nurses (APRNs) in VA facilities. Furthermore, we requested that CRNAs be granted the ability to practice to the full scope of their education, training, licensure, and certification in VA facilities to allow veterans to receive access to safe and timely anesthesia services.
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Nursing Career and Pathways Program Provides All-Around Mentoring for Students

Founder and Executive Director Regina Daniels McKinney, MSN, CRNA, started the Nursing Career and Pathways (CAPS) Program in 2013. It provides a nurturing and supportive environment for students through mentoring; enhancing self-esteem and character; improving study skills; college preparation; and promoting healthy eating and active living. AANA spoke with Daniels McKinney to learn more about her program. Learn more.
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Hot Topics

Do You Have What it Takes to Succeed as an Independent Anesthesia Provider?

If you want to go out on your own, but don’t know the business side of anesthesia, here’s your chance to learn from Juan Quintana and Larry Hornsby, former AANA presidents, who both have launched multimillion-dollar anesthesia group practices. They’re hosting this 8-week university-level course exclusively to AANA members online! They’ll engage with you each week to cover topics such as billing and reimbursement, negotiations, contracts and proposals, differences in practice models, and more.

AANA Membership Exclusive - Earn 16 CE Credits; Next Session starts April 8, 2020

Reserve Your Seat Today! Spring 2020 Session
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Admitted vs. Non-Admitted Malpractice Insurance Companies: Do You Know the Difference?

There are significant differences between admitted and non-admitted malpractice insurance companies – and choosing the wrong company can put you, your reputation, and your personal assets at risk. Learn which questions to ask your insurance agent to ensure you have protection when you need it most. Learn more.
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Deadline: This Friday! 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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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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Do You Know an Outstanding CRNA? Nominate Your Colleague for an AANA Recognition Award!

Nomination Deadline: March 15, 2020.
Do you work with an outstanding program director, didactic instructor, or clinical instructor? Do you know someone who has spent a lifetime advancing the practice of nurse anesthesia as a practitioner, educator, clinician, or advocate? Consider nominating your colleague for one of the national AANA recognition awards.

Visit Recognition Awards for details on the:
  • Agatha Hodgins Award for Outstanding Accomplishment,
  • Helen Lamb Outstanding Educator Award,
  • Alice Magaw Outstanding Clinical Anesthesia Practitioner Award,
  • Ira P. Gunn Award for Outstanding Professional Advocacy,
  • Clinical Instructor of the Year Award,
  • Didactic Instructor of the Year Award, and
  • Program Director of the Year Award.
Nomination deadline is March 15, 2020.
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NewsMaker: CRNA Beth Clayton Seeks to Determine Maternal Racial Disparities

Too many African-American mothers die of pregnancy-related causes, according to a website article at WCPO ABC (Cincinnati). Beth Clayton, DNP, CRNA, FAAN, program administrator of the University of Cincinnati's College of Nursing, is leading research to determine what the racial disparities are in Cincinnati and Hamilton county in Ohio. Clayton, also an obstetrics anesthesia expert, conducts research that includes reviewing medical charts for every maternal death that has happened in the UC Health system over the last five years. "We're looking at race, age, insurance status," said Clayton. "We're going to see if we fall in our community along with what we're seeing nationally." 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 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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Anesthesia Manager: New Hanover Regional Medical Center, North Carolina

Forbes Magazine has announced New Hanover Regional Medical Center is one of America’s Best Employers of 2018. Our organization is the region’s largest healthcare provider, employing over 7,000 people who have a passion for making a positive difference in the lives of others. This is the ideal place for you to further your career.

The Anesthesia Manager is responsible for the management of patient care activities, Anesthesia personnel and administration of department. The Manager performs the job duties of a certified registered nurse anesthetist to include all aspects of patient care as needed. Responsible for the direction of anesthesia staff in the implementation of plans of care.

Education: Graduate of an accredited school of nursing and accredited school of nurse anesthesia required. MSN, MA preferred.

Licensure/Certifications: Registered Nurse with current North Carolina License and current certification by NBCRNA. BLS and Advance ACLS required. Learn more.
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CRNA Locums:, Kentucky

CRNA needed for locums coverage in Kentucky.

Working with 30 CRNAs, no MD supervision.

All cases except hearts and neuro. No regional is required except the occasional bier block.

Four 10's or four 12's per week.

$150/hr; $175/HR OT paid malpractice mileage and housing.

Experience working independently.
Commitment of at least 6 months working every week.
Start date April/May. Learn more.
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Assistant Program Director: Jefferson College of Nursing (Thomas Jefferson University), Pennsylvania

The Jefferson College of Nursing (JCN) seeks a motivated, dynamic leader to serve as its Assistant Program Director for its Nurse Anesthesia DNP Program. The Assistant Program Director will work in close collaboration with the Program Director in assuring compliance with the Council on Accreditation on Nurse Anesthesia Educational Program’s Standards and Guidelines. The successful candidate will lead the program in curriculum development, implementation and evaluation. The Assistant Program Director will collaborate in the development and implementation of departmental mission and vision; provide effective leadership for the department, faculty, students and alumni; teach in assigned courses; and support coordination initiatives of clinical rotations.

Perform other duties as assigned.

This is a full-time, 12-month faculty position. Current clinical practice experience is valued and supported by allowing a one-day scholarship day for faculty to utilize toward clinical practice, scholarship or curriculum development.

Qualifications & Experience:
  • Doctorate (DNP, DNAP, or PhD) in nursing from an accredited institution required.
  • License to practice professional nursing and nurse anesthesia in the Commonwealth of Pennsylvania.
  • Current certification or current recertification by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) required.
  • Formal teaching experience in curriculum, evaluation and instruction is preferred.
  • Administrative and leadership experience is preferred.
  • Evidence of team science skills and collaboration.
Learn more.
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CRNA: Confidential, Colorado

Beautiful Southern Colorado University Town to join the leading 350 Bed, Level II Trauma Regional Medical Center and provide care to a 400,000-person service area.
  • Expansion of Services.
  • New Orthopedic Hospital in addition to main campus Trauma Center.
  • Urban Community.
  • 4 Season community with 300+ days of sunshine a year.
  • Comprehensive Benefit Package to include: Base Salary, Overtime Pay, Specialty Call Pay, Student Loan Repayment, Sign on & Relocation.
  • Great Pathology of Patients.
  • Inclusive pathology, multispecialty OR cases.
  • Team model.
Learn more.
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CRNA: San Juan Regional Medical Center, New Mexico

San Juan Regional Medical Center Anesthesiology in Farmington, New Mexico, is seeking a CRNA. Covered procedures include General, Acute Pain Service, Pre-op screening, Outpatient surgery, Neurosurgery, Trauma Anesthesia, Critical Care Medicine, Orthopedic, Pediatric, Obstetric, Thoracic Anesthesia, Ped/Adult Dental, OMFS. Anesthesiologists supervise CRNAs. Successful Applicants must have New Mexico CRNA license upon hire and NBCRNA certification.

You can look forward to:
  • Base salary is competitive with MGMA median.
  • Outstanding benefit package.
  • Competitive sign-on bonus and relocation package.
  • Quality work/life balance.
San Juan Regional Medical Center is a non-profit and community governed facility. Farmington offers a temperate four-season climate near the Rocky Mountains with world-class snow skiing, fly fishing, golf, hiking and water sports. Easy access to world renowned Santa Fe Opera, cultural sites, National Parks and monuments. Farmington is located 45 minutes away from Durango, CO, and 3 hours away from Moab, UT. Farmington’s strong sense of community and vibrant Southwest culture make it a great place to pursue a work-life balance. Learn more.
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CRNAs: Evangelical Community Hospital, Pennsylvania

Choose your Schedule! 24s, 10s, 8s or Per Diem; GREAT Quality of Life in Central PA - Multiple CRNA Openings!

Are you ready to join a dynamic anesthesia team in beautiful central Pennsylvania? We are looking to expand our anesthesia department to support our growing surgical volume. We are a state-of-the-art community hospital with a highly respectable reputation within our community. We have three standing facilities for which we cover a total of 12 ORs, 1 OR for OB, and 6 Endo Suites. The average CRNA time of service is 10 - 15 years. Our work is exceptional, once you start here, you won't want to leave.
  • Group providers anesthesia services to hospital with on-campus ASC and nearby endoscopy center. Eight (8) OR suites, four (4) ASC rooms, two (2) endoscopy suites, OB floor.
  • NO call.
  • CRNA coverage 24/7; scheduled coverage in partnership with employed Anesthesiologists.
  • OR case volume average 50% Ortho, 20% General, 12% OB, 10% Vascular and 5% Urology.
  • 25-35 cases per day.
  • Choose your schedule! 24s, 4 ten (10) hour shifts per week, 5 eight (8) hour shifts per week, or Per Diem.
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.

Aviation-Style Computerized Surgical Safety Checklist Displayed on a Large Screen and Operated by Anesthesia Provider Improves Checklist Performance

University of Washington researchers hypothesized that shifting surgical safety checklists to a computerized format would improve the performance of the lists, which often go uncompleted. They designed a prospective study to test the theory, observing use of a four-part checklist both before and after it was converted from a wall poster into an aviation-style computerized system. Under the new protocol, the anesthesia provider managed the computerized version, which was projected onto a large, centrally located screen. Investigators compared 671 cases of checklist use before the switchover and 547 afterwards, with direct observers paying special attention to the first part of the checklist that was initiated ahead of anesthesia induction. Full completion of the checklist items occurred 86.3 percent of the time after the computerized format was introduced, versus just 2.1 percent of the time before it was adopted. Looking at the data from another angle, the share of cases that completed fewer than 75 percent of checklist items shrank from 72.7 percent before computerization to just 0.5 percent after computerization.

From "Aviation-Style Computerized Surgical Safety Checklist Displayed on a Large Screen and Operated by Anesthesia Provider Improves Checklist Performance"
Anesthesia & Analgesia (02/20) Vol. 130, No. 2, P. 382 Jelacic, Srdjan; Bowdle, Andrew; Nair, Bala G.; et al.

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Neuraxial Guidance Device Beats Palpation-Guided Spinal Anesthesia in Obese Patients

With the rising body mass index (BMI) of patients complicating the spinal anesthesia process, researchers explored a hand-held guidance tool as a potential solution. The study, conducted in Italy, included adults with a BMI of 30 kg/m2 or greater who underwent lower-limb orthopedic surgery. According to randomized assignment, some participants received spinal block after palpation of cutaneous landmarks while others were scanned with the battery-operated ultrasound probe. Based on analysis from 99 men and women who completed the study, the investigators determined that the hand-held device significantly lowered the number of needle redirections and passes through the skin while performing spinal block. This is important, according to senior author Daniela Ghisi, MD, because multiple needle insertions and redirections can impact spinal block safety. The research, which appears in Regional Anesthesia & Pain Medicine, also found, however, that it took less time to scan with the traditional palpation-guided method.

From "Neuraxial Guidance Device Beats Palpation-Guided Spinal Anesthesia in Obese Patients"
Anesthesiology News (02/19/20) Kronemeyer, Bob

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Ketamine Could Be a Reliable Alternative for Pain Relief, Sedation in ICU

Despite a lack of direction on how to use the powerful anesthetic in the intensive care unit (ICU), researchers bet that continuous ketamine infusion would deliver multiple benefits in this setting. To test the theory, they retrospectively analyzed 390 adults treated with the drug at 25 ICUs between 2014 and 2017. They found that ketamine administration correlated to more time spent in target score range for both pain and sedation. Moreover, the approach significantly decreased the need for other analgesics—including propofol, opioids, benzodiazepine, and dexmedetomidine. While the results suggest that ketamine could be a viable option for ICU patients, investigators agree that randomized, prospective data is needed to determine safety and inform its use. For starters, they note, 5.7% of the patients discontinued treatment because of adverse events including psychotropic effects and increased secretions. The research team presented the work, "Effects of Ketamine on Pain, Sedation, and Delirium in the Intensive Care Unit," at the Society of Critical Care Medicine's 49th Annual Critical Care Congress in Orlando.

From "Ketamine Could Be a Reliable Alternative for Pain Relief, Sedation in ICU"
HCPLive (02/18/20) Sturts, Adam

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FDA OKs First Once-Daily IV COX-2 Preferential NSAID for Pain

Based on evidence from multiple efficacy and safety trials, the Food and Drug Administration has approved meloxicam injection for the treatment of moderate to severe pain in adults. Meloxicam—or Anjeso, the brand name—is a long-acting, preferential cyclooxygenase type 2 (COX-2) pathway inhibitor with analgesic, anti-inflammatory, and antipyretic properties. To be delivered once a day as an intravenous bolus push, the drug can be administered alone or in tandem with other nonsteroidal anti-inflammatory drugs (NSAIDs). It is not recommended, however, in cases demanding rapid onset of analgesia, as it actually slows onset. "While traditional opioid medications have proven effective at providing pain relief, the associated adverse side effects, including sedation and respiratory depression, have driven physicians to employ a multi-modal approach to treating post-operative pain," said Keith Candiotti, MD, with the University of Miami's anesthesiology department. I.V. meloxicam, he adds, "has the potential to serve as a meaningfully differentiated analgesic alternative."

From "FDA OKs First Once-Daily IV COX-2 Preferential NSAID for Pain"
Medscape (02/21/20) Brown, Troy

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Trans-Cricothyroid Membrane Injection of Local Anesthesia Attenuates Cough Response and Postoperative Sore Throat to the Nasotracheal Tube

Trans-cricothyroid membrane injection of 2% lidocaine mitigates cough response and postoperative sore throat (POST), evidence suggests. Researchers at China's Wuhan University analyzed results from about 120 patients who received general anesthesia with nasotracheal tube for oral and maxillofacial surgery. Participants were randomized in a 1:1 ratio to receive trans-cricothyroid membrane injection of lidocaine or saline placebo before anesthesia. More than 67 percent of patients in the control group experienced cough response upon extubation, versus less than 42 percent of patients in the intervention group. The rates dropped to 41 percent and 20 percent, respectively, five minutes after extubation. Mean arterial pressure and heart rate, meanwhile, were much lower with lidocaine than without during emergency from general anesthesia. Additionally, the team observed that the rate of POST was greatly reduced in the lidocaine patients at both one and six hours postoperatively compared with the controls. The findings suggest that trans-cricothyroid membrane injection of local anesthesia simply and effectively curbs cough response during emergency from general anesthesia and lowers the incidence of POST following surgery.

From "Trans-Cricothyroid Membrane Injection of Local Anesthesia Attenuates Cough Response and Postoperative Sore Throat to the Nasotracheal Tube"
Therapeutics and Clinical Risk Management (02/20/20) Vol. 2020, No. 16, P. 103 Huang, Lili; Wang, Li; Peng, Wei; et al.

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Spinal Anesthesia Allows Babies to Stay Awake During Surgery

A hospital in New Hampshire is going against the grain by giving infants spinal anesthesia rather than general anesthesia when they undergo surgery. Although there is still much debate and uncertainty surrounding the neurological effect of general anesthesia on children younger than age three, the team at Elliot Hospital in Manchester says they are motivated simply by the clear benefits of administering spinal anesthesia to their tiniest patients. The process involves inserting a 25-gauge needle filled with numbing medication into the back. The process only takes seconds, and the effects kick in within a few minutes, after which the baby typically falls asleep naturally during the procedure. "They tolerate this practice so beautifully—they have major surgery while taking a nap," explains Elizabeth Soukup, MD, a pediatric surgeon at Elliot. If they do not drop off on their own, nurses sing to them to keep them calm. General anesthesia, on the other hand, sends infants into a medically induced coma and requires a ventilator to breathe for them. Elliot's Charles Eastwood, MD, a pediatric anesthesia provider, notes that the process takes much longer and incurs more risks. While some doctors do not appreciate the short duration of spinal anesthesia and both they and some parents would prefer not having the baby awake for surgery, Eastwood encourages other hospitals to consider the option. "We definitely have familiarity with a technique that isn't widely used, however we feel that it could easily be adopted at any number of institutions," he says. "We are doing this at a community hospital and showing this is a feasible, safe, effective technique." Of 201 procedures performed at Elliot since late 2016, 99.5 percent were successful.

From "Spinal Anesthesia Allows Babies to Stay Awake During Surgery"
Modern Healthcare (02/15/20) Castellucci, Maria

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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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Phone: (855) 526-2262 (toll-free)/(847) 692-7050
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Attn: Cathy Hodson
E–ssential Editor
February 27, 2020