Anesthesia E-ssential

AANA Anesthesia E-ssential, February 6, 2020

Vital Signs

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 anesthesia students 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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Get to the Heart of the Matter for American Heart Month

February is American #HeartMonth! Raise awareness about heart health and urge those around you to prevent heart disease. Friday, February 7 is National Wear Red Day to promote awareness. Visit the National Institute for Health's website for social media resources, articles to include in newsletters, fact sheets to share, and more. #AANAWellness
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Post-Graduate Advanced Pain Management Fellowship: Now Accepting Applications

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 to apply for the cohort beginning Fall 2020 is April 1. Learn more.
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Hot Topics

Hurry! Nomination Deadline for AANA Award for State Government Relations Advocacy is Feb. 15

State Associations: Submit your entry for the Excellence in State Government Relations Advocacy Award, to be presented at the AANA Mid-Year Assembly in April 2020. This annual award is not tied to a specific “victory” in the state legislative or regulatory arena, but is given based on the quality of the state association effort.

Examples of state association efforts include successful lobby days, legislative/regulatory efforts, or increased member participation in grassroots or other efforts. For more information and to submit your state’s application by Feb. 15, 2020, visit the AANA website.
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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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Call for Abstracts: Share Your Story at 2020 Leadership Summit

AANA members are invited to submit an abstract for the new Leadership Summit mini-session series, “Leadership in Action.” This is an excellent opportunity to be recognized as a thought leader and to share your experience with hundreds of engaged CRNA leaders in various levels of leadership. 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, February 28. Visit our information page to learn more about submission guidelines, the selection process, and topic suggestions.
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A New Mobile Journal App Coming Soon – February 2020

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.

Expanded functionality:
  • 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 will be able to download the app for free from Google Play, Apple App Store, or the Amazon App Store.
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FY2021 CRNA-PAC Committee - New Application Deadline is now April 30, 2020!

CRNAs and SRNAs interested in serving on the CRNA-PAC Committee beginning in the 2021 AANA 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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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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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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CRNA Jobs: Locum Tenens and Permanent Placement Opportunities Across the Country

United Anesthesia – Various Locations. United Anesthesia has been a leading CRNA and Anesthesiologist Locum Tenens and Permanent Placement firm in the country for 40 years. By specializing in only anesthesia placement, we can partner with you to find the ideal situation to suit your strengths, your priorities, your dreams. Your dedicated personal coordinator is looking forward to your call! Learn more.
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Associate/Full Professor and Associate Dean for Research: Texas Christian University, Texas

 The Harris College of Nursing & Health Sciences at Texas Christian University (TCU) invites applications for a full-time, tenure-track faculty position to serve as Associate Dean for Research. The successful candidate will be able to provide an innovative vision and leadership in the Dean’s Office for supporting faculty and student research endeavors in addition to supporting and facilitating growth in the extramurally funded research portfolio of the college. The appointment is 50% administrative and 50% academic (with faculty appointment in an academic unit of the college) and reports directly to the Dean of the Harris College of Nursing & Health Sciences.

The Associate Dean for Research advises and supports the Dean to develop and create resources to achieve the research mission of the college. In addition, this individual will lead research doctoral education in the college by serving as the program director for the interdisciplinary Ph.D. in Health Sciences program. Additional roles and opportunities include but are not limited to:
  • Serving as the college liaison to the Office of Research and Sponsored Projects;
  • Leading and working with the Harris College Research Committee to develop, oversee and assess a strategic plan for research productivity and extramural funding across all academic units and college institutes/centers;
  • Fostering collaborative, interdisciplinary research associations between departments/schools of Harris College and between Harris College and other units at TCU;
  • Providing guidance and support for faculty mentorship/development plans (especially junior faculty) focused on growing and sustaining programs of research;
  • Monitoring and develop the appropriate college infrastructure necessary to support funded programs of research across all academic units;
  • Pursuing scholarly endeavors, and teaching classes as appropriate.
Learn more.
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CRNA: WellSpan Health, Pennsylvania

Join a well-respected health system in south central Pennsylvania. WellSpan Health, an integrated health system serving central Pennsylvania and northern Maryland, 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.

About the Practice
  • Full-time positions available; PRN also available.
  • 4 10-hour shifts, or 5 8-hour shifts available; no weekends/no holidays.
  • CRNAs with prior Ambulatory experience are encouraged to apply.
  • Exciting opportunity to join an established surgical center.
  • Case mix includes: GI, Plastics, Urology, General, ENT, Peds, Podiatry, Ortho and Ophthalmology.
  • Enjoy a well-balanced lifestyle, excellent hours and schedule and no call.
  • Competitive salary, signing bonus, and outstanding benefits.
Learn more.
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Certified Registered Nurse Anesthetist: UPMC Pinnacle, Pennsylvania

Join UPMC Pinnacle — a growing, multisite health system with seven acute care hospitals — as a Certified Registered Nurse Anesthetist, an essential member of the UPMC Pinnacle health care team who is responsible for assessing, planning, implementing, evaluating, and coordinating the total anesthesia care of patients. Through collaboration with all members of the anesthesia care team, the nurse anesthetist diagnoses and treats the human response of the patient and family to the anesthesia process, continuously monitoring, analyzing, and improving the performance of clinical activities. The nurse anesthetist is self-directed, empowered, and accountable for the direct supervision of all team members delivering care to assigned patients.

Multiple opportunities are available including UPMC Pinnacle Harrisburg, Community Osteopathic, and West Shore hospitals.

CRNAs practice includes various case types including General, Pediatric, Vascular, ENT, GI, GU, GYN, EP, Robotics, Thoracic, Orthopaedics, OB, Transplant, and IR.

Job Opportunity:
  • Enjoy flexible schedule, generous time off, excellent work-life balance, and overtime opportunities.
  • Be part of a supportive and family-oriented team within a department that offers a strong, supportive culture.
  • Practice in an environment that is safe, medically directed, and affords CRNAs the opportunity to practice in a high functioning capacity that is very collegial and collaborative.
Job Requirements:
  • Graduate from an approved school of nursing and hold current Pennsylvania RN licensure.
  • Graduate from an accredited nurse anesthesia program.
  • Successful completion of the certification examination or board eligible as defined by the AANA.
  • Comply with criteria for biennial recertification as defined by the NBCRNA.
  • Health, life, and disability insurance.
  • Medical malpractice insurance.
  • Defined contribution plan; 403(b) plan with employer match.
  • Professional dues and CME allowance.
Learn more.
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CRNA: University of Arizona and Banner Health, Arizona

Join the Banner Health Team in Tucson, AZ – where you’ll have the time to connect with your patients, your practice, your family and the great outdoors! We offer dedication to work-life balance unmatched in our industry. Meaning you get to spend more time doing what you love. That’s HEALTH CARE made easier, LIFE made better!

Details and requirements include:
  • Current Board, CPR, BLS, and ACLS certifications.
  • Current Arizona License.
  • Responsible for performing general, regional, and monitored anesthesia services across a broad scope of the health continuum in a Directed Program.
Banner Health and University of Arizona Health Network have come together to form Banner – University Medicine, a health system anchored in Arizona that makes the highest level of care accessible to Arizona residents.
Learn more.
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CRNA: North Mississippi Medical Center, Mississippi

Certified Registered Nurse Anesthetist- $10,000 Sign-on Bonus.
  • Performs and documents a pre-admission assessment and evaluation.
  • Request consultations and diagnosis testing.
  • Develops and implements as plan of care.
  • Selects, orders, and administers anesthesia based on procedure.
  • Determines anesthetic technique to be used: general, local, intravenous sedation, etc.
  • Monitors patient during the procedure and recovery process for any adverse effects.
  • Document medical conditions to be aware of for anesthesia.
  • Update patient documentation regarding anesthesia accurately and timely.
  • Obtains informed consent for anesthesia.
  • Provides post-anesthesia follow-up evaluation and care related to anesthesia side effects or complications.
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.

General Anesthesia in Cesarean Deliveries Increases Odds of Postpartum Depression by 54 Percent

New research out of Columbia University has tied general anesthesia during cesarean section to unfavorable mental health outcomes in the mothers. The team examined 428,204 cases of cesarean births, including 34,356 that were performed under general anesthesia. Compared with women who received regional anesthesia for their C-section, patients who underwent general anesthesia for the procedure were 54 percent more likely to develop postpartum depression requiring hospitalization. General anesthesia recipients also were 91 percent more likely to experience suicidal thoughts or self-inflicted harm. "Our findings underscore the need to avoid using general anesthesia for cesarean delivery whenever possible, and to provide mental health screening, counseling, and other follow-up services to obstetric patients exposed to general anesthesia," said study co-author Guohua Li, MD, DrPH. The findings appear online in Anesthesia and Analgesia.

From "General Anesthesia in Cesarean Deliveries Increases Odds of Postpartum Depression by 54 Percent"
Medical Xpress (02/04/20)

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Choice of Anesthetic for Breast Tumor Resection May Influence Cancer Outcomes

The idea that choice of general anesthetic during tumor resection can drive cancer outcomes continues to gain momentum in the research community. As the argument goes, stress and inflammatory responses caused by surgery, pain, and anesthetic agents may affect cellular and physiological systems in ways that foster metastatic recurrence. The latest evidence comes from Stony Brook University Cancer Center in New York, where preclinical studies have demonstrated that breast cancer metastasis depends on how the anesthetic used for resection affects cytokines and the tumor microenvironment. In the lab experiments, mice anesthetized with sevoflurane during surgery for primary breast tumors were much more likely to develop metastatic disease than those that were anesthetized with propofol. The findings dovetail with other research showing that inhaled anesthetics such as sevoflurane stimulate the proliferation and spread of different types of cancer cells, whereas intravenous anesthetics like propofol disrupt cancer cell signaling pathways, tumor cell migration, and metastasis. Writing in Nature Communications, the investigators acknowledge that it is still unknown whether choice of anesthetic changes the risk of cancer recurrence or cancer-related mortality.

From "Choice of Anesthetic for Breast Tumor Resection May Influence Cancer Outcomes"
News-Medical (01/31/20) Robertson, Sally

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Comparison of the Double-Space Technique vs. the Single-Space Technique in Combined Spinal-Epidural Anesthesia for C-Section

In the setting of cesarean section, investigators wondered if it is better to perform combined spinal-epidural anesthesia (CSEA) using the single-space or the double-space technique. They assembled a sample population of 40 parturients, who were randomly assigned to one approach or the other. There were no evident differences in intraoperative outcomes—including time to readiness or level of sensory block—between the two techniques, nor did adverse effects differ significantly. With the sensory level maintained at a higher level postoperatively, however, the findings do suggest that double-space CSEA may do a better job of managing pain after C-section. Additionally, the double-space technique yielded higher scores for parturient satisfaction.

From "Comparison of the Double-Space Technique vs. the Single-Space Technique in Combined Spinal-Epidural Anesthesia for C-Section"
BMC Anesthesiology (01/30/20) Vol. 20, No. 29 Chun, Eun Hee; Cho, Sooyoung; Woo, Jae Hee; et al.

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Spinal Versus General Anesthesia for Patients with Parkinson's Disease

Anesthesia providers typically prefer using general anesthesia (GA) with patients who have Parkinson's disease (PD), but spinal anesthesia (SA) may be a safer option in this population. Not only are there implications for drug-to-drug interactions between the agents used in GA and PD medications, but GA also may camouflage neurological symptoms intraoperatively and worsen them after surgery. To compare the effect of GA and SA in PD patients, researchers at Jordan University of Science and Technology conducted a small, retrospective study. They identified 10 patients who had hip fracture surgery, six of whom received SA and four of whom underwent GA. No perioperative complications were reported in the SA group, whereas three of the four GA recipients experienced problems. During the postoperative period, meanwhile, three out of four patients in the GA group developed complications within one month of discharge compared with just a single patient in the SA group. Length of hospital stay was prolonged in the GA patients, who were admitted for a mean nine days versus 5.8 patients for the SA group.

From "Spinal Versus General Anesthesia for Patients with Parkinson's Disease"
International Journal of General Medicine (2020) Vol. 2020, No. 13, P. 9 Bani Hani, Diab A.; Aleshawi, Abdelwahab J.; Al Shalakhti, Majd H.; et al.

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Effect of Timing of Intravenous Fentanyl Administration on the Incidence of Posttonsillectomy Nausea and Vomiting

Researchers in South Korea wondered if manipulating the timing of fentanyl administration following pediatric tonsillectomy might influence the rate of postoperative nausea and vomiting (PONV). The drug usually is given toward the end of the procedure to prevent emergence delirium and alleviate postoperative pain, but it is also known to delay anesthesia emergence and elevate the risk of PONV. To examine the effect of fentanyl timing, two treatment arms were created for a prospective study. The 140 participants, aged three to seven years old, were randomly assigned to receive fentanyl either at the end of tonsillectomy or 10-15 minutes before the end. The incidences of PONV and emergence delirium were similar between the two groups, but the researchers did observe other benefits with earlier fentanyl administration. Both return to regular breathing and time to emergence were achieved sooner when tonsillectomy patients received fentanyl 10-15 minutes before the end of surgery.

From "Effect of Timing of Intravenous Fentanyl Administration on the Incidence of Posttonsillectomy Nausea and Vomiting"
The Laryngoscope (01/27/2020) Kim, Hye Jin; Kim, Min-Soo; Kim, Ha Yan; et al.

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Comparison of Adductor Canal Block and Femoral Nerve Block for Early Ambulation After Primary TKA

A single-site study compared recovery outcomes in patients following total knee arthroplasty, based on whether they underwent adductor canal block (ACB) or femoral nerve block (FNB). Per randomized assignment, 43 participants received standard care plus ACB and 41 received standard care plus FNB. The researchers expected to observe increased ambulation distance in the ACB group, and this proved to be true on postoperative day one—but not on postoperative day two. They also had anticipated a reduction in opioid demand in the ACB group; however, there was no difference in the consumption of oral morphine equivalents from one group to the other. There also were no between-group differences in visual analog pain scores, patient satisfaction with analgesia, or patient participation in physical therapy.

From "Comparison of Adductor Canal Block and Femoral Nerve Block for Early Ambulation After Primary TKA"
Docwire News (01/22/20)

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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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Phone: (855) 526-2262 (toll-free)/(847) 692-7050
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Attn: Cathy Hodson
E–ssential Editor
February 6, 2020