AANA Anesthesia E-ssential, January 10, 2019
 
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Vital Signs


2018 Top 10 Anesthesia E-ssential Articles

In case you missed these stories on their original run, here are the Top 10 AANA stories of 2018.

1. New Research Confirms Safety of Nurse Anesthetists, Raises Questions About Anesthesiologist Assistants, May 31, 2018

New research published online in the journal Anesthesiology confirms the quality and safety of anesthesia provided by Certified Registered Nurse Anesthetists (CRNAs) while raising questions about the role and value of anesthesiologist assistants (AAs) in patient care.

The study, title "Anesthesia Care Team Composition and Surgical Outcomes," was funded by the American Society of Anesthesiologists.

"The value of healthcare professionals is measured in different ways, one of which is the safety and quality of the care they provide," said Bruce Weiner, DNP, MSNA, CRNA, president of the 52,000 member American Association of Nurse Anesthetists. "But in today's healthcare system, other measurable factors that are critically important to meeting the growing patient demand for healthcare services are the cost-effectiveness of the provider and the provider's ability to ensure patients have access to the care they need."

Read more.


2. AANA Board of Directors Withdraws Amendment 7 to AANA Bylaws (Article XI Resolutions), September 6, 2018

Dear Colleagues,

On September 4, the AANA Board of Directors met via conference call and unanimously voted to withdraw proposed Amendment 7 to the AANA Bylaws (Article XI Resolutions).

I want to assure you that Amendment 7 was never intended to silence the voice of AANA members in the governance of our association. The AANA always has been, and always will be, a member-driven organization. In fact, it is our bylaws that define a resolution as "a written 'main motion' (submitted in advance of the annual Business Meeting) which contains serious subject matter potentially having significant impact on the business of the association." Clearly, the members' intent has always been to have an active voice and drive important issues impacting the profession.

The intent of the amendment was simply to bring Article XI Resolutions in line with the AANA Articles of Incorporation and Illinois state law; a recommendation by our new parliamentarian and co-author of Robert's Rules of Order, Newly Revised, Thomas J. Balch. The Board decided that changing the language in Article XI could have a negative impact on efforts to increase member engagement and participation in the AANA by creating the perception that the amendment was meant to stifle the voice of our members. So much good work has been done by the Board, member task forces, committees, and staff to enhance engagement, participation and communication, that damaging this forward progress due to ongoing debate over Amendment 7 was deemed counterproductive. The considerable, ongoing, and often emotional feedback of the membership via social media and other communication was particularly impactful on the Board's decision-making. Finally, prior to the Board's conference call, the extensive research that had been undertaken by the Bylaws Committee, Resolutions Committee, and AANA parliamentarian and legal counsel which helped frame the development of Amendment 7 in the first place, was reconsidered.

Most likely the inconsistency between bylaws, Articles of Incorporation, and Illinois state law will need to be addressed at some point in the future. Before that time comes, this Board has elected to begin a process that will include member input in the development of bylaw language moving forward. For now, however, as your president I accept full responsibility for the current Board's decision to approve this amendment; for failing to anticipate the possible perceptions of our members; and for not fully appreciating the importance that our members place on the ideology of resolutions to our organization.

In other words, the membership has made itself heard, and the Board has taken the members' concerns to heart. Throughout the year, including in relation to Amendment 7, our work and our decisions have been based only on what we believe to be in the best interests of the collective membership. While some members may not agree with some of our decisions, in our hearts and minds the choices we've made have been based on data as well as feedback, comments, and recommendations from members and staff. Our decision to withdraw Amendment 7 is consistent with that.

I have been honored to serve with a Board comprised of an amazing group of individuals who have worked hard to return the AANA to its "why," are being responsive to member needs, and shoring up our foundation as a member-driven, member service-oriented association where CRNAs feel valued. We have done some remarkable things to reach these milestones, such as initiating a cultural assessment of our organization; amending the CEO Succession Plan and Conflict of Interest Policy; addressing member engagement, recruitment, and retention; developing tools and resources to position our members for new reimbursement models that will impact practice; providing new resources to address the AA issue; initiating a leadership workshop to improve the governance competencies of our members; providing additional funding to support state associations fighting legislative and regulatory battles; developing a new strategic plan that looks ahead 10 years and will make this organization the transformative leader in healthcare; implementing strategies to optimize workforce; and using new and innovative communication channels to connect with the AANA membership. We have sought feedback from the members and considered their ideas, questions, comments, and concerns, often leading to the Board taking bold and sometimes scary steps to move our association forward.

Based on the information provided to the Board, I once again want to assure you that our decision to bring Amendment 7 to the membership was well intentioned. Never did we perceive that our fellow members would see this action as an attempt to silence their voices, especially with so many channels for direct communication available to allow members to be heard by the Board without waiting until Annual Congress. While the member dialogue has been essential, impactful, and maybe even cathartic, I apologize for this misstep and the consternation it has caused.

I look forward to seeing you at the Annual Congress in Boston.

Sincerely,

Bruce Weiner, DNP, MSNA, CRNA
AANA President

3. AANA Responds to President Trump's Proposed FY2019 Budget, February 15, 2018

In response to the release of President Donald Trump’s proposed Fiscal Year 2019 budget, the AANA has grave concerns about its potential far-reaching impact on the nation’s nursing workforce.

The president’s budget proposes significantly cutting the federal healthcare workforce and research programs under Title VIII of the Nurse Workforce Development Program, from $229 million to just $83 million, a decrease of 64 percent.

“For more than 50 years, the programs supported under Title VIII have helped to build the supply and distribution of qualified nurses to meet our nation’s healthcare needs. Title VIII funding has also been critical to educating and training Certified Registered Nurse Anesthetists (CRNAs) who deliver more than 43 million anesthetics to patients each year in the United States, especially those living in rural and other medically underserved areas,” said AANA President Bruce Weiner, DNP, MSNA, CRNA.

“Nurses supported through Title VIII programs go on to provide high-quality, evidence-based healthcare to patients in a variety of settings including hospitals, surgery centers, physicians’ office, long-term care facilities, community centers, state and local health departments, schools, workplaces, patients’ homes, and more. It is imperative that these programs continue to thrive and provide support for institutions that educate and train our future nursing workforce to meet our nation’s growing demand for healthcare services,” Weiner said.

The AANA also is concerned about the addendum to the president’s budget which recommends cutting the National Institute of Nursing Research (NINR) by approximately $3 million, a decrease of 2 percent.

“While the AANA is pleased to see that the president’s proposed budget includes increased funding for the National Institutes of Health, we are concerned about the proposed cuts to NINR,” Weiner said. “Nursing science is critical to promote and improve the health of individuals, families, and communities. Many of the findings from nursing science can be put directly into practice, changing lives and promoting wellness.”

4. AANA Opposes ASA's Amended ACT Statement; Taking Steps to Counter, November 8, 2018

Dear Colleagues,

On Oct. 17, 2018, the American Society of Anesthesiologists’ (ASA) House of Delegates adopted an amended version of its Statement on the Anesthesia Care Team (ACT). To be clear, the AANA has opposed the ACT Statement since it was first approved by the ASA in 1982, and is equally opposed to the recent amendments which promote even tighter practice and educational restrictions for CRNAs and student registered nurse anesthetists (SRNAs).

The purpose of this letter is to inform you of the AANA’s next steps regarding the amended ACT Statement based on a thorough review of the document which has been undertaken by AANA legal counsel and staff, and by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA).

The amended ACT Statement remains problematic for the AANA, CRNAs, and SRNAs because it attempts to diminish the role and value of CRNAs in patient care, misrepresents the way CRNAs and anesthesiologists work together, and seeks to impose stricter limitations on the clinical supervision of SRNAs with no evidence to support the need for such action. You can read the full statement on the ASA website.

Despite the strident nature of the ACT statement, it is not supported by evidence or fact. All AANA members, especially those working in ACT settings serving as clinical education sites for SRNAs, need to understand the following truths which serve as strong counterpoints to inappropriate interpretation and usage of the ACT Statement in the workplace and educational settings:
  • The statement is not in any way legally binding on facilities or providers, nor does it have any authority over the regulation of nurse anesthesia educational programs.
  • The SRNA supervision requirements promulgated by the statement are inconsistent with and more stringent than those of the Centers for Medicare & Medicaid Services (CMS) and many state laws.
  • The amended ACT Statement does not recognize that anesthesia care can be provided by a non-medically directed CRNA, when clearly it can be.
  • The definition of “immediately available” in the ACT Statement has not been adopted by CMS in its Medicare anesthesiologist Part B medical direction policy.

In the coming weeks the AANA will take the following steps to counter the amended ACT Statement, including:
  • Reach out to key stakeholders (chief CRNAs, educators, others) to better understand their position on the statement and how it might impact their practice;
  • Develop a strategic position on the ASA’s ACT Statement that AANA members can use for negotiating, lobbying, and other purposes;
  • Create a plan for ongoing communication with the members on this important matter;
  • Formally communicate the AANA’s concerns about the statement to ASA leadership and seek revisions to the statement which are amenable to the AANA;
  • Produce an FAQ document about the ACT Statement to help members become informed and conversant on the topic;
  • Designate a specific point of contact for members concerning this issue.

To that end, should you detect changes in your workplace or clinical education sites as a potential result of the ACT Statement or have questions on this matter, or encounter payors using the ASA’s definition of “immediately available” in their materials, please contact AANA Chief Clinical Officer Lynn Reede, DNP, MBA, CRNA, FNAP, at lreede@aana.com or (847) 655-1136.

As always, the AANA will keep you apprised of new developments as this matter continues to evolve.

Sincerely,

Garry Brydges, DNP, MBA, ACNP-BC, CRNA, FAAN
AANA President

5. The Joint Commission Updates Hospital Life Safety Standard Affecting Anesthesia, March 8, 2018

Effective March 11, 2018, Joint Commission-accredited hospitals, critical access hospitals, ambulatory surgery centers, and office-based surgery settings must comply with the following standard.

EC 02.05.01 EP 27:

Areas designated for administration of general anesthesia (specifically, inhaled anesthetics) using medical gases or vacuum are as follows:
  • Heating, cooling, and ventilation are in accordance with ASHRAE 170. Medical supply and equipment manufacturers’ instructions are considered before reducing humidity levels to those allowed by ASHRAE.
  • Existing smoke control systems automatically vent smoke, prevent the recirculation of smoke originating within the surgical suite, and prevent the circulation of smoke entering the system intake, without interfering with exhaust function. New occupancies have no smoke control requirement.
  • For hospitals that use Joint Commission accreditation for deemed status purposes: Existing smoke control systems are maintained according to the edition of NFPA 101 adopted by The Centers for Medicare & Medicaid Services at the time of installation. (For full text, refer to NFPA 101-2012: 20/21.3.2.3; NFPA 99-2012: 9.3.1)

6. Two-Year Check-In Deadline Approaching: July 31, July 26, 2018

For most CRNAs who recertified or initially certified in 2016 on or before July 31, the deadline to complete their quick two-year check-in is July 31, 2018. More than 80 percent of all CRNAs due to complete this next step in the CPC Program have already done so.

Don’t wait—only days remain before the July 31 deadline. Complete your Check-in here: http://portal.nbcrna.com. Not sure of your deadline? See the chart on www.nbcrna.com/2YCI. Not sure when you recertified? Click "verify credential" in the top right corner of the NBCRNA website www.nbcrna.com. If you’ve already checked-in or are not due to recertify this year, remind your colleagues.


7. Prescription Gabapetin - Caution Needed, May 17, 2018

Increasing use and misuse of prescription gabapentin is putting opioid-using patients at risk of overdose. Previously thought to be a safe alternative non-narcotic pain reliever, gabapentin has an abuse potential in high doses and, used with heroin, can impair breathing and reverse tolerance to opioids. Since identification of this risk in 2015, some states have taken action to use caution and controls to prevent a new prescription drug epidemic.

8. AANA Board Approves Statement on Titles and Descriptors for CRNAs, August 2, 2018

Dear AANA Members,

This past February, the AANA Board of Directors created the Nurse Anesthesiologist Descriptor Task Force and charged it with analyzing the pros and cons of the AANA recognizing the descriptor "nurse anesthesiologist" for use by CRNAs. After more than five months of information gathering, analysis, and discussion, the task force presented its recommendations to the AANA Board of Directors during the open session of the Board meeting held July 27, 2018.

Following a robust discussion by the Board, a statement concerning the use of titles and descriptors by CRNAs was developed and unanimously approved. The statement, which incorporates input from the task force and the membership at large, is as follows.

The Board wishes to thank the task force members for the time and effort they dedicated to this important assignment.

Statement
The practice of anesthesia has been a recognized nursing specialty for more than 100 years. The AANA presents this statement in an effort to clarify for the public the many ways someone may refer to a CRNA.

The AANA recognizes the following titles:
  • Certified Registered Nurse Anesthetist
  • CRNA
  • Nurse Anesthetist
The AANA acknowledges additional descriptors for nurse anesthetists which could include, but are not limited to, the following:
  • Advanced Practice Registered Nurse (APRN)
  • Licensed Nurse Practitioner (LNP)
  • Licensed Independent Practitioner (LIP)
  • Advanced Practice Provider (APP)
  • advanced practice professional
  • nurse anesthesiologist
Regardless of the title or the descriptor being used, as a profession we believe it is time for the focus to be on the quality of the healthcare provided and not the title of the healthcare provider.

It remains the responsibility of each individual CRNA to remain aware of and comply with the legal requirements of any state or facility in which they practice.

Sincerely,

2018 AANA Board of Directors

9. Thousands Complete CPC Program 2 Year Check-in Early, April 19, 2018

CRNAs due to complete their next step in the CPC Program this year wasted no time in completing the 2-year Check-in when it opened April 3. To date, more than 5,500 CRNAs have already completed the 2-year Check-in, with many reporting that the entire process took less than five minutes.

The 2-year Check-in is the mid-point requirement in the 4-year CPC Program cycle. At check-in, CRNAs will confirm licensure and practice, update contact information, review progress in the CPC Program, and pay the $110 credentialing fee for the upcoming two years — the same fee amount and timing as in the past – which supports year-round NBCRNA activities that seek to keep the credential strong.

Unsure if you need to check in this year? Your 2-year Check-in deadline will depend on your 2016 recertification or initial certification date. Find a 2-year Check-in deadline chart, FAQs, videos, and more at www.nbcrna.com/2YCI. The process is simple, but you can watch videos or download step-by-step instructions to use as a guide.

When you're ready to check in, visit the NBCRNA online portal. This quick and easy process can be completed from a computer, cell phone, or other mobile device.

10. AANA Challenges Anthem on New Anesthesia Policy That Puts Patient Safety at Risk, March 22, 2018

The AANA has expressed its strong opposition to the recent decision by health insurer Anthem, Inc., which directs ophthalmologists to assume responsibility for anesthesia administration and patient monitoring during routine cataract surgeries, calling the move a “dangerous and reckless policy that jeopardizes the safety and well-being of millions of patients, all in an effort to cut costs and increase profits.” The AANA represents more than 52,000 CRNAs, anesthesia experts who frequently provide patient care during eye procedures.

“While cataract surgeries are generally routine,” said Bruce Weiner, DNP, MSNA, CRNA, president of the AANA, “any surgical procedures that require anesthesia, especially those involving hypersensitive areas like the eyes, call for highly educated anesthesia professionals like CRNAs to administer medication and monitor patients properly without distraction.” Read more.

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Hot Topics


AANA Launches the Code of Ethics for the CRNA: Overview and Resources Webpage

In July 2018, the AANA Board of Directors approved a modernized Code of Ethics for the Certified Registered Nurse Anesthetist. This code establishes the ethical standards for the nurse anesthesia profession and guides the Certified Registered Nurse Anesthetist (CRNA) in ethical analysis and decision making in daily nurse anesthesia practice.

The AANA has created a new Code of Ethics for the CRNA: Overview and Resources Webpage to post relevant information, resources, and AANA Journal articles related to the topic of ethics and nurse anesthesia practice.
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AORN Guideline for Surgical Attire Available for Public Comment

The Association of periOperative Registered Nurses (AORN) Guideline for Surgical Attire is currently out for open comment. This document provides guidance to perioperative team members for laundering surgical attire; wearing long sleeves, cover apparel, head coverings, and shoes in semi-restricted and restricted areas; and cleaning of identification badges, stethoscopes, and personal items such as backpacks, briefcases, cell phones, and electronic tablets. CRNAs are encouraged to review and leave professional, diplomatic, and concise comments directly on the AORN site. Note, non-AORN members will be asked to create a free account in order to be able to submit comments.
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Update from the Full Scope of Practice Competency Task Force

A dedicated AANA member webpage (login required) has been created where updates will be posted on the work of the Full Scope of Practice Competency Task Force (FSOPCTF). Members can currently view a summary of the FSOPCTF Dec 15-16, 2018 meeting, held at AANA headquarters. 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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Powerful CRNA Podcast Discusses CRNAs and the Legislature

Former AANA President Sharon Pearce, MSN, CRNA, and CRNA Financial Planning's Jeremy Stanley, CFP, AIF, have launched a series of podcasts called Beyond the Mask. It can be found here and on iTunes. Episode #7 (January 3, 2019) with Patrick Ballantine, who has served in the North Carolina state senate, discusses CRNAs and the Legislature.

Ballantine is currently a lobbyist for the North Carolina Association of Nurse Anesthetists (NCANA), and talks about what kinds of conversations are happening on the legislative level and how you can get involved in making sure CRNA interests are represented in government.
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2019 MIPS Performance Category Fact Sheets Available

The AANA prepared fact sheets that provide an overview of the 2019 updates to the MIPS performance measure categories, which CMS published in the Physician Fee Schedule Final Rule in November 2018. The updates include revised performance measure category reporting requirements, and the scoring weights attributed to each category. The fact sheets are available through the Quality and Reimbursement website on January 4, 2019.
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Join CRNA Delegation to Croatia

Dear Colleague:

As a former president of the AANA, I am honored to have been selected as leader of the CRNA Delegation to the Republic of Croatia. I invite you to join me in this important international exchange. In conjunction with World Learning, a U.S.-based nonprofit organization, this delegation has been developed to foster one-on-one dialogue with our overseas counterparts.

Our delegation will continue World Learning's 85-year legacy of advancing leadership through engaging citizens and forming networks between the U.S. and international colleagues. This delegation will convene in Zagreb, Croatia, in May 2019. I believe you would contribute valued expertise to the team while gaining both personally and professionally from the experience.

The CRNA Delegation will meet with practicing nurse anesthetists and surgical teams to discuss their methods and experiences implementing programs designed by international experts to address shared challenges in healthcare delivery.

The topics of discussion and site/facility visits designed for this program are:
  • Croatian nurse anesthesia practice
  • Anesthesia delivery model(s) in Croatia
  • Structure of nurse anesthesia education
  • Activities undertaken for the promotion of surgical patient safety
  • Analysis of any current drug shortages and how healthcare providers are dealing with them
  • Delivery of anesthesia in the operating theater and remote locations
  • Challenges currently experienced in Croatian healthcare delivery
  • Exploration of opioid addiction in Croatia and how is it being addressed

The professional delegation will convene in Zagreb, Croatia, on May 18, 2019, and conclude in the coastal city of Rijeka on May 24, 2019.

The interactions, site visits, and experiences have been designed to enhance our appreciation for this unique Eastern European country and the diverse populations that define this part of the world.

See the Preliminary Schedule of Activities for an outline of our planned professional opportunities and cultural experiences.

For more information regarding the region's history as well as program details including cost and application process, check out the AANA Delegation pamphlet.

To apply to join me on this rare journey, please go to the World Learning Professional Exchanges page.

I am pleased to be involved in this exciting opportunity, and I hope you will consider participating in this unique event. In the meantime, please feel free to contact me or World Learning with any questions.

Sincerely,

Debra Malina, DNSc, MBA, CRNA
AANA President, Fiscal Year 2012
dmalina01@gmail.com

Dawn Davis
Global Development and Exchange
World Learning
Office: 509-251-9532
dawn.davis@worldlearning.org
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Doing Work Outside of Your Primary Job?

It has become increasingly common for CRNAs to pick up work outside of their primary jobs. If you are looking to add a few extra hours to your work week, ensure you are properly protected with a moonlighting policy through AANA Insurance Services. Get a Quote 
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NewsMakers: CRNA Authors in Top Nurse Managing and Leadership Book of the Year

The American Journal of Nursing has released the winners of its Book of the Year Awards 2018. In the category of Nurse Managing and Leadership, the number one book is Health Policy and Advanced Practice Nursing: Impact and Implications, which features CRNA authors — current AANA President Garry Brydges, DNP, MBA, CRNA, ACNP-BC, FAAN, and former AANA President Christine Zambricki, DNAP, MS, CRNA, FAAN.

Brydges, along with Cynthia Abarado, Kelly Brassil and Joyce E. Dains, authored a chapter titled, "Health Policy Implication for APRNs Related to Oncology Care."

Zambricki's chapter is titled, "Health Care Policy and Certified Registered Nurse Anesthetists: Past, Present and Future."

Former AANA Professional Relations Specialist Maureen Shekleton, PhD, RN, FAAN, also authored a chapter with Melinda Ray titled, "Coalition for Patients' Rights: A Coalition that Advocates for Scope of Practice Issues."

Congratulations to all!
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NewsMaker: CRNA Corey Johnson Discusses Radiofrequency Ablation Pain Management Option

Corey Johnson, MAE, CRNA, ARNP, spoke with a local newspaper about a new procedure at Pullman Regional Hospital in Pullman, Wash., that helps patients reduce pain without opioids. The procedure is called radiofrequency ablation, takes about 30 minutes, and is performed while the patient is under deep sedation.

"The radiofrequency ablation procedure involves radio waves," says Johnson, "which create heat that disrupts the sensory nerves of a certain part of the body, such as the knee or hip."

Read more.
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NewsMaker: CRNA Vicki Coopmans Recipient of Faculty Research Grant

The Webster University 2019 Faculty Research Grant recipients include Vicki Coopmans, CRNA, for her research on "Platelet Release of 5-Hydroxytryptamine with Exposure to Amniotic Fluid: An Investigation Into the Pathyphysiologic Mechanism of Amniotic Fluid Embolism." Coopmans is one of 24 recipients. Read more.
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NewsMaker: CRNA Powerlifting at 76

Think you're in pretty good shape? Meet Pauline Horn, CRNA, whose physical therapist suggested she begin strength training, never imagining she'd become a competitive powerlifter. "At 76, Ms. Horn turns heads in the gym when she deadlifts 185 pounds five times in a row," reports the Wall Street JournalRead more.
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NewsMakers: Illinois CRNAs Get Jump on National CRNA Week

The Illinois Association of Nurse Anesthetists began its National CRNA Week (January 20-26, 2019) campaign early, with a very visible billboard on one of Chicago's busiest highways, and featuring its CRNAs in a local suburban newspaper. They also posted a calendar of events for the entire month of January.

The Daily Herald featured a story titled "Nurse Anesthetists: Always There, Caring for Illinois Since 1880," which combined nurse anesthesia history with quotes and descriptions of what CRNAs do, who they are and how they have served the state. Read more.
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AANA Member Benefits


New AANA Member Advantage Partner: Hagan Barron Intermediaries (HBI)

It is AANA's pleasure to introduce a new AANA Member Advantage Partner, Hagan Barron Intermediaries (HBI). HBI will be managing the group disability and other group insurance offerings through the Member Advantage Program as our official broker on record.

Learn more about the group insurance benefits designed exclusively for AANA members today. Coverage options include:
  • Group Disability Income
  • Term Life Insurance
  • Accident-Only Disability
  • Accidental Death & Dismemberment
HBI is an industry leader in the administration and marketing of insurance programs for professionals. HBI is committed to the AANA and our members, providing an exceptional customer experience. To learn more, visit: myaanainsurance.com.
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Jobs


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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Certified Registered Nurse Anesthetists: Sanford Health, Fargo, North Dakota

Sanford Health Fargo Anesthesia Department is currently seeking Certified Registered Nurse Anesthetists (CRNA) to join its current group of 21 anesthesiologists and 72 CRNAs. Learn more.
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Nurse Anesthetist, CRNA: Mayo Clinic, Rochester, Minnesota

You are invited to be a part of the Mayo Clinic legacy where CRNAs are essential anesthesia care providers within our multidisciplinary integrated group practice. The CRNA role is deeply embedded in the Mayo Clinic practice with Mayo’s nurse anesthesia program being the oldest continually operating program in the country. As a CRNA at Mayo Clinic, you will be a part of a world renowned surgical and procedural environment that presents opportunities that may rarely be experienced elsewhere. As our surgical and procedural practices grow, we invite you to join our diverse team as we provide health, hope, and healing to people from all walks of life. Learn more.
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CRNA: Banner University Medical Center, Tucson (BUMC-T), 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. Must be able to work autonomously as well as part of an integral team of clinicians and physicians. Learn more
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CRNACareers

Check out the new AANA Career Center, CRNA Careers! Whether you’re a seasoned CRNA or just getting started, the new Career Center can connect you to the best opportunities.

Plus, there are robust search tools to help narrow your search, as well as tips for resume writing and salary negotiating. Add your resume and know that you can remain anonymous if you choose. Take advantage today!

Visit CRNAcareers.com to view or place job postings

 

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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.

United States State-Level Variation in the Use of Neuraxial Analgesia During Labor for Pregnant Women

Through a cross-sectional analysis of more than 2.6 million women who gave birth in 2015, researchers have confirmed a suspected uneven pattern of neuraxial labor analgesia use from state to state. The technique is considered the gold standard for pain relief during labor, and results from this retrospective investigation show that it was indeed used by 73.1 percent of the study population. However, usage varied widely, ranging from a prevalence rate of just 36.6 percent in Maine to 80 percent utilization in Nevada. Only a small portion of the variation, 5.4 percent, was explained by U.S. states, with unmeasured patient-level and hospital-level factors likely accounting for the bulk of the discrepancy. The researchers recommend further study to determine the primary reasons behind the variation in practice, as well as whether it has an impact on maternal or perinatal outcomes.

From "United States State-Level Variation in the Use of Neuraxial Analgesia During Labor for Pregnant Women"
JAMA Network Open (12/28/18) Vol. 1, No. 8 Butwick, Alexander J.; Bentley, Jason; Wong, Cynthia A.; et al.

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Sufentanil Sublingual Tablet Well-Tolerated, According to Pooled Safety Data

New manufacturer data reflect acceptable tolerance with the new sufentanil sublingual tablet (SST), approved by the Food and Drug administration late last year. The finding comes from a pooled analysis of relevant clinical trials where Dsuvia was administered to patients dealing with moderate-to-severe acute pain after surgery or in an emergency room situation. In a report appearing in Pain Management, the study authors note that most adverse events associated with SST—including nausea, vomiting, and headache—were mild or moderate in nature. Moreover, the researchers say, "SST 15 mcg was calculated to be equal to approximately 2.5 mg I.V. morphine based on drug utilization in each treatment group" in the first five hours after treatment initiation. Dsuvia, manufactured by AcelRx, is indicated for the management of acute pain in adults only when the pain is severe enough to require opioids, when other treatments are insufficient, and when administered in a certified medically supervised healthcare setting.

From "Sufentanil Sublingual Tablet Well-Tolerated, According to Pooled Safety Data"
Monthly Prescribing Reference (01/07/19)

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A Clinical Trial Comparing Ilioinguinal/Iliohypogastric Nerve Block to TAP Block Following Open Inguinal Hernia Repair

Results are in from a prospective study that examined pain relief with ilioinguinal/iliohypogastric (IINB) compared with transversus abdominis plane (TAP) block after open inguinal hernia repair. Research partners from the University of Buffalo in New York and Iran University of Medical Sciences in Tehran randomized 45 participants recovering from the procedure in the post-anesthesia care unit to IINB and the same number to TAP block, all under ultrasound guidance. Numeric Rating Scale scores were lower for the IINB recipients both at rest and during movement at 24, 36, and 48 hours postoperatively. Analgesic satisfaction levels, meanwhile, were much higher in the IINB group than in the TAP block group. The findings point to superior analgesia from IINB versus TAP block in patients who have undergone open repair of inguinal hernia.

From "A Clinical Trial Comparing Ilioinguinal/Iliohypogastric Nerve Block to TAP Block Following Open Inguinal Hernia Repair"
Journal of Pain Research (01/19) Vol. 2019, No. 12, P. 201 Hamid Reza Faiz, Seyed; Nader, Nader D.; Niknejadi, Soraya; et al.

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Ketamine Shows Potential in Anxious Treatment-Resistant Depression

New evidence suggests that intravenous ketamine could help patients with treatment-resistant depression, regardless of whether their condition is anxious or nonanxious in nature. Harvard Medical School's Naji Salloum, MD, led the pilot study, which involved secondary analyses of data from a recent trial that compared outcomes with IV ketamine relative to midazolam. The primary investigation found ketamine to be the more effective agent, but Salloum and colleagues were interested in stratifying responses based on anxious versus nonanxious depression. Although the 45 study participants with anxious depression had a lower level of disassociative symptoms 40 minutes post-infusion, the change from baseline on several disease rating scales was similar to that of patients with nonanxious depression one and three days after treatment. "Our data suggest that patients with anxious depression respond equally as well to ketamine compared to those with nonanxious depression," the team wrote in Depression & Anxiety. "The exact mechanism behind the differential response to ketamine versus other conventional antidepressants in anxious depression remains unclear. These results are still exploratory and future larger and adequately powered studies designed to specifically test this aim are warranted."

From "Ketamine Shows Potential in Anxious Treatment-Resistant Depression"
Healio (01/04/2019) Demko, Savannah

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Fed Panel Releases Draft Report on Pain Management

The Pain Management Best Practices Inter-Agency Task Force, created in 2016, has come up with a list of recommendations for improving pain care in the United States. According to the panel's 29 expert members, pain management should be individualized, balanced between pharmacological and nonpharmacological solutions, multidisciplinary, and multi-modal. They also emphasize the importance of addressing the needs of special populations, including children, women, older adults, and current and former service members. A draft report on the recommendations shuns "chronic pain" as an inadequate term that often fails to capture problems that may be exacerbated by surgery or other medical catalysts, for example, or characterized by flares from an underlying disease or injury. At the same time, panelists include a slate of conditions—from cancer and multiple sclerosis to lupus and cluster headaches—that can be included under the new category of "chronic relapsing pain conditions." Additionally, the draft report touches on the risks associated with concomitant opioid and benzodiazepine use, the relationship between drug shortages and poor-quality pain care, and opioid prescribing guidelines. The task force will accept public feedback on its draft report during a 90-day comment period, after which the report will be finalized and submitted to Congress.

From "Fed Panel Releases Draft Report on Pain Management"
Pain News Network (01/01/19) Chriss, Roger

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Propofol vs. Inhalational Agents to Maintain General Anaesthesia in Ambulatory and In-Patient Surgery

A meta-analysis compared general anesthesia maintenance with propofol versus inhalational agents, with postoperative nausea and vomiting (PONV) as the primary outcome. A total of 229 randomized controlled trials were included, for a collective sample of nearly 21,000 patients. The risk of PONV was lower with propofol, which also was associated with reduced pain scores after extubation and less time in the post-anesthesia care unit. While it took longer for the propofol patients to achieve respiratory recovery and tracheal extubation, their patient satisfaction scores were still higher than their counterparts on inhalational agents for anesthesia maintenance. Despite the apparent benefits of propofol in this setting, the researchers say adequately powered prospective clinical trials are needed to identify the clinical and economic implications of their results, which are reported in BMC Anesthesiology.

From "Propofol vs. Inhalational Agents to Maintain General Anaesthesia in Ambulatory and In-Patient Surgery"
Medscape (12/26/18)

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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.

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January 10, 2019
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