Anesthesia E-ssential

AANA Anesthesia E-ssential

Vital Signs

Happy National CRNA Week!

This week, CRNAs across the country are celebrating patient access to safe, high-quality anesthesia care—the hallmarks of the nurse anesthesia profession—during National CRNA Week. 
This year’s theme, “Every Breath, Every Beat, Every Second: We Are There,” highlights the watchful care that CRNAs have been providing to their patients for more than 150 years.  
“Every day, in healthcare facilities all over the United States and in the U.S. armed services stationed around the globe, more than 52,000 CRNAs provide patient-centered, holistic pain management and anesthesia care to our patients,” said AANA President Bruce Weiner, DNP, MSNA, CRNA.  “One of the many rewards of being a nurse anesthetist is providing patients with the comfort of knowing that a CRNA will be by their side monitoring their vital signs and adjusting their anesthetics to ensure a pain free and safe anesthesia experience.”

Highlights of #CRNAWeek 2018
As this issue of Anesthesia E-ssential is published, CRNA Week 2018 is shaping up to be highly successful and memorable thanks to the efforts of CRNAs, SRNAs, national and state leadership, and AANA staff. Here are some highlights, with more to come—watch AANA publications, AANA.COM, and social media for further #CRNAWEEK developments. 
  • Watch the kickoff video from AANA President Bruce Weiner, DNP, MSNA, CRNA.
  • The House of Representatives has introduced Res. 702:  "Recognizing the roles and the contributions of America’s Certified Registered Nurse Anesthetists (CRNAs) and their role in providing quality healthcare for the public."
  • Mississippi Association of Nurse Anesthetist's President Sandy Weathers, CRNA, was interviewed on The Delta News on their Morning Show on Jan. 23, 2018, as part of MANA's CRNA Week PR campaign. 
  • Ashley Fedan, MS, CRNA, ARNP, and Brian Schwartz, MHS, CRNA, created a CRNA Week Celebration Video for 2018.
  • Michael Humber, DNP, MNA, CRNA, president of the Alabama Association of Nurse Anesthetists, appeared on the "Talk of Alabama"morning program on Jan. 23, 2018.
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Hot Topics

Practice Documents Available for Open Comment

Two updated practice documents are available for open comment through Feb. 19, 2018:
  • Malignant Hyperthermia Crisis Preparedness and Treatment, Position Statement
  • Regional Anesthesia for Surgical Procedures and Acute Pain Management, Practice Considerations
Download the draft documents at Open Comment Opportunity. Please review and provide feedback to  
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CRNAs Profiled in Minority Nurse for CRNA Week

Minority Nurse spotlighted several CRNAs in a CRNA Week article about the nurse anesthesia profession. AANA Communications Committee Chair Dan Lovinaria, DNP, MBA, MS, CRNA, APRN, spoke about what it’s like to work in a Veterans Health Affairs facility. AANA Treasure Robert Gauvin, MS, CRNA, discussed the advantages of owning his own business. New CRNA Mary Nguyen, DNP, CRNA, also a member of the Communications committee, talked about the importance of the certification examination. AANA Senior Director of Education and Professional Development, Bruce Schoneboom, PhD, CRNA, FAAN, detailed the Continued Professional Certification Program. Lincoln Memoriam University Clinical Coordinator Joy Lewis, CRNA, talked about other responsibilities and working schedules that a CRNA may have. Read more.
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NursingAmerica Video Shows How APRNs Improve Access to Quality, Safe Healthcare

“The State of Healthcare in America,” a video by NursingAmerica, shows how removing practice restrictions for advanced practice registered nurses—CRNAs,  Nurse Midwives, Nurse Practitioners, and Clinical Nurse Specialists—is an important part of the solution to improving access to safe, quality healthcare. Watch the video, and learn more at
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AANA Learn Member Exclusive: Take Advantage of Free Sponsored Course

The online course – Enhanced Recovery after Major Abdominal Surgery –  is now live on AANA Learn. You can find this course in the New! and Member Exclusives categories. This course is worth 1 Class A credit. This is a Member Exclusive course, so it is free to all members. Visit Member Exclusives on AANA Learn and be sure to log in before taking the course.
Enhanced Recovery after Major Abdominal Surgery
  • Price: $50.00
  • Members' Price: $0.00
  • 1.0 Class A Credit
  • 0.50 Pharm Credit
  • Course Expiration Date: 1/16/2019
Supported by an educational grant from Merck.
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Consider Nominating a Colleague for an AANA Award!

Do you work with an outstanding program director, didactic instructor, or clinical instructor? Do you know someone who has spent a lifetime advancing the practice of nurse anesthesia as a practitioner, educator, clinician, or advocate? Consider nominating your colleague for one of the national AANA recognition awards. Visit Recognition Awards for details on the Agatha Hodgins Award for Outstanding Accomplishment, Helen Lamb Outstanding Educator Award, Alice Magaw Outstanding Clinical Practitioner Award, Ira P. Gunn Award for Outstanding Professional Advocacy, Clinical Instructor of the Year Award, Didactic Instructor of the Year Award, and Program director of the Year Award. 
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State Government Affairs

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 Award for Excellence in State Government Relations Advocacy.
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Meetings and Workshops

Registration Open for Spring Upper and Lower Extremity Nerve Block Workshop
March 3-4, 2018, Park Ridge, IL

The Upper and Lower Extremity Nerve Block Workshop is designed to enhance your knowledge in the clinical sciences related to upper and lower block anesthesia. Featuring didactic and hands-on training, this program will expand the CRNA's skills and expertise in upper and lower extremity nerve block anesthesia.

Bonus: Included with registration, all attendees will receive Upper Extremity Blocks, written by featured speaker Charles A. Reese, PhD, CRNA.


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New Location for Spring Spinal Epidural with Obstetric Essentials Workshop
May 3-5, 2018, Cincinnati, OH

This comprehensive workshop combines enrollment for two of our most popular live CE activities: the Essentials of Obstetric Analgesia/Anesthesia Workshop and the Spinal and Epidural Workshop. Earn valuable Class A CE credits and stay current with expert lectures and hands-on instruction. Time will be allotted for group discussions of representative clinical cases.
Bonus: Included with registration, all attendees will receive Clinical Techniques of Regional Anesthesia: Spinal and Epidural Anesthesia Techniques, edited by the workshop's senior faculty member Charles A. Reese, PhD, CRNA.
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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. See the full job description.

Interested candidates should submit an application to the AANA Executive Unit at committees@aana.comby 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.

General Anesthesia Trumps Sedation for Thrombectomy in Randomized Trial

A study done in Denmark documented improved outcomes in patients who underwent thrombectomy for acute ischemic stroke under general anesthesia (GA) as opposed to conscious sedation (CS). The finding from the randomized trial deviates from the results of observational studies that preceded it. While those investigations lauded CS as the better approach, selection bias likely skewed the data because patients with more severe stroke were more likely to be given GA and to suffer poorer outcomes. The new research is based on 128 patients treated at Aarhus University Hospital for large vessel occlusions in the anterior circulation. The main endpoint was infarct growth, which was a median 8.2 mL with GA compared to 19.4 mL with CS—although the small size of the study population undermines the statistical significance of this finding. The team led by Claus Z. Simonsen, MD, PhD, also reported successful reperfusion in 76.9 percent of GA recipients versus 60.3 percent of CS patients. At 90 days followup, the GA group also was more likely to progress to a lower modified Rankin Scale score, signifying greater patient independence. "Contrary to numerous nonrandomized studies that have reported better outcomes with CS, the GOLIATH trial shows signals in favor of GA for multiple endpoints," conclude the investigators, who published their findings in JAMA Neurology.

From "General Anesthesia Trumps Sedation for Thrombectomy in Randomized Trial"
Cardiovascular Business (01/18/18) Allar, Daniel

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Effect of General Anesthesia on Developing Brain

A new paper examines the body of evidence related to anesthesia's effects on the brains of young animals, in hopes of better understanding the implications for humans. Findings from existing studies indicate that "not only can a single long exposure to general anesthetics lead to cognitive deficits, but the data suggest that multiple, shorter-lasting exposures to anesthesia during vulnerable periods cause significant impairments in neurocognitive development," writes author Vesna Jevtovic-Todorovic, MD, PhD. However, the chair of the University of Colorado's anesthesiology department stresses that results from rodent studies are of limited use in learning more about the impact of anesthesia on people. More scientists, she notes, are undertaking investigations that involve nonhuman primates, whose brain development more closely mimics that of humans. Jevtovic-Todorovic's review is published in Anesthesiology.

From "Effect of General Anesthesia on Developing Brain"
ScienceDaily (01/18/18)

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Analysis of Anesthesia Closed Claims Compares Ambulatory Surgery Centers With Hospital-Based Operating Rooms

Investigators compared anesthesia closed claims from ambulatory surgery centers (ASCs) with those from hospital operating rooms (HORs), looking for differences in liability trends. The study used 2007-2014 data from The Doctors Company, a private medical malpractice firm that insures an estimated 5,300 anesthesia providers, among other clinicians. A total of 290 anesthesiology claims were closed during the study period in the ASC setting, and 528 were closed in the HOR setting. Patient injuries were expertly rated on a scale of one to nine, ranging from emotional trauma to death. The data revealed that 20.7 percent of HOR claims were for patient death. Other higher-severity injuries like organ damage and respiratory or cardiac arrest also occurred more often in this setting. Death accounted for just 11 percent of claims, however, in the ASC, where medium-severity claims such as teeth damage and pain were more prevalent. Even so, careful review of the data suggests that anesthesia providers working in the ASC setting can do a better job in the areas of pre-assessment, informed patient consent, and OR collaboration. The study is slated to appear in the Journal of Patient Safety.

From "Analysis of Anesthesia Closed Claims Compares Ambulatory Surgery Centers With Hospital-Based Operating Rooms"
Anesthesiology News (01/17/18) Prudden, James

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Intravenous Acetaminophen May Reduce Hospital Length of Stay in Adolescents Undergoing Posterior Spinal Fusion

A prospective study focused on the impact of intravenous acetaminophen under the setting of posterior spinal fusion surgery in an adolescent population. The investigation included 114 participants aged 10 to 18 years old, all of whom received patient-controlled analgesia and adjuvant therapy. Among them, 70 received I.V. acetaminophen while 44 did not. The control patients were under anesthesia for a longer period of time and required greater amounts of remifentanil. The I.V. acetaminophen recipients, meanwhile, were discharged from the hospital sooner—which may have reduced their opioid consumption. The results, published in the Clinical Journal of Pain, also documented a negative correlation between I.V. acetaminophen and morphine requirement, which significantly prolonged hospital stay. The strength of the findings was reduced by the nonrandomized, observational nature of the study and the fact that the two patient cohorts differed according to surgery duration, ketorolac administration, and remifentanil doses.

From "Intravenous Acetaminophen May Reduce Hospital Length of Stay in Adolescents Undergoing Posterior Spinal Fusion"
Clinical Pain Advisor (01/16/18) May, Brandon

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Can Corticosteroids and Anesthetics Prevent Postherpetic Neuralgia?

A research team from China recently assessed the effectiveness of preventing postherpetic neuralgia, or nerve-related pain, with a subcutaneous injection of corticosteroid and local anesthetic. The investigators recruited 100 patients aged 50 years or older with severe rash due to shingles infection, of which postherpetic neuralgia is a common complication. Participants were randomized to either usual care with oral antivirals and analgesics or to usual care plus a subcutaneous injection of triamcinolone and lidocaine. The injection targeted inflammation of the peripheral nerves that connect the brain and spinal cord as well as in the bundle of nerve cells known as the spinal ganglion, which is believed to promote postherpetic neuralgia. The main outcome of the study was lingering pain three months after shingles rash first presented. Both sets of patients experienced a decline in pain at the three- and six-month marks, but the reduction was markedly greater among those who received a triamcinolone/lidocaine injection. Additionally, only 4 percent of participants in the injection group developed postherpetic neuralgia at three months versus 20 percent who underwent standard care. Both groups reported significant improvement in quality of life at both time checkpoints, and none of the patients who had a subcutaneous injection experienced any major adverse events. With treatments for postherpetic neuralgia largely ineffective, the researchers say the potential for preventing the condition in the first place is encouraging; however, large-scale trials are warranted. The study results appear in Pain Physician.

From "Can Corticosteroids and Anesthetics Prevent Postherpetic Neuralgia?"
Medical News Bulletin (01/15/18) Hizartzidis, Lacey

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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 25, 2018
Earn Your DNAP National CRNA Week Celebration