Anesthesia E-ssential

AANA Anesthesia E-ssential
AANA Member Advantage Program

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National CRNA Week 2018 is Almost Here
Get Ready to Celebrate Your Profession

Are you ready to celebrate National CRNA Week 2018, Jan. 21-27? This year's theme, "CRNAs: Every BREATH, Every BEAT, Every SECOND, WE ARE THERE," speaks to the one-to-one patient care CRNAs are privileged to provide, as well as to the millions of safe anesthetics they deliver each year.

Celebrate Your Profession
See examples and ideas on ways to celebrate National CRNA Week. You’ll find a variety of ideas and templates you can use before, during, and after National CRNA Week, including customizable news releases, proclamations, downloadable ad slicks, posters, social media graphics, and more.

In the News
News about National CRNA Week and the many activities going on around the country will be posted in the Members section during National CRNA Week.
Social Media Hashtag: #crnaweek
Be sure to follow AANA on:
Let Us Know How You Are Celebrating!
Send photos of your CRNA Week activities to AANA Public Relations
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Hot Topics

AANA Welcomes New Member Advantage Program Partner: ONE Advisory Partners

ONE Advisory Partners, an SEC-registered investment advisor, has joined the AANA Member Advantage Program to offer members financial planning services and serve as fiduciaries. Focused on making clients’ lives better, they handle the heavy lifting of your financial life so you can focus on the things that matter the most to you.

ONE Advisory Partners is offering to walk all AANA members through the financial planning process at no charge: a $1,900 value! See the ONE Advisory Partners webpage for details on their services and benefits.
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PharMEDium Services, LLC Expands Nationwide Recall of Compounded Sterile Products

The Dec. 27, 2017, recall is being expanded after PharMEDium conducted an extensive review of all commercially distributed product lots compounded in the Memphis location in response to an FDA request following the most recent inspection.

The original recall included a total of 55 lots of different products impacting 25,327 units. The expanded recall includes all lots within expiry compounded at the Memphis, TN facility. Although there were no defects identified in these products, as a conservative measure, this recall is being expanded.  Learn more
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FDA Requires Safety Labeling Changes to Limit Pediatric use of Codeine or Hydrocodone

The US Food and Drug Administration is requiring safety labeling changes to limit the use of prescription opioid cough and cold medicines containing codeine or hydrocodone in children younger than 18 years old because the serious risks of these medicines outweigh their potential benefits in this population. After safety labeling changes are made, these products will no longer be indicated for use to treat cough in any pediatric population and will be labeled for use only in adults aged 18 years and older.  Learn more.
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NBCRNA Launches New Website

The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) introduces its completely redesigned website, enabling CRNAs to find most-used information and resources faster and easier. The site is also now on an improved platform with many new features and options. Some of the website improvements include:
  • streamlined navigation with intuitive pathways 
  • a contemporary, clean design to reduce clutter
  • and new attributes and technologies for a better site experience
We invite you to look around the site and find the many resources and information that can help you in your everyday practice. And watch for the launch of our new podcast series, as well as CRNA spotlights, videos, and more. Visit today.
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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. For more information and to submit your state’s application, see the Awards for Excellence.
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Meetings and Workshops

Online Registration for #AANAASF Closes Tuesday, Jan. 23
Assembly of School Faculty, Feb. 15-17
The Scottsdale Resort at McCormick Ranch

Don't miss out—register 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.

Low-Dose Ketamine Provides Comparable Acute Pain Relief, More Adverse Events Than Morphine

According to the medical literature, ketamine may be just as effective as opioids in quickly alleviating acute pain but also may carry more risk of neuropsychological adverse events. Researchers performed a systematic review of eight studies, including six randomized clinical trials, with a total of 225 participants. Pain control, opioid requirements, and adverse events were compared in patients who received low-dose intravenous ketamine versus those who received intravenous morphine in the emergency department (ED). Based on moderate-quality evidence, the investigators found that patients experienced similar pain relief at 30 minutes regardless of whether they received low-dose ketamine or morphine. However, participants treated with ketamine were more likely to suffer agitation, hallucination, and other self-limited adverse events. Limited data, meanwhile, prevented researchers from determining if ketamine lowered opioid demand. Reporting in the Annals of Emergency Medicine, they conclude that "low-dose ketamine may be used as an alternative to opioids for acute pain in the [ED] setting" but stress that patient selection criteria and optimal dosing strategies still need to be defined.

From "Low-Dose Ketamine Provides Comparable Acute Pain Relief, More Adverse Events Than Morphine"
Clinical Pain Advisor (01/11/18) Martin, Jessica

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General Anesthesia May Work by Reducing Neuron Communication

Scientists in Australia say they have gained new knowledge about the mechanisms of general anesthesia, which remains largely a mystery despite its widespread use. The team from the University of Queensland (UQ) studied the effects of propofol on synaptic release—which allows neurons to communicate with one another—in single cells. The work revealed that general anesthesia apparently interferes with that communication. "We know from previous research that general anaesthetics including propofol act on sleep systems in the brain, much like a sleeping pill," explained Bruno van Swinderen, an associate professor at UQ. "But our study found that propofol also disrupts presynaptic mechanisms, probably affecting communication between neurons across the entire brain in a systematic way that differs from just being asleep. We think that widespread disruption to synaptic connectivity—the brain's communication pathways—is what makes surgery possible, although effective anesthetics such as propofol do put you to sleep first." He said the finding might explain why people emerge from surgery groggy and disoriented and could guide future drug development. Moreover, it could have implications for patients whose brain connectivity is vulnerable, like children or people with Alzheimer's or Parkinson's disease. "It has never been understood why general anesthesia is sometimes problematic for the very young and the old," van Swinderen noted. "This newly discovered mechanism may be a reason.”

From "General Anesthesia May Work by Reducing Neuron Communication"
PsychCentral (01/11/18) Pedersen, Traci

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Excessive IV Fluids on Day of Surgery Ups Peri-op Mortality

Patients who receive high volumes of intravenous fluid on the day of major abdominal surgery are at higher risk for perioperative death, according to research out of Duke University Health System. Led by Thomas Hopkins, MD, the retrospective study covered about 36,000 patients discharged from nearly 400 hospitals nationwide. Overall, 21 percent of the patients received more than 6 liters of IV fluid the day of their procedure, and 2 percent received at least 9 liters. Hopkins and his team found that these high levels of fluid administration greatly inflated the 48-hour inpatient mortality rate, even after adjusting for individual variables including age and comorbidities. "Our preliminary data suggest that the way we administer fluid in the operating room and the way that we administer fluid on the surgical wards following the operation can have an impact on perioperative morbidity, length of hospital stay and ultimately on patient survival," said Hopkins. He cautioned, however, against simply cutting the amount of fluid, as there also are problems associated with too little fluid on surgery day. "The best solution is to consider a dynamic approach to perioperative volume resuscitation that leverages a patient-specific and a patient-tailored strategy," he surmised.

From "Excessive IV Fluids on Day of Surgery Ups Peri-op Mortality"
General Surgery News (01/10/18) Kronemyer, Bob

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Acetaminophen May Slow Language Development

An Icahn School of Medicine study adds to evidence that acetaminophen taken during pregnancy causes behavioral and developmental problems in offspring. Researchers at the New York-based institution worked with 754 women in early pregnancy, who reported how many tablets of the popular over-the-counter drug they took from conception to study enrollment and consented to testing of their urine for acetaminophen concentrations. According to the results, including a follow-up questionnaire completed by the mothers, toddlers exposed to acetaminophen in utero had a slower rate of language development at 30 months—although only slightly so in boys. More specifically, female offspring born to mothers who took acetaminophen more than six times in early pregnancy were almost six times more likely to have language delay than girls born to mothers who did not use the pain reliever. The investigators speculate that maternal use of acetaminophen during pregnancy eliminates the well-known female advantage in language development during the early years. "Given the prevalence of prenatal acetaminophen use and the importance of language development, our findings, if replicated, suggest that pregnant women should limit their use of this analgesic during pregnancy," declared senior author Shanna Swan, PhD. The study appears in European Psychiatry.

From "Acetaminophen May Slow Language Development"
Pain News Network (01/10/18) Anson, Pat

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Association Between Handover of Anesthesia Care and Adverse Postoperative Outcomes Among Patients Undergoing Major Surgery

While handovers of anesthesia care during surgery run the risk of critical information getting lost between outgoing and incoming clinicians, researchers predicted they would not increase the risk of adverse postoperative events. As part of a retrospective study conducted at multiple locations in Ontario, they documented the experience of patients who underwent a complete changeover during their procedure and patients who kept the same anesthesia provider for the duration. The study population included more than 313,000 adults who had major surgery from 2004 to 2015, nearly 6,000 of whom had a complete transfer of anesthesia care. The data indicated that 44 percent of these patients experienced a composite of all-cause mortality, hospital readmission, or major post-op complications within 30 days of surgery vs. 29 percent of patients whose operations did not include any transition in anesthesia care. Contrary to the investigators' hypothesis, complete intraoperative handover of anesthesia responsibilities was in fact associated with an increased risk of adverse postoperative outcomes.

From "Association Between Handover of Anesthesia Care and Adverse Postoperative Outcomes Among Patients Undergoing Major Surgery"
Journal of the American Medical Association (01/09/18) Vol. 319, No. 2, P. 143 Jones, Philip M.; Cherry, Richard A.; Allen, Britney N.; et al.

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Doctors Are Taking Sharpies to Their Scrub Caps — And It Could Save Lives

An anesthesia provider in Australia has started a movement to improve communication in the operating room (OR) by having surgery team members write their name and profession on their scrub caps. While an item on the World Health Organization's surgical safety checklist calls for personnel introductions prior to an operation, Rob Hackett, MD, suspects that this step is too often ignored. However, he believes that being easily identified in the OR—whether anesthesia staff, nurses, surgeons, or other medical professionals—can help avoid confusion and save lives when time is of the essence. The cap trend is taking off in the medical community, with backers including Royal Australian College of Surgeons Executive Director John Quinn, MD, and Australian and New Zealand College of Anesthetists President David Scott. "No one strategy is going to make a dramatic difference," Scott remarked. "But knowing who's who in a busy operating room means teams will be able to communicate more effectively."

From "Doctors Are Taking Sharpies to Their Scrub Caps — And It Could Save Lives" (01/09/18) Clarendon, Dan

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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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Attn: Linda Lacey
E–ssential Editor
January 18, 2018
National CRNA Week Celebration