Anesthesia E-ssential

AANA Anesthesia E-ssential, January 24, 2019
 
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House of Representatives Honors Nurse Anesthetists During CRNA Week

Reps. Schakowsky, Graves, Roybal-Allard introduce resolution
recognizing anesthesia experts

Park Ridge, Ill.—Calling nurse anesthetists “essential to America’s healthcare system” for providing high-quality, cost-effective anesthesia care to tens of millions of patients each year, Reps. Jan Schakowsky (D-IL), Lucille Roybal-Allard (D-CA), and Sam Graves (R-MO) today introduced a bipartisan resolution on the House floor to honor the nation’s 53,000 Certified Registered Nurse Anesthetists (CRNAs) during the 20th annual National CRNA Week, Jan. 20-26, 2019.

“On behalf of our country, today I am expressing gratitude for the role nurse anesthetists play in our healthcare system,” said Rep. Schakowsky. “Across Illinois and the nation, patients expect high quality care and nurse anesthetists deliver. I am proud to introduce this resolution with my colleagues to honor them for their service and their continued care nationwide.”

The legislation resolved that “the House of Representatives thanks and promotes the profession of Certified Registered Nurse Anesthetists by encouraging patients, hospital administrators, healthcare professionals, policymakers, and others to become more familiar with the CRNA credential and the exceptional healthcare professionals who have earned it by participating in National CRNA Week.”

“I am proud to co-lead this resolution saluting our nation’s 53,000 Certified Registered Nurse Anesthetists for the expertise and compassion they provide to millions of patients in need of anesthesia each year,” said Rep. Roybal-Allard. “Decades of research have shown that nurse anesthetists provide the same safe and high-quality anesthesia care as other medical professionals, but at a significantly lower cost to our healthcare system. In districts across the country, including urban settings like my 40th Congressional District of California, nurse anesthetists are a cost-effective method of helping to curb escalating health care prices.”

The resolution outlined the role, value and history of CRNAs in the U.S. healthcare system, noting that the profession got its start more than 150 years ago when nurse anesthetists became the nation’s first anesthesia specialists. Nurses first gave anesthesia to wounded soldiers on the battlefields of the American Civil War.

Today, CRNAs practice in every type of healthcare setting in which anesthesia is delivered, the resolution stated. They safely deliver more than 45 million anesthetics to patients each year and are the primary providers of anesthesia care in rural America, enabling healthcare facilities in these medically underserved areas to offer obstetrical, surgical, trauma stabilization, and pain management services.

“Nurse anesthetists play a critical role in rural healthcare,” said Rep. Graves. “North Missouri healthcare facilities depend on the high-quality care that they provide at a low cost. I’m grateful for the important work they do in my district and around the country.”

The resolution further noted that CRNAs have been the main provider of anesthesia care to U.S. military personnel on the front lines since WWI, including all current U.S. military actions around the globe.

“CRNAs are passionate about providing the best possible patient care,” said Garry Brydges, DNP, MBA, ACNP-BC, CRNA, FAAN, president of the American Association of Nurse Anesthetists (AANA). “Day in and day out, the safe, high-quality, cost-effective anesthesia care delivered by CRNAs ensures patients across the U.S. access to the surgical, obstetrical, emergency, and chronic pain services they need. So it truly is humbling to be recognized by the House of Representatives for doing what we love to do and for doing it well.”

See text of Resolution.


About the American Association of Nurse Anesthetists


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Happy National CRNA Week – Say it Loud, Say it Proud!

The American Association of Nurse Anesthetists extends a hearty “Happy CRNA Week!” to all CRNAs and SRNAs! You are the heart of an amazing profession that sees each patient safely through anesthesia care every day, every year. We salute and thank all of you for your hard work, kind words, compassionate deeds, and everything you do. From the rural areas to urban central to the far-flung corners of the world, CRNAs and SRNAs are getting it done. Happy National CRNA Week! Thank you for all you do!
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Happy CRNA Week from AANA Insurance Services!

Thank you for being there – every breath, every beat, every second. It has been our privilege to help safeguard your career for nearly 30 years. On behalf of AANA Insurance Services, Happy CRNA Week!
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Hot Topics


AANA Submits Comments to FDA Regarding Anesthesia Drug Shortages

On January 11, 2018, the AANA submitted a comment letter to the FDA regarding drug shortages' impact on anesthesia care and proposed solutions. The letter describes CRNAs' experience with drug shortages, including clinical impacts on patients. These impacts include, but are not limited to, drug rationing and less effective care, increased risk of medication error due to new medication protocols, and increased side effects, complications and mortality due to drug substitutions.

The letter also addressed economic impacts of the drug shortage crisis, methods CRNAs use to mitigate drug shortages, and potential strategies and policies to help alleviate the persistent drug shortage problem. The letter emphasized the AANA’s commitment to collaborating with the FDA, other healthcare associations, and industry to mitigate and resolve this complex problem that undermines patient safety.
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Nomination Deadline for AANA Award for State Government Relations Advocacy is February 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 2019. 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 February 15, 2019, visit the AANA website.
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Council on Accreditation (COA) Seeks Nominations for Two CRNA Director Openings

The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is seeking nominations for one CRNA Educator director and one CRNA Practitioner director. Candidates must be available to attend three-day COA meetings, typically held in January, May and October. The term of office is three years, beginning Fall 2019 through Fall 2022.

The elected candidates then would be eligible to be considered for reelection to a second three-year term. The deadline to apply is March 15, 2019. For position criteria and application requirements, please visit www.coacrna.org.
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NewsMakers: CRNA Takes SRNAs on Medical Mission to Chad

Ian Hewer, PhD, MA, CRNA, assistant professor and director of Western Carolina University's nurse anesthesia doctoral program, traveled to the Republic of Chad (Africa) with SRNAs Ben Woody and Jenny Della Posta late in the fall semester of 2018. The three, along with Della Posta's husband, A.J., were participating in a medical mission trip to assist a surgeon providing free services for residents of the village of Bere. Hewer provides a first-person account of the trip. Read more.
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AANA Member Benefits


Nationwide
Nationwide: How to Overcome Common Business Mistakes

Here are a few of the most common business mistakes and ways to overcome them.


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Jobs


CRNA Opportunity: Envision Physician Services, Tampa Bay, Florida

Envision Physician Services has a featured opportunity for a qualified CRNA to join our expanding team at Florida Hospital North Pinellas and surrounding ambulatory surgery centers. The surgery centers covered would include: Belleair Surgery Center, New Port Richey Surgery Center, Countryside Surgery Center, and Ambulatory Surgery Center Group. Learn more about this exciting opportunity and the benefits of working for Envision. Consider joining a company that encourages work-life balance and invests in their employees! Learn more.
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CRNA Opportunity No Call, No Weekends, No Holidays - Join us in Florida: Envision Physician Services, Tampa Bay, Florida

Envision Physician Services has an outstanding opportunity for a qualified CRNA to join our growing team in southwest Florida; covering St. Andrews Surgery Center in Venice, FL and Gulf Point Surgery Center in Port Charlotte, FL. Both locations are conveniently located between the gorgeous city of Sarasota and beautiful Fort Myers. Learn more about this exciting opportunity and the benefits of working for Envision. Consider joining a company that encourages work-life balance and invests in their employees! Learn more.
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Certified Registered Nurse Anesthetist (CRNA): Yuma Endoscopy Center, LLC – Tucson (BUMC-T) – Yuma, Arizona

We are currently looking for a full-time permanent Certified Registered Nurse Anesthetist (CRNA) to join our team for an Endoscopy Center located in Yuma, Arizona! Enjoy working in our state-of-the-art endoscopy center. No call, no nights, no weekends or holidays! Excellent Salary. Outpatient endoscopic facility. Learn more.
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CRNACareers

Kick-start the new year and give your career a reboot with updates and new resources via the AANA official career center, CRNA Careers. Here are the top three features to check out:

  1. Career Resources: The turn of the year is the perfect time to catch up on industry news or read tips about advancing your career. The AANA Career Center is a great resource, whether you're looking for industry updates or available positions.
  2. Location Radius Job Search: Searching for a job can be time-consuming. Now when entering a job search location, you will be presented with matching locations to autocomplete your search. You can also choose a specified mile radius from which to pull open jobs.
  3. Job Alert Quick Create: When searching for a job on CRNA Careers, you can also create a job alert. In one easy step, you can search for a job and be alerted when a job you're interested in becomes available.


Wishing you career success and a happy 2019! Get started today!


 

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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.

Data Show Role of Residual Neuromuscular Blockade in Reintubation

The effects of neuromuscular blockade can linger after surgery, with new research estimating that as many as three-quarters of patients require immediate postoperative reintubation as a result. Led by Benjamin Matelich, MD, an assistant professor of anesthesiology at the University of Minnesota Medical School, investigators reviewed the records of 44 patients reintubated at a single site between 2013 and 2015. Although the absence of twitch monitoring in the postanesthesia care unit did not allow for a direct association between residual paralysis and reintubation, a scoring system based on a series of risk factors let researchers gauge the likelihood that persistent blockade influenced reintubations in the PACU. The scores found it "unlikely" that this was a factor in 38.5 percent of patients, "possible" that it was in 38.7 percent, and "probable" for 20.5 percent. Matelich, who reported the finding at the 2018 annual meeting of the International Anesthesia Research Society, said he and his team believe the results underscore the importance of monitoring for residual neuromuscular blockade in the intraoperative and postoperative periods. Due to study limitations, however, they say the results should be considered speculative.

From "Data Show Role of Residual Neuromuscular Blockade in Reintubation"
Anesthesiology News (01/19/19) Vlessides, Michael

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Pain Protocol Facilitates Outpatient Mastectomy

Research points to same-day discharge and other benefits for mastectomy patients who receive liposomal bupivacaine as part of a multimodal pain protocol. Investigators at the University Medical Center New Orleans followed 72 women who underwent the surgery between November 2015 and July 2017. Nerve block with liposomal bupivacaine—administered in conjunction with intraoperative IV acetaminophen and IV ketorolac—resulted in less opioid use during recovery, reduced need for antiemetics, and lower postoperative pain levels. "If the nerve block is performed properly, the vast majority of patients wake up in the recovery room with little or often no pain whatsoever," said surgical oncologist Adam Riker, MD, the study's lead researcher and author. He hopes the findings encourage more clinicians to readjust their pain control strategies for this population, which could facilitate more outpatient mastectomies. In turn, Riker believes patient satisfaction could improve and costs could be reduced. The findings were presented at the 2018 Clinical Congress of the American College of Surgeons.

From "Pain Protocol Facilitates Outpatient Mastectomy"
Clinical Oncology (01/19) Frangou, Christina

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Effect of Ketorolac in Intra-articular Injection Analgesia for Postoperative Pain in Patients Undergoing Shoulder Arthroscopy

A pilot study out of China measured the safety and efficacy of using ketorolac in combination with a multimodal drug strategy for pain control after shoulder arthroscopy. The researchers randomized 60 participants in a 1:1 ratio to receive ropivacaine, morphine, and triamcinolone acetonide or the same regimen plus ketorolac. Patients in the ketorolac group reported lower Visual Analog Scale (VAS) scores during every interval checked during the first 48 hours postoperatively, with the exception of the first 60 minutes. On movement, the VAS scores were lower with ketorolac than without at 24 and 48 hours postoperatively. Meanwhile, there was no additional anesthesia demand for 60 percent of the ketorolac patients compared with just 33.3 percent of the controls; and lower doses were required for those patients in the experimental group who did need it. Initial analgesic desired time was significantly delayed with ketorolac. The findings indicate that adding ketorolac to intra-articular injection analgesia is viable pain relief after shoulder arthroscopy, although additional studies are needed to inform treatment guidance.

From "Effect of Ketorolac in Intra-articular Injection Analgesia for Postoperative Pain in Patients Undergoing Shoulder Arthroscopy"
Journal of Pain Research (01/19) Vol. 12, P. 417 Xu, Jianda; Qu, Yuxing; Li, Huan; et al.

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Supine Positioning After Greater Occipital Nerve Block May Improve Outcomes

While clinicians understand that patient positioning can impact local anesthetics, researchers recently studied this effect for the first time in the specific setting of greater occipital nerve (GON) block. In all, 95 patients with treatment-refractory headache disorder were administered GON block as part of the prospective, non-randomized study. Based on patient preference, 34 participants sat up and 61 reclined for 10 minutes immediately post-procedure. In the upright group, 29 percent of patients said they felt substantial relief for a median 25 days and 18 percent said their pain was completely resolved for a median 119 days. In the supine group, by comparison, those percentages were 44 percent for a median 70 days and 28 percent for a median 84 days, respectively. The results, reported in Clinical Neurology and Neurosurgery, suggest that lying down could improve treatment outcomes after GON block; but the investigators agree that a multi-site, randomized controlled trial is needed to confirm their findings.

From "Supine Positioning After Greater Occipital Nerve Block May Improve Outcomes"
Neurology Advisor (01/17/19)

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Surgeons Find Opioids Often Overprescribed for Elbow Fractures in Children

Clinicians are overprescribing opioids to pediatric patients after surgery for a common elbow injury, researchers report. The prospective study out of Children's Hospital of Philadelphia (CHOP) included 81 kids, with a mean age of six years, who were suffering from a supracondylar humerus fracture. On average, the children used less than a quarter of the opioids they were prescribed after closed reduction and percutaneous pinning of the break. Although younger children are less likely to abuse opioids, there is still a risk of accidental ingestion of leftover medication. "This study suggests that orthopaedic surgeons really need to think about our current prescribing practices and how we can help decrease the potential for overprescription and opioid diversion," said lead study author Apurva Shah, MD, an orthopedic surgeon at CHOP. "Based on this study, which we believe can be applied to other common types of orthopedic injuries, a prescription for a much shorter period of time seems to be appropriate." The findings are reported in the Journal of Bone and Joint Surgery.

From "Surgeons Find Opioids Often Overprescribed for Elbow Fractures in Children"
ScienceDaily (01/16/19)

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Efficacy of Local Anesthetic Solutions on the Success of Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis

Effectively managing pain during root canal is critical to avoid fear and anxiety, prevent other medical issues, complete the procedure within the normal time frame, and maintain the provider's reputation. To this end, researchers performed a systematic review and network meta-analysis to determine what approach delivers superior pupal anesthesia for Inferior Alveolar Nerve Block (IANB) during the treatment of irreversible pulpitis. They ultimately included 11 randomized clinical trials that compared two or more anesthetic solutions in this setting. The collective study population was 750 adults; and five different anesthetics were scrutinized. According to the data, only mepivacaine significantly boosted the success rate of IANB compared to lidocaine, but it did not perform similarly in comparison to other anesthetic agents. After mepivacaine, prilocaine had the biggest impact on IANB success, followed by articaine, bupivacaine, and lidocaine. The results of the review suggest that mepivacaine with epinephrine offers the best chance for effective anesthesia during IANB for irreversible pulpitis. More high-quality clinical trials are warranted, however, to validate the findings.

From "Efficacy of Local Anesthetic Solutions on the Success of Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis"
International Endodontic Journal (01/14/2019) Nagendrababu, Venkateshbabu; Pulikkotil, Shaju Jacob; Suresh, A.; et al.

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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.

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: Cathy Hodson
E–ssential Editor
chodson@aana.com
January 24, 2019
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