Brydges Presents at the FDA Opioid Policy Steering Committee
President-elect Garry Brydges, DNP, CRNA, ACNP-BC, Executive MBA, presented at the Jan. 30 meeting of the US Food and Drug
Administration (FDA) Opioid Policy Steering Committee. The purpose of the meeting was to gather stakeholder input on new approaches to promote the safe use of opioid analgesics. Dr. Brydges urged the committee
to reapproach pain management from a single modal to a multi modal, opioid-sparing approach, stressed the need for interdisciplinary team collaboration, and advocated for CRNAs as part of the solution to address
the opioid crisis. View Brydges’ presentation, beginning at 26 minutes.
FDA’s Ongoing Efforts to Mitigate Impact of Saline Shortages During Flu Season
This year’s flu season has been particularly challenging, with a notable number of cases leading to hospitalization. The US Food
and Drug Administration (FDA), in coordination with the US Centers for Disease Control and Prevention, continues to monitor this situation. The FDA is working to improve the large and small IV bag shortage and tracking potential shortages of critical
medical products, such as the empty IV containers. The FDA has heard from some health care providers that there are spot shortages of antivirals used to treat the flu and flu tests; however, at this time, there is no nationwide shortage of these products.
Read more information about FDA’s ongoing efforts.
The Joint Commission Posts FAQ on Oxygen Cylinder Storage
The frequently asked question response states that cylinders defined as empty by the Joint Commission-accredited organization must be segregated from all other cylinders
intended for patient care. These cylinders must be marked empty by tagging, indicated by the integral gauge, or group signage, as appropriate. The FAQ notes that full and partially full cylinders are permitted to be stored together.
CMS and Accreditation Standards for Hospital Operating Room Environmental Controls
Accreditation and Centers for Medicare & Medicaid Services (CMS) surveys often find environmental controls for operating rooms, c-section
rooms, and other environmentally sensitive areas (e.g., endoscopy, cardiac catheterization and interventional radiology labs) out of compliance with CMS standards. Surveyors expect that hospitals will comply with the Federal Guidelines Institute (FGI)
guidelines, which in turn require compliance with ASHRAE ST170 Standards for Ventilation in Healthcare Facilities - 2008 Edition. The ASHRAE standards apply to air pressure, temperature, and humidity in hospitals. Under the ASHRAE standards, hospital
ORs and C section rooms must have positive pressure ventilation, a temperature between 68 and 75 degrees F, and humidity between 20 and 60 percent. Exceptions that allow exceeding the minimum ranges exist to meet surgical patient care needs.
For temperature and humidity, the hospital should monitor and document the levels at least once a day. It is also important to check positive pressure ventilation frequently. Many facilities monitor and document air pressure in critical areas,
such as ORs, daily. If the air pressure is reversed or temperature and humidity are out of range, policy and procedure can be developed outlining who to notify, corrective action, and retesting protocols. Make sure corrective action and
retesting are documented. Read on for additional tips for compliance
Consider Nominating a Colleague for an AANA Award!
Deadline is March 15
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 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.
What is Cash Drag and Why can it Adversely Affect your Investment Portfolio?
Read "Cash Drag: Your Portfolio’s Subtle Downer," an article by AANA Member Advantage Partner ONE Advisory Partners, to educate yourself about cash drag and ways to avoid potential investment pitfalls. You'll find the article and other useful
information about investment and retirement planning on the ONE Advisory Partners webpage.
Foundation and Research
AANA Foundation 2018 Award Nominations Deadline Extended to March 1
Each year the AANA Foundation presents awards at the AANA Annual Congress to individuals who have made a difference in the nurse anesthetist community. The extended deadline for Award nominations is March 1.
Nomination/application forms are available online for:
- Advocate of the Year—presented to an advocate committed to supporting the AANA Foundation and encouraging others to do the same.
- John F. Garde Researcher of the Year—Presented to an individual who has made a significant contribution to the practice of anesthesia through clinical research.
- Rita L. LeBlanc Philanthropist of the Year—Presented to an individual who has donated time, talent and direct financial support to the AANA Foundation and other deserving organizations.
- Janice Drake CRNA Humanitarian Award—Presented to a CRNA who wishes to volunteer and provide anesthesia, education, and training in underserved areas.
Forward the completed form to the AANA Foundation. Email to firstname.lastname@example.org
or mail to 222 S. Prospect Avenue, Park Ridge, IL 60068.
Thank you in advance for recognizing a member of the nurse anesthesia community. If you have any questions, please contact the AANA Foundation at (847) 655-1170 or email@example.com
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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.
New Anticoagulant Guidelines for Cardiac Surgery Released
The Society of Cardiovascular Anesthesiologists, Society of Thoracic Surgeons,
and American Society of ExtraCorporeal Technology worked together to draft new guidelines governing the use of blood-clotting agents during cardiac surgery. Heparin has been the go-to standard for more than a half a century, according to lead
author Linda Shore-Lesserson, MD, but anticoagulant use during heart surgery has not been subject to dosing recommendations and other standardized clinical practices. The new guidelines, however, address optimal heparin dosing for cardiopulmonary
bypass, identification of contraindications to heparin use, alternatives to heparin, and ideal strategies for anticoagulation reversal after the procedure. “These recommendations will help fill the evidence gap and establish best practices
in anticoagulation therapy for cardiopulmonary bypass,” Shore-Lesserson said.
From "New Anticoagulant Guidelines for Cardiac Surgery Released"
Modern Medicine (02/05/18) Blank, Christine
Current Tobacco Use Linked With Increased Pain, Narcotic Use After Total Shoulder Arthroplasty
Patients undergoing total shoulder arthroplasty
experienced more pain and needed more narcotic analgesics if they were active smokers, according to a new study. The 163 patients were stratified based on whether they were current tobacco users, former users, or nonusers. VAS scores before surgery
and at 12 weeks afterwards were significantly higher among the 28 current smokers than among the 47 reformed smokers and 88 nonsmokers. Current smokers also saw much less improvement in their VAS scores, the researchers reported in the Journal of Shoulder and Elbow Surgery.
Moreover, participants who smoked used significantly more oral morphine equivalent per day as well as at 12-week follow up. “Not only does tobacco use negatively impact ultimate outcome after shoulder replacement, which is already known,
but it is also associated with a more difficult postoperative course,” remarked Thomas W. Throckmorton, MD. There was no major between-group disparity, however, in length of stay or complication rates.
From "Current Tobacco Use Linked With Increased Pain, Narcotic Use After Total Shoulder Arthroplasty"
Healio (02/04/2018) Tingle, Casey
The Analgesic Effect of Ultrasound-Guided Quadratus Lumborum Block After Cesarean Delivery
A Norwegian study assessed the efficacy
of quadratus lumborum (QL) block after surgical childbirth. The researchers hypothesized that the more posterior location for this technique might better deliver local anesthetic to the thoracolumbar fascia and paravertebral area compared with
more widely used ultrasound-guided (US) transversus abdominis plane blocks, which target the inferior abdominal wall. To investigate, the team from Oslo University Hospital recruited 40 women scheduled for cesarean section. All participants received
spinal anesthesia with bupivacaine and sufentanil as well as postoperative care that included paracetamol, ibuprofen, and ketobemidone delivered via patient-controlled analgesic pump. The multimodal regimen also included bilateral US-guided QL
block, with half of the patients randomized to ropivacaine and the other half randomized to saline. The primary endpoint for the study was ketobemidone consumption in the first 24 hours following surgery, which proved to be lower in the QL-ropivacaine
group than in the QL-saline group. The active group also generated much better effective analgesic scores, both at rest and during cough. Based on their results, the researchers found that QL block with ropivacaine, as part of a multimodal analgesic
protocol that excludes neuraxial morphine, lower postoperative ketobemidone requirement and alleviates pain intensity in women after C-section.
From "The Analgesic Effect of Ultrasound-Guided Quadratus Lumborum Block After Cesarean Delivery"
Anesthesia & Analgesia (02/18) Vol. 126, No. 2, P. 559 Krogh, Anders; Ullensvang, Kyrre; Rosseland, Leiv Arne; et al.
Cuffed vs. Uncuffed Tracheal Tubes in Children
Researchers from Princess Margaret Hospital for Children in Perth, Australia, spearheaded
an investigation into the performance of cuffed tracheal tubes versus uncuffed tubes in mechanically ventilated surgical patients. Newborns and children up to age 16 years were randomly assigned to one intubation approach or the other for routine
elective surgery. There was much less leakage with cuffed tubes, both during volume-controlled ventilation and pressure-controlled ventilation, the team discovered. Additionally, tidal volumes were higher in the cuffed group and increased over
time, while they were lower and decreased over time in the uncuffed group. The uncuffed tubes also were associated with a higher rate of short-term complications, although no major complications were documented in any of the children over the
long term. With standardized ventilator settings, the study concluded, cuffed tracheal tubes produced better ventilation characteristics than uncuffed tracheal tubes during general anesthesia for pediatric surgery.
From "Cuffed vs. Uncuffed Tracheal Tubes in Children"
Anaesthesia (02/01/18) Vol. 73, No. 2, P. 160 Chambers, N.A.; Ramgolam, A.; Sommerfield, D.; et al.
Improving Patient Safety During Procedural Sedation Via Respiratory Volume Monitoring
Researchers designed a randomized clinical trial
to investigate the utility of minute ventilation (MV) monitoring in procedural sedation. The study population included 73 patients undergoing upper endoscopy, randomly separated into two treatment arms. The anesthesia provider was able to view
the screen of a noninvasive respiratory volume monitor (RVM) for 32 participants and use the data on MV, tidal volume and respiratory rate to help manage their cases. For the other 41 participants, the anesthesia provider was blinded to the RVM
screen and data. Use of MV monitoring cut respiratory depression in half, suggesting that the approach is helpful in preventing this complication during procedural sedation.
From "Improving Patient Safety During Procedural Sedation Via Respiratory Volume Monitoring"
Journal of Clinical Anesthesia (02/01/2018) Vol. 44 Mathews, Donald M.; Oberding, Michael J.; Simmons, Eric L.; et al.
How Many Opioids Do You Need After Surgery?
With about 115 Americans lost each day to the opioid epidemic, medical professionals are
scaling back the number of doses they authorize. Many are drawing inspiration from the Opioid Prescribing Engagement Network (OPEN), which targets surgery and dentistry as key areas where opioid analgesic use can be curbed. The group offers data-driven
recommendations on the appropriate number of opioids to prescribe for gall bladder or colon removal, along with 12 other common procedures. "We have so many opioids in our community," says OPEN co-director Chad Brummett, an associate professor
of anesthesiology at the University of Michigan. "Drawing back to where that person got the prescription is not easy in many cases. But we think acute care is the most important opportunity for prevention." At the Geisel School of Medicine at
Dartmouth in New Hampshire, meanwhile, surgery professor Richard Barth, MD, and colleagues developed guidelines for prescribing opioids for five specific procedures. As they reported in the Annals of Surgery last year, opioid prescriptions
were cut by more than half four months after sharing the recommendations with physicians, nurses, and other clinicians at their facility.
From "How Many Opioids Do You Need After Surgery?"
Wall Street Journal (01/29/18) Reddy, Sumathi
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Anesthesia E-ssential is an executive summary of noteworthy articles of interest to nurse anesthetists. It is distributed weekly to AANA members.
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