Anesthesia E-ssential

AANA Anesthesia E-ssential, February 7, 2019

Vital Signs

Engage with the Full Scope of Practice Competency Task Force

The Full Scope of Practice Competency Task Force (FSOPCTF) wants to hear from you! Visit the FSOPCTF AANA member webpage (login required) to view the latest updates on the work of the task force. Members can view summaries of the task force’s recent meeting and call. This webpage also contains a comment form, where members can provide the FSOPCTF with feedback any time throughout this process. The task force looks forward to hearing from members as they continue this important work.
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Learn to Lead and Influence at State Leadership Workshop

The AANA State Leadership Workshop will inspire state leaders to lead and influence through crucial conversations and emotional intelligence. Held March 23-24, 2019, in San Diego, the workshop also will cover state board orientation, governance principles, and sharing best practices and success stories with other state association leaders.

The state leadership workshops are held around the country and make the education and training of state association leaders as convenient and efficient as possible by "taking the show on the road." These critically acclaimed workshops bring expertise, resources, and tools around governance and leadership closer to the states.

Register for the San Diego workshop. (Member login required.)
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Hot Topics

Rhode Island Passes Law That Requires Hospitals, ASCs to Use Surgical Smoke Evacuation Systems

After 42 years of breathing surgical smoke, Julie Greenhalgh, RN, BSN, CNOR, past president of the Association of periOperative Registered Nurses (AORN), helped lead the effort for Rhode Island to become the first state to pass legislation that requires all hospitals and ambulatory surgery centers to use surgical smoke evacuation systems. The law took effect on New Year's Day. Facilities have 90 days from Jan. 1 to report that they've adopted smoke policies to the Rhode Island Department of Health.

Read more about the Rhode Island story in Outpatient Surgery.

Learn more about AORN Go Clear Campaign to which AANA contributed.

AORN Surgical Smoke FAQs
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Do You Have Malpractice Insurance Questions?

AANA Insurance Services has answers! We are happy to answer your questions, whether you hold a policy with AANA Insurance Services or not. Contact us by phone, email, or through our online General Inquiry Form.
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MIPS Data Submission Office Hours

CRNAs who need information about or assistance with 2018 Merit-based Incentive Payment System (MIPS) Data submission can register for online Office Hour Sessions presented by CMS on Tuesday, Feb. 26th and Tuesday, March 19, 2019.

Attendees can ask questions during the Question and Answer portion or submit questions in advance. CMS also posted several videos that demonstrate how to submit MIPS data, which are available through the Resource Library of Quality Payment Program website.
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Vote for Delegate to the AANA Education Committee

CRNA members attending the Assembly of Didactic and Clinical Educators (ADCE) are eligible to vote for a delegate to the Education Committee. Voting takes place during the ADCE. Check out the candidates on the AANA website.
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Program Administrators/Faculty: Nominate an SRNA for the Student Excellence Award

One student will receive the Education Committee Student Excellence Award at the AANA Annual Congress. The winner will be recognized at the Student Luncheon.

The award will be presented to a student in good academic standing who demonstrates outstanding leadership and professionalism during their nurse anesthesia program, participates in activities that foster a positive public image of nursing, participates in activities that foster high quality healthcare to consumers, or engages in volunteer activities of community service or support of healthcare. The student must be nominated by the program administrator or the program administrator’s faculty designee. All individuals who are a student at the time of the submission deadline are eligible.

Defining characteristics of nominees include:
  • Evidence of professional promise.
  • Record of extracurricular activities or other contributions to the college or community.
  • Consistent excellent performance in the clinical setting for at least two semesters.
Award guidelines:
  • One submission per program.
  • Submission must be a narrative of no more than 1,000 words.
  • The narrative should provide specific details on how the student demonstrates excellence in leadership, scholarship, service or a related area.
Nominations must be submitted on program letterhead via e-mail to the Education Department at by April 22, 2019. Please direct any questions to the Education Department at 847-655-1161 or
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Student Writing Contest – Submission Deadline is April 22

Submissions are now being accepted for the annual Student Writing Contest. Students must submit an essay of no more than 1,500 words, including references, on a topic pertinent to education, professional practice and development, wellness, healthcare, or health policy. Potential essay topics include, but are not limited to:
  • Leadership,
  • Case reports,
  • Health policy,
  • Professional development,
  • Quality improvement,
  • Student wellness,
  • Diversity,
  • Interprofessional collaboration,
  • Community service,
  • Work-life balance,
  • Simulation,
  • Innovative use of technology in education,
  • Ethics; and
  • Generational issues.
Citations must follow AMA formatting style.

The winner will be recognized during the Student Luncheon at Annual Congress. There is also an opportunity for the winning essay to be published in the AANA NewsBulletin as a Student News column.

Essays must be submitted via email to the Education Department at Questions may be directed to the Education Department at 847-655-1161 or
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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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NewsMaker: CRNA Ladan Eshkevari Named FNINR Ambassador

Ladan Eshkevari, PhD, CRNA, FAAN, has been named to the 2019 Ambassador cohort of the Friends of the National Institute of Nursing Research (FNINR). She is the first CRNA to serve in this capacity.

The ambassadorship ensures that Eshkevari will be on the frontline in helping to educate state and federal policy makers on the importance of nursing research and the necessary funding required to support the health and well-being of all Americans.

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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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CRNA: Banner University Medical Group, Tucson, Arizona

Banner University Medical Group (BUMG) is seeking a CRNA to join our team at Banner University Medical Center – Tucson (BUMC-T). You’ll be involved in clinical management of patients, performance of therapeutic and diagnostic procedures, interpretation of diagnostic tests, prescribing medications, patient education, consultation, and research. Learn more.
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Full-time CRNA: Sweet Dreams, LLC, Salt Lake City Area, Utah

Unique and rewarding opportunity for full or part-time independent contractor CRNA to join a busy CRNA-only group practice providing IV sedations to dental offices with an emphasis on pediatrics. Learn more.
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Certified Registered Nurse Anesthetists: Sanford Health, Fargo, North Dakota

Sanford Health Fargo Anesthesia Department is currently seeking Certified Registered Nurse Anesthetists (CRNAs) to join its current group of 21 anesthesiologists and 72 CRNAs. Learn more.
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CRNA Opportunity: Riverside Associates in Anesthesia, Binghamton, New York

Our group of 8 anesthesiologists and 12 CRNAs has been serving the beautiful Southern Tier for over 55 years! Our group covers one large community hospital with a case load of about 10,000 cases a year. We offer a wide range of anesthesia, including orthopedics, pediatrics, obstetrics, bariatric, and cosmetic. (No hearts, heads or trauma). Our CRNAs enjoy a team approach to patient care and a pleasant working environment. As some of our CRNAs start looking toward retirement, we find ourselves in a position to welcome a few new members to our team! Learn more.
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CRNA: Immediate Need With No Call, $220,000 to $300,000 Income Range, $20,000 Signing Bonus Plus Relocation Assistance, Midwest, Merritt Hawkins, Fort Wayne, Indiana

No hearts, no heads, and little to no trauma. 
  • No micromanagement or supervision—autonomy to handle your own cases independently.
  • Great working relationships with anesthesiologists… “They are here for us when we need them, but let us manage our own cases otherwise.”
  • Tailor your schedule to your desires with 8, 10, and 12-hour shift options available.
  • Quality of life balance with no call.
  • Average providers earning MGMA 90th percentile—$220,000+ with some earning in low $300,000s, plus a $20,000 signing bonus.
  • Retention/premium rate bonus with tenure.
  • Annual pension/profit sharing distribution.
  • 6 weeks of PTO increases with seniority.
Learn more.
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CRNA Corning NY, Sayre PA: The Guthrie Clinic, Sayre, Pennsylvania

The Guthrie Clinic - Corning Hospital has opportunities for CRNAs to practice in their newly built (2014) hospital. Workplace culture built on Teamwork, Excellence and Patient Centeredness
  • Traditional and nontraditional work hours - typical hours 7:00 a.m.-3:30 p.m. with no call.
  • Anesthesia Care Team Model used.
  • Wide spectrum of cases with the exception of Cardiac and Neurosurgery.
  • The highest volumes are Orthopedics, ENT, General Surgery, OB/GYN, and Plastics.
  • CRNAs may participate in OB cases if they are qualified/trained in OB and motivated to do so.
  • Anesthesia Department manages O.R. schedule providing the necessary structure for a smooth, efficient work day.
  • Robust EHR (EPIC).
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.

Multimodal Analgesia Model for Post–C-Section Halves Opioids Prescribed at Discharge

Managing post-cesarean pain with a multimodal analgesic strategy cut opioid prescriptions at discharge by half, according to a study out of Chicago's Mount Sinai Hospital. The institution's approach combined various analgesics with nonopioid components such as nonsteroidal anti-inflammatory drugs, acetaminophen, and gabapentin; and, when needed, added hydromorphone. Investigators compared outcomes in 155 women who delivered their babies via c-section before the protocol was put in place with those of 166 mothers who underwent the procedure after the institution starting using multimodal analgesia. Findings from the retrospective chart review indicated that morphine milligram equivalents prescribed during hospitalization fell from an average of 44.9 mg before the new approach was adopted to 23.5 mg afterwards. Only 32.5 percent of patients in the latter group were released with opioids, meanwhile, versus 89 percent of those in the earlier group. Utilization of multimodal analgesia shortened the hospital stay by half a day.

From "Multimodal Analgesia Model for Post–C-Section Halves Opioids Prescribed at Discharge"
Pharmacy Practice News (02/05/19) Kronemyer, Bob

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TAP Block Reduces Pain and Narcotic Consumption After Robot-Assisted Distal Pancreatectomy

Researchers assessed the impact of bilateral, intraoperative transversus abdominis plane (TAP) block on outcomes after robot-assisted distal pancreatectomy (RADP). Colleagues at Beth Israel Deaconess Medical Center in Boston conducted the retrospective case-control study as an interrupted time series, with 48 participants meeting eligibility before and 33 after TAP implementation. Patients who received TAP block with bupivacaine consumed 4.52 fewer intravenous morphine milligram equivalents than controls during the first six hours postoperatively. They also reported better numerical rating scale pain scores at both six and 12 hours after the procedure, although that benefit wore off by 24 hours post-surgery. While bupivacaine TAP block significantly lowered opioid demand and pain in RADP patients, it did not have much of an impact on postoperative morbidity and length of hospitalization.

From "TAP Block Reduces Pain and Narcotic Consumption After Robot-Assisted Distal Pancreatectomy"
HPB (02/19) Solis-Velasco, Monica A.; Ore Carranza, Ana S.; Stackhouse, Kathyrn A.; et al.

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Amisulpride for the Rescue Treatment of Postoperative Nausea or Vomiting in Patients Failing Prophylaxis

Researchers evaluated intravenous amisulpride, a dopamine D2/D3-antagonist, as a rescue medication for when antiemetics fail to prevent postoperative nausea or vomiting. The target population for their prospective, multinational trial was adults who experienced this adverse effect within 24 hours of surgery under general inhalational anesthesia, despite having received standard antiemetics. About 700 patients meeting this profile were randomly allocated to treatment with 5 or 10 mg of amisulpride or matching placebo. The primary endpoint was complete response, meaning no emesis or need for rescue antiemetics for 24 hours after taking amisulpride, except within the first 30 minutes. This outcome was achieved by 41.7 percent of patients in the 10 mg group, 33.8 percent of patients in the 5 mg group, and 28.5 percent of the controls. The results show that 10 mg of amisulpride is superior to placebo in alleviating established postoperative nausea or vomiting in patients for whom antiemetics did not provide sufficient prophylaxis. Cutting the dosage in half, however, eliminated the benefit.

From "Amisulpride for the Rescue Treatment of Postoperative Nausea or Vomiting in Patients Failing Prophylaxis"
Anesthesiology (Winter 2019) Vol. 130, No. 2, P. 203 Habib, Ashraf S.; Kranke, Peter; Bergese, Sergio D.; et al.

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Perioperative Management and In-Hospital Outcomes After Minimally Invasive Repair of Pectus Excavatum

The Society for Pediatric Anesthesia Improvement Network reports results from its inaugural study, which focused on minimally invasive repair of pectus excavatum (MIRPE). The researchers set up a multicenter observational database to characterize the analgesic techniques used for children undergoing the procedure. They then drew on outcome data from 348 patients at 14 participating centers in order to evaluate the relationship between different analgesic approaches and pain. The findings highlight a range of pain management options for MIRPE patients, including epidural catheter (EC), paravertebral catheter, wound catheter, no regional analgesia, and intrathecal morphine. While the data suggests that most children will experience mild-to-moderate postoperative pain regardless of the analgesic approach, managing them with EC appears to lower pain scores and curb opioid requirements in the early recovery stage more so than the other treatment strategies.

From "Perioperative Management and In-Hospital Outcomes After Minimally Invasive Repair of Pectus Excavatum"
Anesthesia & Analgesia (02/19) Vol. 128, No. 2, P. 315 Muhly, Wallis T.; Beltran, Ralph J.; Bielsky, Alan; et al.

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Effects of Bupivacaine or Levobupivacaine on Cerebral Oxygenation During Spinal Anesthesia in Elderly Patients Undergoing Hip Surgery

While bupivacaine and levobupivacaine are commonly used in spinal anesthesia, researchers in Spain wondered if one medication was riskier to older patients than the other. Specifically, they were interested in differences in regional cerebral O2 saturation, cognitive status, and neurological outcomes. The team assembled a study population of 58 patients, aged 70 years and older, having surgery to repair a hip fracture. Participants were evenly and randomly divided into two groups—one that received levobupivacaine and one that received bupivacaine, both combined with fentanyl and both delivered intrathecally. The main outcome was the percentage of intraoperative time with regional cerebral desaturation, which did not differ significantly between groups. Additionally, there was no meaningful difference in cognitive impairment as measured by changes in the Short Portable Mental Status Questionnaire. Neurological complications, however, were more prevalent with patients who received bupivacaine—half of whom were affected, versus fewer than a quarter of those who received levobupivacaine. The researchers also observed different levels of sensory and motor block achieved with the two drugs.

From "Effects of Bupivacaine or Levobupivacaine on Cerebral Oxygenation During Spinal Anesthesia in Elderly Patients Undergoing Hip Surgery"
BMC Anesthesiology (01/31/19) Vol. 19, No. 17 Vives, Roser; Fernandez-Galinski, Diana; Gordo, Francisca; et al.

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Under-Drape Suctioning, Minimal Oxygen Delivery Decreases Risk for OR Fires

Surgical fires under monitored anesthesia care (MAC) are rare but can be avoided altogether, report the authors of a systematic review. The literature search included English-language studies in the past 10 years that focused on MAC surgeries of the head, neck, and face. The researchers turned up six relevant studies with a collective 31 participants as well as one questionnaire-style study with more than 8,500 respondents. According to the evidence, MAC procedures are vulnerable to fire due to high oxygen delivery using nasal cannulas or other open gas devices. When fires break out in the OR during these operations, they typically involve the pooling of oxygen beneath surgical drapes or within the operative site. Anesthesia providers can reduce the risk of fire, however, by lowering oxygen saturation. Ways to accomplish this include using a vacuum to reduce oxygen levels around the patient's face; limiting oxygen flow rates to less than 4 L per minute; using a blower to increase ventilation under head drapes meant to maintain body temperature; and observing a safe physical distance between ignition sources and oxygen. "These interventions aim to reduce the available oxidizer in the surgical field and can be readily performed by the anesthetist provider to help reduce the risk of a surgical fire," said researcher Izaskun Green, RN, a student at Miami's Florida International University.

From "Under-Drape Suctioning, Minimal Oxygen Delivery Decreases Risk for OR Fires"
Anesthesiology News (01/30/19) Doyle, Chase

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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.

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 7, 2019
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