Anesthesia E-ssential

AANA Anesthesia E-ssential, January 23, 2020

Vital Signs

National CRNA Week: Thank You!

We Are ThereIt might be hard to remember on a day-to-day basis why you decided to become a nurse anesthetist. Or to realize how much your patients appreciate you taking good care of them. It has been heartening to read the social media posts this week about how you got into nurse anesthesia, and the shout outs to all the people who mentored you. Especially rewarding are the shout outs to CRNAs from colleagues, facilities, and others who work with you and employ you. As hard as it may be to realize, you are appreciated. Not just during National CRNA Week, but every day. Be sure to take a look at all the posts on social media, especially if you need a lift. Breathe it in and know that what you do is vitally important to your patients and healthcare itself. Happy National CRNA Week from AANA and its staff. We appreciate you too. #CRNAWeek #WeAreThere
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AANA Foundation: Celebrate National CRNA Week!

As CRNA Week comes to a close, the AANA Foundation would like to thank CRNAs for all you do, all year long.

Your dedication to the profession is truly appreciated and valued by so many.

Celebrate CRNA Week by making a donation to nurse anesthesia research and education today!
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Webinar: FDA Drug Topics - Research Funding Opportunities to Reduce Preventable Harm

The FDA Drug Topics webinar "Research Funding Opportunities to Reduce Preventable Harm," will be held January 28, 2020, from 1-2 p.m. EST.

This series of educational webinars is designed to help nurses, CRNAs, pharmacists, physicians, physician assistants, pharmacy technicians and other healthcare professionals to provide better patient care by knowing how to find relevant FDA regulatory information that will improve drug safety. The CDER Safe Use Initiative funds research projects aimed at "reducing preventable harm from drugs." Learn more and  Register.
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Webinar: AA Legislation: Strategy and Insights

Join AANA's AA Strategic Advisory Panel (AASAP) on Wednesday, January 29, from 7-8 p.m. for a webinar, "AA Legislation: Strategy and Insights." AASAP will discuss issues related to AA legislation and strategy. Register today.
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Hot Topics

A New Mobile Journal App Coming Soon – February 2020

Stay current with the latest CRNA research and industry news using the new AANA Journal mobile app! You’ll get the same great AANA Journal content, quickly and conveniently across your mobile devices.

Expanded functionality:
  • Listen to Articles - All articles will include narrated audio.
  • Watch Videos - Video resources can be viewed in the app.
  • Easily navigate - View external resources and pages online directly from the app.
AANA members will be able to download the app for free from Google Play, Apple App Store, or the Amazon App Store.
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Gain Inspiration: State Leadership Workshop – Newport Beach, California

When: March 7-8, 2020
Location: Hyatt Regency Newport Beach

Join us in Newport Beach, Calif., for a day-and-a-half workshop that will inspire leaders to:
  • Conduct an effective crucial conversation and how to influence change for positive outcomes.
  • Describe the applied skills in emotional intelligence and how this relates to your role as a state leader.
  • Develop strategies for improving association board governance.
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MHAUS Seeks Feedback to Develop Upcoming Anesthesia Machine Preparation Webinar

In February 2020, MHAUS will provide a webinar on options to clean anesthesia machines for MH-susceptible patients and answer specific questions attendees may have on this topic. To ensure the information given will meet attendees' needs, they are soliciting information through a short survey. Please provide feedback to help MHAUS develop a solid and insightful webinar for all.
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Nomination Deadline for AANA Award for State Government Relations Advocacy is Feb. 15

State Associations: Submit your entry for the Excellence in State Government Relations Advocacy Award, to be presented at the AANA Mid-Year Assembly in April 2020. This annual award is not tied to a specific “victory” in the state legislative or regulatory arena, but is given based on the quality of the state association effort.

Examples of state association efforts include successful lobby days, legislative/regulatory efforts, or increased member participation in grassroots or other efforts. For more information and to submit your state’s application by Feb. 15, 2020, visit the AANA website.
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FY2021 CRNA-PAC Committee - New Application Deadline is now April 30, 2020!

CRNAs and SRNAs interested in serving on the CRNA-PAC Committee beginning in the 2021 AANA fiscal year are encouraged to submit an application through the AANA online committee submission form located on the committee page

Responsibilities of Committee members include:
  • Setting the CRNA-PAC income and expenditure policy;
  • Participate in fundraising duties;
  • Reviewing open-seat and challenger candidates for federal office; and
  • Volunteering at CRNA-PAC events and national meetings.
Committee members are expected to attend two in-person meetings per year (Joint Committee Conference in September 2020 and Mid-Year Assembly in April 2021) and conference calls on an as-needed basis.

If you have any questions, please contact Catharine Harris, AANA Associate Director of Political Affairs, at or call (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 without reprisal. The guidelines are merely suggestions. You are free 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 its 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. Each contributor must be a U.S. Citizen.

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NewsMaker: CRNA Christi Hardy Becomes Mayor of Taylor, Miss.

Christi Hardy, CRNA, has been elected Mayor of Taylor, Miss. According to The Oxford Eagle, "During a special election on Dec. 17, Hardy defeated two other candidates to replace Jim Hamilton, who announced his resignation as mayor in November."

Another local news source says Hardy grew up in nearby Oxford, but spent summers on the family farm in Taylor, and now lives there. She currently works part-time at North Mississippi Medical Centre Women's Hospital and Surgery Center in Tupelo. She graduated with a master's of nurse anesthesia in 1998 from the University of Alabama at Birmingham.

Hardy will finish the remaining 18 months of Hamilton's term and then begin plans to run for re-election in 2021. Learn more.
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AANA Meetings: Refresh Your Knowledge and Make New Connections

Come Meet Your Future

Earn Class A CE credits, build your support network, and meet AANA leaders. To view all upcoming live events, visit
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Mid-Year Assembly 2020: Advocate for Your Profession on Capitol Hill

When: April 18-22, 2020
Location: Renaissance Washington D.C. Downtown, Washington, D.C.

The Mid-Year Assembly is the most important nurse anesthesia advocacy meeting. Join us on Capitol Hill as we gather, rally, and impress the importance of nurse anesthesia on our legislators.

Register Today!
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Ultrasound-Guided Peripheral Nerve Block Workshop

When: March 28-29, 2020
Location: AANA National Headquarters, Park Ridge, Ill.

Earn 12 Class A CE credits and refresh your knowledge of ultrasound-guided peripheral nerve block techniques. This weekend workshop features expert lectures, hands-on instruction, and group discussions of representative clinical cases. Register now for advance registration rates.
Get Details or Register
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Save the Date! Spinal Epidural with Obstetric Essentials Workshop

When: April 30-May 2, 2020
Cincinnati, Ohio (University of Cincinnati College of Nursing)

Earn 23.50 Class A CE credits with 4.25 Pharmacology/Therapeutics credits with expert lectures and hands-on instruction. Topics include: normal and abnormal physiology of pregnancy, pharmacology, analgesia/anesthesia techniques, clinical applications of spinal and epidural anesthesia procedures, and introduction to the application of ultrasound using live models.
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AANA 2020 Annual Congress: The Power of the Past. The Force of the Future.

When: August 14-18, 2020
Location: San Diego Convention Center, San Diego, Calif.

Get details
Sign up for updates
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Foundation and Research

AANA Foundation – Call for Review Committee Members; Respond by January 31, 2020

The Foundation is currently looking for CRNAs to serve on the Research and Scholarship Committees. The Research Committee reviews applications for research grants, fellowships and poster sessions. The Scholarship Committee reviews student scholarship applications. The Board of Trustees makes funding decisions based on the recommendations of these committees. If you are interested, please submit a statement of interest along with your CV to by January 31, 2020.
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AANA Member Benefits

Innovation Lab Offers Free Obstetrics Hands-on Cadaver Lab and Workshop

This free course is for the healthcare professional seeking to advance a platform enhancing patients' experiences after surgery. Lectures, hands-on workshops on fresh frozen human cadavers, and live-model scanning are included.

When: Jan. 25, 2020, 8:30 a.m. - 1:30 p.m.
Where: Embassy Suites hotel, Grapevine, Texas

Objectives include:
  • Describe the opioid epidemic as it specifically relates to the women's health arena.
  • Review legislative movement toward opioid minimization.
  • Outline society guidelines addressing a multimodal approach for postsurgical care in obstetrics and gynecological procedures.
  • Analyze the scientific literature that supports opioid avoidance.
  • Build out an interactive multimodal and enhanced recovery pathway.
  • Use a cadaveric model focused on surgical techniques applicable to addressing pain management in C-section as well as vaginal, open and minimally invasive surgeries.
  • Demonstrate skill in ultrasound-guided transversus abdominis plane blocks, including live model scanning and cadaveric real-time application.
Register and learn more.
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CRNACareers - The New Year is Here! What Will 2020 Bring for Your Career?

Maybe you need a change of scenery or a new challenge. 2020 is here with new opportunities and goals to keep your career stimulated, and jobs for which you are uniquely qualified. Find the new you on!

  • Search and apply to locum tenens or permanent positions at industry-leading facilities.
  • Upload your resume anonymously and allow employers to contact you.
  • Set up job alerts to receive notifications on new openings.
  • Access free career resources to assist with resume and interview preparation.

Learn more today!

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Seeking CRNAs: University of Rochester Health System, New York

Looking for an exciting career w/ excellent work-life balance and supportive mentors/colleagues? Come and join our expanding team of CRNAs at the University of Rochester! We offer competitive salary, generous benefits including retention/loan forgiveness, opportunities for continuing education or participating in Grand Rounds, and excellent work-life balance w/ no weekends and no call requirements!

Our CRNAs see a broad spectrum of patient cases - including Orthopedics, OB/GYN, Ambulatory Surgery, GI, General Surgery, Neurosurgery, and more - enjoy supportive, respectful working relationships w/ Anesthesiology providers.

Other Highlights
  • Flexible shift length (dependent on OR cases for the shift).
  • Large team of Anesthesia MDs, CRNA providers, and Anesthesia Techs.
  • Optional afternoon/evening or weekend shifts available, if desired.
Learn more.
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Faculty – CRNA Program: WellSpan Health, Pennsylvania

WellSpan Health, a sophisticated medical community in South Central Pennsylvania, is seeking a full-time faculty member to join the staff of our Nurse Anesthetist Program at York College. Employment with WellSpan Medical Group allows you to enjoy a fulfilling career in an organization with strong physician leadership, a culture of support and low turnover. WellSpan Health is a top-rated integrated health system with a focus on high-quality patient care.

About the Opportunity
  • Participate in didactic instruction, simulation laboratory and clinical instruction.
  • Work collaboratively with the clinical and didactic faculty of the Nurse Anesthetist Program and the York Hospital CRNA Clinical Coordinator in maintaining school activities and policies.
  • Participate on program, college, hospital and other committees as required.
  • Assists with coordination of all aspects of the program, academic and clinical, ensuring patient safety.
  • Participate in the admissions procedures, including recruitment interviews and selection of students.
  • Perform continuous evaluation of the clinical aspect of instruction at York Hospital.
Learn more.
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CRNA: Banner Health, California

Banner Health, a Top 5 Large Health System and one of the country's premier non-profit healthcare networks is expanding its team of advanced practice providers and is seeking an experienced CRNA to join our highly trained surgical team where you’ll enjoy a smaller hospital setting and become part of the fabric of the community.

Banner Lassen Medical Center (BLMC), built in 2004, in Susanville, California has a growing younger population with four seasons and a short winter and is located just 90 minutes from Reno, Nevada. Proximity to Eagle Lake and the mountains, the area offers many outdoor recreational opportunities including hiking, biking, golfing, fishing and hunting. Susanville and Lassen County is an outdoor paradise where the beautiful Sierra Nevada and Cascade mountains meet the desert of the Great Basin. The unique and diverse terrain offers something for everyone with an ideal year-round climate with an average summer high of 89 degrees and daytime temps of 40 degrees during the winter months.

This represents an excellent opportunity for a passionate and energetic CRNA to join a well-respected surgical team providing Orthopaedic, General Surgery and Scopes.
  • CRNA-only practice model.
  • Responsible for performing general, regional, and monitored anesthesia services including Ultrasound-guided block, and OB.
  • 3 years’ experience preferred.
  • 2 weeks on, 1 weeks off.
Banner Health offers a competitive salary and recruitment incentives along with an industry leading benefits package that provides security for you and your family:
  • Comprehensive medical, dental, vision and pharmacy plans.
  • Paid time-off plans.
  • Eligible for benefits coverage within 30 days.
  • Financial savings resources.
  • Career advancement and optimal work/life balance.
  • Employee Discounts.
Learn more.
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Midwestern Academic Setting: University of Missouri

The University of Missouri Department of Anesthesiology is seeking additional CRNAs to join their dynamic academic health center in mid-Missouri, home to the only children's hospital and Level I Trauma Center between St. Louis and Kansas City. A tremendous opportunity to join a group of energetic, self-motivated and culturally diverse faculty and staff with a strong commitment to support the growth in surgical volumes and expansion of surgical facilities. Highlights of these important positions with the region's most comprehensive healthcare network include:
  • Enjoy a variety of cases via MU's main hospital, Women's & Children's Hospital, Orthopedic Institute and surgical/endoscopy centers.
  • Variety of shifts available: 8-, 10-, 12-, and 24-hour options available.
  • Only 1-2 weekend call shifts per year (no nights).
  • Mentoring program available to newer graduates and new hires.
  • Impressive collaboration between CRNA and MD staff - offering medical direction vs. supervision.
  • Opportunity to participate in research studies, clinical trials, and operational improvement projects.
  • Full benefit package including pension/retirement (including employer contributions) and all insurances and HSA.
  • Competitive salary with paid options for additional shifts or extra call if desired.
  • Benefits also provide a generous PTO plan, including paid holidays.
Home to the University of Missouri (MU), and two other colleges, Columbia is an educational center with an eclectic feel. It serves as a medical, technological and cultural base for central Missouri. Columbia's non-student population is around 120,000. The University of Missouri is an equal access, equal opportunity, affirmative action employer and is fully committed to achieving the goal of a diverse and inclusive academic community of faculty, staff and students. We seek individuals who are committed to the goal and our core campus values of respect, responsibility, discovery and excellence. Learn more.
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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.

Prevalence of Malignant Hyperthermia Diagnosis in Obstetric Patients in the United States, 2003 to 2014

Despite the fact that malignant hyperthermia (MH) is a rare complication, new research supports keeping medication to treat it readily available in maternity units. The use of general anesthesia—a trigger for MH—is low in the obstetric setting, suggesting that maternity wards need not keep it stocked. However, a review of community hospital data for 2003 to 2014 calculated the rate of MH susceptibility at approximately one in 125,000 cesarean deliveries—which is about the same rate as observed in non-obstetrical surgery inpatients. Given this evidence, the study authors conclude that it is financially worthwhile to stock dantrolene in maternity units.

From "Prevalence of Malignant Hyperthermia Diagnosis in Obstetric Patients in the United States, 2003 to 2014"
BMC Anesthesiology (01/20/20) Vol. 20, No. 19 Guglielminotti, Jean; Rosenberg, Henry; Li, Guohua

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Surgical Patients Want to See Docs Complete Pre-op Checklists

Surgical safety checklists can be completed in less than a minute and have been shown to improve patient safety, but anesthesia providers often avoid using them in front of patients. While providers voice concern about exacerbating patients' anxiety, new research reveals that people are not nearly as uncomfortable with the process as providers believe and actually are comforted by checklist validation. The prospective observational study, which appears in the European Journal of Anaesthesiology, queried 125 adults who underwent elective ear, nose and throat or maxillofacial surgery as well as 110 anesthesia providers. Based on their responses to three questions surrounding checklists, both providers and patients agreed that completing pre-op checklists lowers the risk of errors. However, the researchers wrote, "Patients experience far less discomfort observing the use of pre-induction checklists directly before induction of anesthesia in the operating room than anesthesia providers expect." This skewed perception, meanwhile, encourages providers to skip questions that they think will make patients anxious and possibly cause a delay in anesthesia induction and/or surgery.

From "Surgical Patients Want to See Docs Complete Pre-op Checklists"
Medscape (12/19/19) Hackethal, Veronica

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Study Finds That Disruptive Behavior in Operating Rooms Often Goes Unreported

Disruptive scenes often unfold in the operating room (OR), but researchers report in the Canadian Journal of Anesthesia that witnesses tend to sweep the behavior under the rug. According to study authors at the University of Manitoba, 97 percent of all clinicians surveyed failed to report all of the disruptive behavior they observed. Three out of every 10 clinicians—especially those who are young, female, or not in management positions—never reported the behavior at all. When management was notified of such incidents, meanwhile, the response was acceptable to just one in five clinicians. The findings, based on responses from 4,775 OR clinicians in seven countries, have implications for patients and providers alike. "Disruptive behaviors range from incivility to egregious abuse, and are important because they not only affect the well-being of those working in the operating room, but can also undermine patient care," said anesthesia provider and senior study author Eric Jacobsohn, MD.

From "Study Finds That Disruptive Behavior in Operating Rooms Often Goes Unreported"
Medical Xpress (01/17/20)

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Exposure to Anesthesia in Young Increases Risk for ADHD

A study out of New York City's Columbia University concludes that even one exposure to anesthesia before age five increases the risk for later medical management of attention-deficit/hyperactivity disorder (ADHD). Researchers documented outcomes in 42,687 children who had early anesthesia exposure for pyloromyotomy, inguinal hernia repair, circumcision, or tonsillectomy/adenoidectomy and compared them with those of 213,435 matched controls. "Our primary outcome of interest was persistent ADHD medication use, which we defined as the presence of pharmacy claims for at least two filled prescriptions for greater than 30 days at any time after exposure to anesthesia," reports anesthesiology professor Caleb Ing, MD. Children who were exposed—regardless of the age they were when the exposure occurred—had a 37 percent higher risk for persistent ADHD medicine use than did the children with zero exposure to anesthesia. The finding was not especially surprising, considering that behavior and deficits of executive function have been linked to ADHD, and it dovetailed with earlier research along these lines. Study authors do not expect their results to sway clinical practice anytime soon, however. "It's one thing if it's a study of fatty foods and you tell the children not to eat fatty foods," Ing explains. "But you can't tell someone to not undergo a [tonsillectomy/adenoidectomy], for example, because they need that for a medical reason."

From "Exposure to Anesthesia in Young Increases Risk for ADHD"
Anesthesiology News (01/15/20) Vlessides, Michael

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Latest NC Research Finds Potential New Treatment for PTSD

A three-year study on treating post-traumatic stress disorder (PTSD) with a technique more often used to manage pain has wrapped up in Research Triangle Park, N.C., with promising results. The Department of Defense bankrolled the project, which found that injecting local anesthetic into the stellate ganglion nerves of the neck—which control the body's "fight or flight" instincts—relieved PTSD stemming from the horrors of military combat as well as trauma from other experiences, including sexual assault and car accidents. The process, known as stellate ganglion block (SGB), takes just 30 minutes to administer, with little to zero recovery time. However favorable the findings, this is the first clinical study on the technique in PTSD patients and there are still many unknowns, according to Kristine Rae Olmsted, one of the investigators. "Nobody knows how it works, we now just know that it does," says the behavioral epidemiologist at RTI International, which led the research. "The degree to which it takes away the symptoms altogether or it simply lessens the biological response to them is an excellent question and one that we really haven't studied yet," she adds. Once two additional grants from the U.S. Army come through, Rae Olmsted says her team will look at how long the average treatment lasts and whether some patients need multiple injections. They also will perform a secondary analysis of their index work to delve deeper into the findings.

From "Latest NC Research Finds Potential New Treatment for PTSD"
North Carolina Health News (01/14/20) Knopf, Taylor

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The Effect of Dexmedetomidine as Adjuvant to Ropivacaine for Femoral Nerve Block on Strength of Quadriceps Muscle in Patients Undergoing TKA

Researchers wondered whether they could improve the effects of femoral nerve block (FNB) after knee replacement surgery by lowering the amount of ropivacaine used and supplementing it with dexmedetomidine. While FNB is known for stellar pain relief in this setting, the high concentration of ropivacaine typically used for the technique lends to quadriceps muscle weakness and elevates the risk of postoperative falls. In an effort to counter this shortcoming, investigators recruited 90 patients scheduled for total knee arthroplasty (TKA), all of whom had access to intravenous patient-controlled analgesia with morphine. Based on randomized assignment, each participant also received continuous FNB postoperatively with 0.2% ropivacaine, 0.1% ropivacaine, or 0.1% ropivacaine plus dexmedetomidine. The main outcome was quadriceps muscle strength as determined by manual muscle testing (MMT) and Timed Up and Go (TUG) testing. For MMT, patients who received the ropivacaine/dexmedetomidine mix demonstrated higher quadriceps muscle strength postoperatively than the two comparator groups. TUG testing, which measured walking ability, also produced better scores in the ropivacaine/dexmedetomidine group at 24 and 48 hours after surgery. The findings indicate that adding dexmedetomidine to 0.1% ropivacaine preoperatively would preserve quadriceps muscle strength with satisfactory analgesia in patients undergoing TKA. The results are published in the Journal of Pain Research.

From "The Effect of Dexmedetomidine as Adjuvant to Ropivacaine for Femoral Nerve Block on Strength of Quadriceps Muscle in Patients Undergoing TKA"
Docwire News (01/13/20)

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News summaries © copyright 2020 SmithBucklin

Anesthesia E-ssential is an executive summary of noteworthy articles of interest to nurse anesthetists. It is distributed weekly to AANA members.

Anesthesia E-ssential is for informational purposes, and its contents should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

If you are interested in advertising in Anesthesia E-ssential contact HealthCom Media at 215-489-7000.

For more information on AANA and Anesthesia E-ssential, contact:

222 S. Prospect Avenue
Park Ridge, IL 60068
Phone: (855) 526-2262 (toll-free)/(847) 692-7050
Fax: (847) 692-6968

Attn: Cathy Hodson
E–ssential Editor
January 23, 2020