Anesthesia E-ssential

AANA Anesthesia E-ssential
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New Anesthesia Methods Fueled by Artificial Intelligence and Opioid Addiction

President-elect Garry Brydges, DNP, MBA, ACNP-BC, CRNA, spoke with The Huffington Post recently about artificial intelligence and the effects of opioid addiction, and how they are affecting new technology in anesthesia.
Brydges discusses how the cerebral oximeter, optimizing a patient's fluid status, Enhanced Recovery After Surgery (ERAS), artificial intelligence, and even ultrasound used in tandem with regional anesthesia are all affecting the advancement of anesthesia.
“We’re starting to see the industry consolidate their products into a one-device for the end-user anesthesia provider,” Brydges said. “We are being pushed to do a better job at lowering pain, which means higher quality medical care at a lower cost of healthcare delivery.”
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Hot Topics

Ready to Buy or Refinance Your Home? Take Advantage of Exclusive Mortgage Savings From Quicken Loans

Start 2018 off with the purchase of your dream home or save money for the new year with a refinance! Mortgage rates have been consistently low, making now a great time to explore your options. AANA Member Advantage Program Partner Quicken Loans' dedicated AANA Home Loan Experts are here to help you with all of your mortgage needs.
These special savings are available exclusively to American Association of Nurse Anesthetists:
  • $500 cash back* after closing, PLUS a $500 closing cost credit*
  • A complimentary mortgage review to compare your mortgage options
  • VIP treatment from a dedicated team of Home Loan Experts
Your friends and family members can also take advantage of these savings when they purchase or refinance!
Visit or call (855) 245-5911 to get started. 
*See website for details.  
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FDA Expects Shortage of IV Saline Solution to Improve in Early 2018

The U.S. Food and Drug Administration (FDA) is confident that the shortage of saline IV fluids and bags caused when Hurricane Maria hit Puerto Rico last year will soon subside. "Based on the information we’re receiving from the companies, we expect that the shortage of IV saline fluids will improve in early 2018, with continuing improvements in the weeks ahead," FDA Commissioner Scott Gottlieb said in a statement. Baxter, a leading producer of IV saline fluids, announced that all of their facilities on the island have returned to the commercial power grid. Read more in the FDA’s statement.
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Lyme Disease and Anesthesia: Five Facts

An article in the December 2017 issue of AANA Journal, “Lyme Disease and Anesthesia Considerations,” by Tammy Smit, MSNA, CRNA, discusses possible effects of anesthesia on Lyme disease patients undergoing surgery. Here are some important facts to know:
  1. In the pre-operative assessment interview, patients should let their anesthesia professional know if they have been in an area where there is a risk of contracting Lyme disease, such as hiking areas where ticks are present. Patients who know they have Lyme disease should discuss the choice of anesthetic with their anesthesia provider.
  2. General anesthesia may suppress the immune system. Volatile anesthetic agents may affect the functioning of white blood cells in combatting disease.
  3. Patients with “systemic infections” (those that affect the entire body) such as Lyme disease may need to be cautious with spinal or epidural anesthesia, as they may introduce infective agents into the central nervous system. This can be especially important in the early stages of the disease when there may not yet be signs of central nervous system involvement.
  4. Since 2005, 20,000-30,000 confirmed infections are reported to the Centers for Disease Control and Prevention each year.
  5. Of the diseases required by law to be reported to government authorities, Lyme disease is the fifth most common nationally. Lyme disease is also the most commonly reported infection transferred from one living organism to another in the U.S.Each disease or health condition has its considerations for anesthesia and surgery.
Patients are encouraged to speak freely with their anesthesia provider to ensure that all health considerations are included in the anesthesia plan. Telling the anesthesia provider about allergies, health conditions, complementary or alternative drug use, prescription and illicit drug or alcohol misuse helps to keep the patient safe throughout surgery.
The full article, "Lyme Disease and Anesthesia Considerations,"is available in print and on the AANA website.
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LAST CALL for Candidates: Delegate to Education Committee
Deadline is Jan. 15

The AANA Education Committee is seeking candidates interested in serving on the committee as a delegate. The deadline for receiving completed candidate packets is Jan. 15, 2018. The election will be held, and the winner announced, at the Assembly of School Faculty in February 2018.
The candidate information packet is available on the AANA website.
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Nomination Deadline for AANA Award for State Government Relations Advocacy is February 15

Has your state nurse anesthetist association made significant efforts in state government relations advocacy this year? Describe your state’s efforts and enter to win the AANA Award for Excellence in State Government Relations Advocacy, to be presented at the AANA Mid-Year Assembly in April 2018. This annual award is not predicated on a specific “victory” in the state legislative or regulatory arena, but is based on the quality of the undertaken effort. Examples of state association efforts include successful lobby days, legislative/regulatory efforts, or increased member participation in grassroots and other efforts.
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ATTN State Presidents! Nomination Deadline for Daniel D. Vigness Federal Political Director Award is Jan. 15

Is your state's Federal Political Director (FPD) awesome? Then nominate him or her for the Daniel D. Vigness Federal Political Director Award, which is presented during the AANA Mid-Year Assembly in April 2018. Named for the late Dan Vigness, CRNA, of South Dakota, the first AANA FPD of the Year, this honor recognizes a CRNA who has been involved in federal political campaigns, developed close working relationships with federal officials, led successful CRNA advocacy efforts, helped contribute and raise funds for the CRNA-PAC, and helped recruit CRNAs to participate in political campaigns. Learn more at AANA Awards.
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FDA Launches New Smoking Cessation Education Campaign

Nearly 70 percent of current adult smokers say they want to stop smoking. The U.S. Food and Drug Administration (FDA) has launched a new smoking cessation education campaign, “Every Try Counts,” which features tools, tips, and educational resources to help quit smoking. Share these tools with your patients to educate about the health benefits of quitting smoking. Read more in the recent FDA Consumer Update.
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PharMEDium Services, LLC Issues Voluntary Recall of Certain Lots of Compounded Sterile Products

PharMEDium Services, LLC is voluntarily recalling certain lots of drug products due to a lack of assurance of sterility. Administration of a drug product intended to be sterile that is not sterile could result in serious infections that may be life-threatening. To date, PharMEDium has not received any reports of complaints related to the products but is issuing this recall out of an abundance of caution. Learn more and review the affected lots.
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Professional Practice

Joint Commission Surveys: Hand Hygiene Focus

In 2018, The Joint Commission will increase scrutiny of hand hygiene during accreditation surveys.  If a surveyor witnesses an individual failing to perform required hand hygiene during patient care activities, the organization will be cited for a deficiency under Infection Prevention and Control standard IC.02.01.01, element of performance 2.  That element requires organizations to use standard precautions, as well as personal protective equipment, to reduce infection risk.  Citations will lead to a Requirement for Improvement. The Joint Commission will also continue to survey for compliance with its National Patient Safety Goal 07.01.01, which requires the implementation and maintenance of a hand hygiene program, setting goals for improved compliance, and improving results through appropriate actions.  The Joint Commission notes that hand hygiene is widely known to be the most important intervention for preventing healthcare–associated infections. Read about this survey focus.
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Meetings and Workshops

Register Now for the Assembly of School Faculty
Feb. 15 - 17, 2018
The Scottsdale Resort at McCormick Ranch

Registration is now open for the only forum that brings all nurse anesthesia educational programs together in one place to discuss and define the future of the profession. If you are passionate about nurse anesthesia education, the Assembly of School Faculty is the must-attend meeting of the year. Find out more, and register now!
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Registration for the AANA Mid-Year Assembly is Now Open!

Join us April 21-25, 2018, at the Grand Hyatt Washington for the most important CRNA advocacy meeting. The AANA Mid-Year Assembly prepares nurse anesthetists to effectively advocate on Capitol Hill for protecting and advancing CRNA practice and reimbursement. You'll get briefings on the important issues facing CRNAs and hear from seasoned political pundits on how to communicate effectively with the legislators who can support the nurse anesthesia profession. 
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Federal Government Affairs

Applications to serve on the CRNA-PAC Committee are due Jan. 31, 2018

Are you a CRNA or SRNA with a strong interest in furthering the nurse anesthesia profession through federal political advocacy? If so, we invite you to apply for a position on the CRNA-PAC Committee beginning in fiscal year 2019.

Responsibilities of Committee members include setting and overseeing the CRNA-PAC expenditure and income policy, determining funding of open-seat and challenger candidates, fulfilling duties at CRNA-PAC events and AANA national meetings, participating in fundraising activities, and attending in-person meetings at the Mid-Year Assembly and Joint Committee Conference. A full job description can be found here.
Interested candidates should submit an application to the AANA Executive Unit at by Jan. 31, 2018. Student applicants should submit a letter of permission from their program director along with their application. Additional criteria for student applicants can be found on  CRNA-PAC.COM.
If you have any questions, please contact Catharine Harris, AANA Associate Director of Political Affairs, at or (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 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 our 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. All contributors must be US citizens.
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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.

Periarticular Injection With or Without Adductor Canal Block Improves Pain Control After Total Knee Arthroplasty

New evidence suggests that effective pain control after knee replacement can be achieved by administering periarticular injection, with adductor canal block or not, as part of multimodal analgesia. Based on recent findings, investigators initially suspected that including adductor canal block in this setting would prepare patients for discharge half a day sooner than without it; but the results showed otherwise. The research involved 111 patients, all of whom received intraoperative neuraxial anesthesia, multimodal analgesia, and an accelerated rehab protocol. Randomization, however, determined whether they additionally received periarticular injection with adductor canal block or periarticular injection only. Readiness for hospital discharge, determined by the patients' ability to independently negotiate stairs, proved to be comparable between the two sets of patients: a median 26.4 hours with adductor canal block and 25.8 hours without it. Enrique Goytizolo, MD, of the Hospital for Special Surgery, said: "This study has demonstrated that both of these approaches are viable techniques and have the same basic results in terms of discharge," the primary outcome. The researchers noted, however, that the combination of adductor canal block and periarticular injection with an accelerated rehabilitation protocol increased patient satisfaction and delivered greater pain relief the day of surgery.

From "Periarticular Injection With or Without Adductor Canal Block Improves Pain Control After Total Knee Arthroplasty"
Pain Medicine News (01/08/2018) Doyle, Chase

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Bariatric Surgery Linked to Prolonged Post-op Opioid Use

Evidence continues to show that patients undergoing weight loss surgery are more likely to develop persistent postoperative opioid use than other patients. Researchers used the Michigan Bariatric Surgery Collaborative database to identify thousands of patients who filled out questionnaires about their consumption of narcotic painkillers before and after the procedure. For comparative purposes, the team also consulted the Michigan Opioid Prescribing Engagement Network to retrieve data on general surgery patients. The numbers showed that, among all 14,063 bariatric patients, almost 25 percent were still using opioids one year post-surgery. About 75 percent of the bariatric patients said they were opioid-naive, meaning they had not used prescription painkillers in the year before surgery. Among this subset, 8.8 percent were still taking opioids a year after starting them for postoperative pain versus 6 percent of opioid-naive general surgery patients who did the same. The researchers recommend screening patients for substance abuse risk factors, prescribing fewer opioids in the first prescription, and performing local nerve blocks intraoperatively to curtail the need for opioids postoperatively.

From "Bariatric Surgery Linked to Prolonged Post-op Opioid Use"
Gastroenterology & Endoscopy News (01/18) Frangou, Christina

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IV Acetaminophen for Post-Op Pain Control

Intravenous acetaminophen has been explored as an alternative to opioids in the surgical setting, including for pediatric patients. For one prospective study, researchers with Children's Mercy Hospitals and Clinics in Kansas City, Mo., assessed the effect of I.V. acetaminophen on the postoperative pain course of children with perforated appendicitis. A total of 82 patients were randomly assigned to receive either standard patient/nurse-controlled analgesia (PCA) or PCA plus I.V. acetaminophen. Investigators documented and compared primary duration of PCA use before switching to oral pain medications. There was no statistically significant difference between the two groups in that main endpoint, nor in the amount of oral narcotics consumed. Based on the study results, the investigators concluded that I.V. acetaminophen does not expedite the transition time from PCA to oral pain medications following pediatric surgery for perforated appendicitis. The research is published in the European Journal of Pediatric Surgery.

From "IV Acetaminophen for Post-Op Pain Control"
Practical Pain Management (01/18)

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Sex-Related Differences in Effect-Site Concentration of Remifentanil for Preventing Anesthetic Emergence Cough in Elderly Patients

Target-controlled infusion (TCI) of remifentanil is known to effectively curb cough on anesthetic emergence, a potentially dangerous surgical complication, but the sex of the patient is a factor in the amount of drug administered. Gender differences in effect-site concentration (Ce) of remifentanil have previously been observed in young patients, and South Korean researchers have now documented a similar effect in older adults. The group from Ajou University School of Medicine considered 23 male and 22 female patients aged 60-75 years. Following extubation, the investigators calculated Ce of remifentanil using isotonic regression method with a bootstrapping approach, following Dixon's up-and-down method. Based on isotonic regression, the amount needed to prevent cough emergence in 50 percent of the study population was 1.67 ng/mL of remifentanil in females versus 2.60 ng/mL in males. To prevent the complication in 95 percent of the population, 2.30 ng/mL was required for women and 3.41 ng/mL was needed for men. Dixon's up-and-down method also pointed to significantly lower mean Ce in females than in males. The findings indicate that patient gender should be factored in when using remifentanil TCI to suppress emergence cough in older adults.

From "Sex-Related Differences in Effect-Site Concentration of Remifentanil for Preventing Anesthetic Emergence Cough in Elderly Patients"
Clinical Interventions in Aging (01/05/18) Vol. 13, P. 81 Lee, Sook Young; Jeong, Yun Yong; Lee, Byung Ho; et al.

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Epidural Analgesia May Reduce Short-Term Mortality in Acute Pancreatitis

Research done in Europe concluded that epidural analgesia, versus no pain management strategy, may lower 30-day mortality rates in people suffering from critically acute pancreatitis. The retrospective study examined data from multiple intensive care units in France and Belgium, where about 1,000 patients presented with the condition between 2009 and 2014. They compared outcomes in 46 patients who underwent thoracic epidural analgesia for pain relief and 957 patients who received usual care with no epidural analgesia component. Some 22 percent of patients receiving standard care died within 30 days of admission to the ICU compared with just 4 percent of patients who received epidural analgesia—a disparity that held even after adjusting for mortality-related variables. The difference was even more stark after propensity score analysis, which calculated a 2 percent mortality rate for patients who received an epidural versus 17 percent for those who did not. Although the study is retrospective in nature and has other limitations, the investigators believe the evidence has "clinical relevance."

From "Epidural Analgesia May Reduce Short-Term Mortality in Acute Pancreatitis"
Clinical Pain Advisor (01/04/18) May, Brandon

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Persistent Opioid Use Among Pediatric Patients After Surgery

Researchers from the University of Michigan and the Michigan Opioid Prescribing Engagement, both located in Ann Arbor, sought to learn more about the development of persistent opioid use among adolescents and young adults after surgery. As part of a retrospective cohort study, the investigators reviewed commercial claims over a five-year period ended December 2014. They identified 146,588 opioid-naïve patients between the ages of 13 and 21 who underwent various surgical procedures, 88,637 of whom filled a postoperative opioid prescription. For comparison purposes, they also included a random sample of 110,432 nonsurgical, opioid-naïve patients who matched eligibility criteria and were assigned fictitious surgery dates. Persistent opioid use—defined as at least one refill between 90 and 180 days postoperatively—was observed in 4.8 percent of the surgical patients but just 0.1 percent of the control group. Because persistent opioid use was more prevalent among teens and young adults who had operations than among those who had not, the researchers suspect that surgery may represent a pathway to prescription opioid abuse. They stress the need for safe prescribing and monitoring habits in the postoperative setting to prevent long-term addiction, misuse, and adverse effects—especially among at-risk patients.

From "Persistent Opioid Use Among Pediatric Patients After Surgery"
Pediatrics (01/01/18) Vol. 141, No. 1 Harbaugh, Calista M.; Lee, Jay S.; Hu, Hsou Mei; et al.

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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.

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.

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January 11, 2018
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