AANA Anesthesia E-ssential

Vital Signs

Media Spotlight Shines on CRNAs in January and December

Thanks to aggressive, ongoing media outreach efforts on behalf of the AANA membership, as well as the recent publication of new research favorable to CRNAs (“Geographical Imbalance of Anesthesia Providers and its Impact on the Uninsured and Vulnerable Populations,” Nursing Economic$, Sept./Oct. 2015), the media spotlight has rarely shined brighter on the nurse anesthesia profession than these past two months. Much of the exposure has been in publications read widely by hospital administrators and other healthcare executives, and just in time for CRNA Week! Among the many highlights:

  • An AANA white paper titled "Answering Today's Need for High-Quality Anesthesia Care at a Lower Cost" was published in its entirety in Becker’s Hospital Review. (1/20/16)
  • A commentary titled “Advanced Practice Nurses Still Face Too Many Barriers” by AANA President Juan Quintana, DNP, MHS, CRNA, appeared in Modern Healthcare. (1/6/16)
  • President Quintana and Lorraine Jordan, PhD, CRNA, CAE, FAAN, executive director of the AANA Foundation and Research & Quality, were interviewed for an episode of The Nursing Show on CRNAs, the Nursing Economic$ research, and more. (1/4/16)
  • In Nurse Watch, a weekly feature in Hospital & Health Networks that rounds up interesting nursing-related news items, Jordan is quoted in a piece titled “Expanding access to anesthesia in underserved areas,” which covered the Nursing Economic$ research. (12/16/15)
  • An article in Clinical Pain Advisor titled, “Is Anesthesia Care Socioeconomically Imbalanced?” covered the Nursing Economic$ research paper, with quotes from Jordan. (12/9/15)

In addition, full-page, four-color ads delivering the message: “CRNAs: Making a Difference One Patient at a Time” appeared in the December issue of Becker’s Hospital Review, the January issue of Hospitals & Health Networks, along with ads in related e-publications produced by Becker’s and AHA.

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CPC Facts

Personalized CPC Overview Videos Available

The NBCRNA’s CPC Program Discovery Series has developed three, 10-minute “Overview/“Next Steps” videos for the odd-year, even-year, and newly certified CRNAs. Voiced by 2015-2016 NBCRNA President Steve Wooden, DNP, CRNA, NSPM-C, these brief videos will walk you through the program as it relates to your situation and details your next steps. View the videos, a CPC calculator, and more on the NBCRNA CPC Program page.

For more information about the NBCRNA's Continued Professional Certification (CPC) Program, which will launch on August 1, 2016, go to the cpc-facts.aana.com website.

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Hot Topics

AANA Connect Launches All-Member General Community

AANA Connect, the exclusive online community for AANA members, has been a resounding success since the launch of its Practice Management and SRNA communities in November. The AANA is pleased to announce the next phase: the All-Member General Community. All AANA members now have access to discussions and resources in this community. Join the discussion and connect with thousands of colleagues across the nation. Be sure to log in to the General Community on Saturday, Feb. 6, at 5 p.m. Central Time, for a live chat with President Juan Quintana, DNP, MHS, CRNA. Want to join the conversation via your phone or tablet? Download the AANA Connect mobile app, available for Apple and Android.

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During CRNA Week, US News and "CBS This Morning" Recognize Nurse Anesthetist as a Top Job in 2016

On “CBS This Morning” on Jan. 26, Nurse Anesthetist was identified as #4 among all U.S. jobs in 2016, and #3 among healthcare jobs. See the CBS story and the US News and World Report story it was based on.

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Nomination Deadline for Service on the 2016-17 CRNA-PAC is January 31

If you or a colleague would like to serve on the CRNA-PAC Committee, Jan. 31 is the deadline for submitting an application online. In September 2016, the nine-member committee will have two CRNA vacancies, each for three-year terms. One student registered nurse anesthetist vacancy will also open for a one-year term. Two members of the AANA Board of Directors serve on the CRNA-PAC Committee, each for a one-year term that may be renewed for one additional year while the member also serves on the Board.

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Nominations Sought for AANA Recognition Awards: Deadline March 15

The AANA is seeking nominations for the following recognition awards, to be presented at the Nurse Anesthesia Annual Congress: 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. Visit Recognition Awards for further information and to download a nomination form. The deadline for receipt of nomination is: March 15, 2016.

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American Society for Enhanced Recovery Hosts 2016 Annual Congress in Washington DC, April 2016

American Society for Enhanced Recovery will be hosting the 2016 Annual Congress of Enhanced Recovery and Perioperative Medicine April 20-22 in Washington, D.C. This three-day congress will address issues related to enhanced recovery and perioperative medicine from a multidisciplinary perspective. At the conclusion of this activity participants will be able to understand new care delivery models and approaches, and how to apply these models in their hospital. For more information, including a full list of speakers and topics, registration information and more visit the ASER website or contact the ASER Office (info@aserhq.org, 414-389-8610).

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Professional Practice

AAMI Foundation Releases Free Toolkit to Help Meet Joint Commission ‘s Alarm Management Requirements

The AAMI Foundation has developed a free toolkit to help healthcare organizations meet The Joint Commission's National Patient Safety Goal on clinical alarms. Beginning 1/1/16, The Joint Commission will expect hospitals to establish and implement policies and procedures for managing clinical alarms and will cite facilities for noncompliance. The AAMI Foundation’s Clinical Alarm Management Compendium includes specific tips, describes practices used by leading institutions, and provides a set of sample default alarm parameters that could be used to benchmark alarm system settings. Suggestions include:

  • Issuing a call to action, championed by executive leadership, recognizing the challenges, risks, and opportunities of alarm management, and committing to solving them.
  • Convening a multidisciplinary team to spearhead action and build consensus.
  • Gathering data and intelligence to identify challenges and opportunities.
  • Prioritizing patient safety vulnerabilities and risks to target with alarm management improvements.
  • Setting and sharing goals, objectives, and activities to address these vulnerabilities and risks.
  • Developing and piloting potential solutions.
  • Evaluating the effectiveness of improvements and making adjustments as needed.
  • Developing policies and procedures.
  • Educating staff to build and maintain competencies.
  • Scaling up and sustaining by creating ownership at the unit level and with continuous improvement.
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New National Perioperative Guideline for Care of Geriatric Surgical Patients Released

Responding to the needs of the country’s growing older adult population, a new collaborative best practices guideline was released on Jan. 4 for optimal care of older adults immediately before, during, and after surgical operations. The new consensus-based guideline was developed by the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) and the American Geriatrics Society’s (AGS) Geriatrics-for- Specialists Initiative (GSI), with support from The John A. Hartford Foundation. “Optimal Perioperative Management of the Geriatric Patient: A Best Practices Guideline” from the ACS and the AGS has been published online on the Journal of the American College of Surgeons (JACS) website and will appear in print editions of JACS and the Journal of the American Geriatrics Society later this year. A free standing volume of this perioperative guideline was also released on Jan. 4 in tandem with publication in JACS.

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State Government Affairs

New Video: Member’s Role in Successful State Government Relations Strategy

“Member’s Role in Successful State Government Relations Strategy,” a new video for AANA members from the AANA Government Relations Committee and State Government Affairs Division staff, has been posted at
NA-Testimonials.aspx. Members of the AANA Government Relations Committee and other experienced CRNA advocates discuss elements of state government relations strategy and share their personal stories. Whether you’re new to state advocacy or have years of experience, don’t miss this great new video!

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Meetings and Workshops

Book Your Meeting, Hotel and Travel Now for Mid-Year Assembly 2016 in Downtown Washington, DC

The AANA Mid-Year Assembly to be held April 2-6, 2016, returns to downtown Washington, D.C! But because our site and our dates coincide with additional major events in the Nation’s Capital – namely the 2016 Cherry Blossom Festival and parade – AANA members are encouraged to register and book their lodgings and air travel as early as possible.

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Don't Miss the Assembly of School Faculty

We're excited to announce that advance registration is now open for the 2016 Assembly of School Faculty. Join us in historic San Antonio on February 25-27, 2016, for the premier convergence of nurse anesthesia program faculty.


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Register Now for Business of Anesthesia Conference

On June 24-25, join the AANA for a two-day conference on Chicago’s Magnificent Mile that will arm you with critical tools for navigating the business aspects of anesthesia practice. Get real-world advice from expert speakers with experience in building and maintaining a successful practice.

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Save the Dates for These Popular Hands-On Workshops

Jack Neary Pain Management Workshop

  • Rosemont, IL
  • April 23-25, 2016

Jack Neary Pain Management Workshop II

  • Rosemont, IL
  • October 29-30, 2016

Upper and Lower Extremity Nerve Block Workshop

  • AANA Foundation Learning Center
  • March 19-20, 2016
  • September 24-25, 2016

Essentials of Obstetric Analgesia/Anesthesia Workshop

  • AANA Foundation Learning Center
  • April 20, 2016
  • November 2, 2016

Spinal and Epidural Workshop

  • AANA Foundation Learning Center
  • April 21-23, 2016
  • November 3-5, 2016
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Foundation and Research

Last Call for FY16 Post-Doctoral/Doctoral Fellowship Applications: Deadline is February 1

Attention Researchers…Post-Doctoral and Doctoral Fellowship applications are currently available on the AANA Foundation. The deadline date for submission is Feb. 1, 2016. If you have any questions, please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com.

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AANA Foundation Student Scholarship Application Deadline is March 1

The AANA Foundation is pleased to continue its long history of funding nurse anesthesia education. Applications for nurse anesthesia student scholarships are available online and the application deadline is March 1, 2016. Scholarship awards range from $1,000 to $3,000 each. To apply for a scholarship, you must be enrolled in a program for at least six months prior to March 1, 2016.

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AANA Foundation 2016 Award Nominations Deadline Extended to March 31

Each year the AANA Foundation presents awards at the AANA Annual Congress to individuals who have made a difference in the nurse anesthetist community. Take the time to recognize someone you appreciate. The deadline for Award nominations has been extended to March 31, 2016.

See Applications and Program Information to access the nomination/application forms for:

  • Advocate of the Year. Presented to an advocate committed to supporting the AANA Foundation and encouraging others to do the same.
  • John F. Garde Researcher of the Year. Presented to an individual who has made a significant contribution to the practice of anesthesia through clinical research.
  • Rita L. LeBlanc Philanthropist of the Year. Presented to an individual who has donated time, talent and direct financial support to the AANA Foundation and other deserving organizations.
  • Janice Drake CRNA Humanitarian Award. Presented to a CRNA who wishes to volunteer and provide anesthesia, education, and training in underserved areas.

Forward the completed form to the AANA Foundation–email to foundation@aana.com or mail to 222 S. Prospect Avenue, Park Ridge, IL 60068.

Thank you in advance for recognizing a member of the nurse anesthesia community. If you have any questions, please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com.

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Register Today for the February Fiesta on the Riverwalk at ASF

If you’re planning to attend the AANA Assembly of School Faculty (ASF) meeting in February, you won’t want to miss the AANA Foundation’s February Fiesta on the Riverwalk event. If you’ve already registered for ASF and would like to purchase event tickets, please contact Margaret Brennan, AANA Registrar, at (847) 655-1180. If you have any questions, please contact Luanne Irvin, AANA Foundation Development Officer, at (847) 655-1173. We hope to see you there!

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Federal Government Affairs

Pre-Submit Your VHA APRN Full Practice Authority Comments Now

Supporting veterans’ access to quality healthcare can be done with one new click, as the AANA has now made it possible for members to pre-submit comments to the Veterans Health Administration (VHA) in favor of CRNA and APRN Full Practice Authority.

Already, tens of thousands of AANA member messages have landed on Capitol Hill. With the VHA anticipated to publish a proposed rule expanding veterans’ access to quality healthcare with CRNA and APRN Full Practice Authority, that rule is expected to be followed by a public comment period. CRNA voices will need to be heard during the regulatory public comment process. With the American Society of Anesthesiologists telling its members that they have to submit 20,000 comments to such a rule, and hosting phone trees to mobilize its members in many healthcare facilities against CRNA Full Practice Authority, AANA members and their colleagues, family and friends all must take action and be heard.

Colleagues, friends, and family can use the site of the Veterans Access to Quality Care Alliance website, www.Veterans-Access-to-Care.com, to make their voices heard.

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VHA Full Practice Authority Issue Rundown

Here is the current update on our issue of expanding veterans’ access to care through Full Practice Authority for VHA CRNAs and APRNs:

  • On Jan. 8 the Secretary of Veterans Affairs submitted a proposed rule to the White House Office of Management and Budget (OMB) for review and publication in the Federal Register. The OMB has 90 days to either publish it in the Federal Register, triggering a 60-day public comment period, or return it to the VHA for more work. The AANA is encouraging members to make their voice heard and pre-submit a comment in favor of expanding veterans access to care through CRNA and APRN Full Practice Authority.
  • Bipartisan legislation is pending in Congress supporting expanding veterans access to care through Full Practice Authority for CRNAs and other APRNs in the VHA. In the U.S. House of Representatives, HR 1247 (Graves-Schakowsky) has 45 cosponsors. In the Senate, S 2279 (Merkley-Rounds) has 8 cosponsors.
  • Our advocacy plans include engaging our state associations of nurse anesthetists to take action. Federal Political Directors and State Presidents should prepare to receive a detailed action packet via email from AANA Federal Government Affairs soon.
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VHA Full Practice Issue 101: What Do These Key Terms Mean?

The procedural issues involved in the VHA expanding veterans’ access to care by granting Full Practice Authority to CRNAs and other APRNs can be confusing. The Secretary of veterans Affairs has proposed a rule now under review at the White House Office of Management and Budget. Legislation is pending in Congress. How does it all fit together?

If Congress passes the laws, what gives agencies the authority to issue regulations? Laws (statutes) enacted by Congress give agencies like VHA their authority to issue regulations. In some cases, the President may delegate existing Presidential authority to an agency. An agency must not take action that goes beyond its statutory authority or violates the Constitution. Agencies must follow an open public process when they issue regulations. This process, the Administrative Procedure Act (APA), includes publishing a statement of rulemaking authority in the Federal Register for all proposed and final rules.

Why does the VHA Full Practice Authority issue need sign-off from the OMB? Currently, the proposal to grant APRNs in the VHA with Full Practice Authority is under review by the White House Office of Management and Budget (OMB). This step allows administration officials to analyze draft proposed rules to ensure their consistency with the law and administration policy before they are published in the Federal Register.

So what’s the next step after the OMB? Once OMB clears the proposal, the VHA publishes it in the Federal Register as a Notice of Proposed Rulemaking (NPRM), an official document that announces and explains the agency’s plan to address a problem or accomplish a goal. All proposed rules must be published in the Federal Register, a daily publication of the U.S. government, to notify the public and provide an opportunity to submit comments.

And my input is needed during a “Comment Period?” Yes, your voice has a very important role in this process! An NPRM published in the Federal Register specifies a period during which it will accept comments from the public. Comments provide the agency additional information on the public’s views and how the policy will impact various stakeholders.

What happens when the comment period is over? The agency will evaluate the public comments and any other information accumulated during the pre?rule and proposed rule stages. To move forward with a final rule, the agency must conclude that its proposed solution will help accomplish the goals or solve the problems identified. It must also consider whether alternative solutions would be more effective or cost less. If the rulemaking record contains persuasive new data or policy arguments, or poses difficult questions or criticisms, the agency may decide to delay or terminate the rulemaking. But if after this analysis period the agency decides to finalize the rule, it is published in the Federal Register as a final rule – a law with an effective date that is usually 30-60 days after its publication.

Why is there also legislation pending in Congress on this issue? Members of Congress concerned with promoting solutions that improve veterans’ access to healthcare have introduced S 2279 and HR 1247 with the support of AANA. The VHA has the authority it needs to propose and finalize a regulation expanding veterans’ access to care through Full Practice Authority for CRNAs and other APRNs. In Congress, the legislation demonstrates support for the overall policy of APRN Full Practice Authority in the VHA and provides legislators a platform to communicate that support on Capitol Hill.

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Medicare Administrative Contractor Wisconsin Physicians Service Insurance Corporation Issues Draft Local Coverage Determination on Lumbar Epidural Injections; AANA Responding

The Medicare Administrative Contractor (MAC) Wisconsin Physicians Service Insurance Corporation (WPS) issued a draft local coverage determination (LCD) affecting coverage of CRNA pain management services in six states where WPS administers the Medicare program. The AANA is reviewing the proposal and preparing a response to protect patient access to care provided by CRNAs. WPS’s draft LCD affects Medicare coverage in the following states: Indiana, Iowa, Kansas, Michigan, Missouri, and Nebraska. The AANA is preparing comments to the draft LCD, which involve lumbar epidural injections. This LCD includes language relating to provider qualifications that is being evaluated for possible impact on CRNAs, and that consistent with the provider-neutral language issued by other MACs. Comments to WPS are due on March 26. Members with any questions or comments regarding these LCDs are invited to contact AANA DC at info@aanadc.com and include the words “WPS LCD” in the subject line. Read the draft WPS LCD on lumbar epidural injections.

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Framework for Alternative Payment Models Released

On Jan. 12, the Health Care Payment and Learning Action Network’s (LAN) its Alternative Payment Model (APM) Framework, which categorizes APMs and establishes a standardized and nationally accepted method to measure progress in the adoption of APMs across the U.S. healthcare system. The AANA participated in LAN webinars addressing the APM framework, and worked with coalition partners to comment on the LAN’s previous draft. While the finalized draft did not incorporate the AANA and Advance Practice Registered Nurses (APRN) coalition partners’ suggestion to highlight barriers to the use of APRNs in the draft, the LAN did acknowledge our comments in previous webinars, indicating the important role of APRNs in the creation and implementation of APMs. The AANA continues to serve as a stakeholder in the LAN and will continue to provide updates to membership.

For further information, read the LAN APM Framework paper and the APRN coalition comment letter (Requires AANA password and login.)

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Feb. 1 Iowa Caucuses Kick Off Presidential Voting Season

The Iowa caucuses on Tue., Feb. 1, kick off five months of voting for presidential nominees concluding with the national political party elections in July. The AANA encourages all CRNAs to actively support the candidate of their choice, but neither the association nor the CRNA-PAC endorses candidates for President. As elections take place through the winter and spring, presidential primary dates do not necessarily coincide with congressional or other primaries. For example, the Iowa caucuses on Feb. 1 are only for presidential nominees; that state’s congressional primary takes place on June 7. Following the Iowa Caucuses, the next few elections take place as follows:

  • Feb. 9, New Hampshire presidential primary
  • Feb. 20, Nevada Democratic presidential caucus, South Carolina Republican presidential primary, and Washington state Republican presidential caucus.
  • Feb. 23, Nevada Republican presidential caucus.
  • Feb. 27, South Carolina Democratic presidential primary.
  • March 1, presidential primaries in Alabama, Arkansas, Georgia, Oklahoma, Tennessee, Texas, Vermont and Virginia. Presidential caucuses in Alaska (Republicans only), American Samoa (Democrats only), Colorado and Minnesota. Congressional primaries in Arkansas, Alabama and Texas.

See an up-to-date list of 2016 election dates by state and by date.

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The Veterans Affairs Commission on Care met Tuesday, Jan. 19, in Washington, to continue considering options for the agency’s future.

  • The House and Senate are in session the week of Monday, Jan. 31.
  • Monday, Jan. 18, marked Dr. Martin Luther King Day, and our December 2015 AANA Journal includes an important “Imagining in Time” article outlining a day in 1958 when Dr. King urgently needed care at a New York hospital – and his care team included Goldie Brangman, CRNA, later president of the AANA. Read the article.
  • The Congressional Budget Office (CBO) has increased its estimates for future federal budget deficits. In a report released Jan. 19, Uncle Sam is forecast to run a $544 billion budget gap in 2016, compared with last August’s projection of a $414 billion deficit. The CBO also expects the deficit to continue rising over the next decade, attributing the increased shortfall to additional spending approved by Congress last December, reduced revenues from a slower economy and from tax reductions, and other factors. The deeper deficit will likely make it more difficult for Congress and the President to increase the red ink this year or in the future. See its December 2015 interim report to the president.
  • Engage with your profession’s social media feed on Facebook and Twitter .
  • Keep up with the AANA’s new efforts for educating hospital administrators, healthcare policymakers and other health industry leaders about the role and value of CRNA care at The Future of Anesthesia Care Today.

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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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Visit www.crnacareers.com to view or place job postings

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Featured Career Opportunity

Certified Registered Nurse Anesthetist (CRNA) – U.S. Army Nurse Corps


The US Army Medical Recruiting Brigade honors Certified Registered Nurse Anesthetists during National CRNA week. Click here for information on CRNA training and career opportunities.


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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.

Epidural Anesthesia Has Some Adverse Effects on Newborns

Epidural anesthesia can negatively impact neonates, according to University of Granada investigators. Based on their retrospective analysis of more than 2,600 infants born between 2010 and 2013 at a single hospital in Spain, resuscitation was required significantly more often in babies born after epidurals. Additionally, the study found that early breast feeding onset was less frequent in those infants; that they were more likely to be admitted to the Neonatal Intensive Care Unit; and that their Apgar index values, derived from a quick test to evaluate the general health of newborns, were slightly lower. The Granada team speculates that negative effects on the baby are caused either by direct transmission of the anesthetic from the mother through the placenta or as a result of physiological changes in the mother—such as hormonal shifts—triggered by the drug. Lead researcher Concepcion Ruiz Rodriguez, a professor in the university's nursing program, acknowledges the efficacy of epidural anesthesia but stresses that the adverse effects should be probed further. She writes in Midwifery, "We consider that it's important that both mothers and health professionals (obstetricians and midwives) know and have in mind those risks when the time for taking a decision comes."

From "Epidural Anesthesia Has Some Adverse Effects on Newborns"
News-Medical (01/25/16)

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Policy: Manage Neonates' Pain Without Drugs When Possible

New American Academy of Pediatrics policy—which will appear in the February issue of Pediatrics—dictates that health care professionals should strive to manage mild to moderate pain in newborns without administering drugs. This approach might include skin-to-skin contact, swaddling, or massage. Providers could step up treatment to oral sucrose and/or glucose if babies do not respond, before moving on to a pharmacologic regimen that includes opioids or other drugs. When this point is reached, the focus must then be on the risks and benefits of giving a neonate a particular drug, according to the authors of the policy. Routine pain management is recommended for major procedures and surgery. Additionally, the updated standards emphasize the need to apply proven neonatal pain assessment tools before, during, and after painful procedures so that infant pain can be monitored and documented.

From "Policy: Manage Neonates' Pain Without Drugs When Possible"
AAP News (01/16) Jenco, Melissa

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Effect of U.S. Drug Enforcement Administration's Rescheduling of Hydrocodone Combination Analgesic Products on Opioid Analgesic Prescribing

The U.S. Drug Enforcement Administration's (DEA) move to put more stringent regulations on hydrocodone combination analgesic products resulted in more than 1 billion fewer tablets dispensed and 26.3 million fewer prescriptions for the drugs in the year after rescheduling. The drugs were involved in nearly 100,000 abuse-related emergency department visits in the United States in 2011. In October 2014, DEA reclassified hydrocodone combination products as Schedule II substances, instead of Schedule III. In a research letter to JAMA Internal Medicine, federal researchers present an analysis of data from before and after the rescheduling, using information from the IMS Health National Prescription Audit. The data show that in the 12 months after rescheduling, dispensed hydrocodone combination product prescriptions fell by 22 percent compared with the 12 months before rescheduling, while dispensed hydrocodone combination product tablets dropped by 16 percent. The decline was largely due to refills, which are prohibited under the new regulations. Meanwhile, dispensed prescriptions for non-hydrocodone combination product opioid analgesics rose nearly 5 percent in the year after hydrocodone combination product rescheduling, and dispensed tablets rose by 1.2 percent. The researchers note that the reductions in dispensed hydrocodone combination products were seen in most health care professional specialties, particularly among primary care physicians and surgeons. While other actions may contribute to the reductions, "the abrupt change in dispensing of hydrocodone combination analgesic products immediately after rescheduling suggests a primary role for this intervention in the observed change," the authors write. Further study is needed to determine whether the effects are long-term and whether they have helped to reduce abuse and overdose.

From "Effect of U.S. Drug Enforcement Administration's Rescheduling of Hydrocodone Combination Analgesic Products on Opioid Analgesic Prescribing"
JAMA Internal Medicine (01/25/16) Jones, Christopher M.; Lurie, Peter G.; Throckmorton, Douglas C.

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Study Finds No Link Between Surgical Anesthesia and Mild Cognitive Impairment

The medical community is exploring a possible correlation between surgical anesthesia and prolonged cognitive impairment in older patients, but new Mayo Clinic findings offer no evidence to that effect. Investigators at the clinic analyzed detailed information on more than 1,700 patients, 85 percent of whom underwent at least one operation requiring general anesthesia after age 40. While 31 percent did present mild cognitive impairment during the study, which evaluated participants every 15 months starting in October 2004, anesthesia was eliminated as a potential cause. "The bottom line of our study is that we did not find an association between exposure to anesthesia for surgery and the development of mild cognitive impairment in these patients," Mayo Clinic anesthesiologist and lead study author David Warner, MD, reports. Additional research is needed, he stresses, especially given growing proof that some cognitive decline in elderly patients may be triggered by vascular issues that cause stroke and other problems. That suggests that while people older than 40 may not be affected by surgical anesthesia, those aged 60 and older could be. The new research appears in the February issue of Mayo Clinic Proceedings.

From "Study Finds No Link Between Surgical Anesthesia and Mild Cognitive Impairment"
Medical Xpress (01/20/16)

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Obstructive Sleep Apnea Death and Near-Miss Registry Collecting Cases, But Society Says More Needed

Researchers are building a new registry in hopes of uncovering patterns tied to unexpected perioperative deaths and near misses in patients with obstructive sleep apnea (OSA). Ultimately, through analysis of detailed case reports included in the database, the Society of Anesthesia and Sleep Medicine and the Anesthesia Closed Claims Project aim to increase risk prevention. "Assembling a series of cases and documenting the details would better highlight the safety concerns in these patients," says Case Western associate anesthesiology professor Norman Bolden, MD. "It would help physicians learn more about the circumstances surrounding these events and possibly acquire data to develop 'best practices' for OSA." According to Laura Cheney, MD, professor of anesthesia patient safety at University of Washington Medicine, the new registry has about 46 cases to date—which she says is not adequate for comprehensive analysis. "To start seeing patterns and clumps," she adds, "100 cases are needed."

From "Obstructive Sleep Apnea Death and Near-Miss Registry Collecting Cases, But Society Says More Needed"
Anesthesiology News (01/19/16) Doyle, Chase

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Needle-Free Administration of Anesthetic in the Mouth Could Save Costs, Improve Patient Compliance

Brazilian researchers have come up with a way to deliver dental anesthetic through an electric current instead of a needle, a development that would have benefits across the board. "Needle-free administration could save costs, improve patient compliance, facilitate application and decrease the risks of intoxication and contamination," explains study co-author Professor Renata Fonseca Vianna Lopez of the University of Sao Paulo. "This may facilitate access to more effective and safe dental treatments for thousands of people around the world." In hopes of completely eliminating injections in the dentist office, Lopez and colleagues sought to get topical anesthetics—typically used to reduce the pain of the needle—into the system more quickly. In animal testing, they discovered that a process known as iontophoresis did deliver anesthetics quickly and more effectively. The anesthesia also was long-lasting. The team intends to work on an iontophoretic drug-delivery device designed specifically for use in the mouth, followed by preclinical trials.

From "Needle-Free Administration of Anesthetic in the Mouth Could Save Costs, Improve Patient Compliance"
News-Medical (01/19/16)

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Brain Wave Activity Can Predict Your Optimal Dosage of General Anesthesia

New research has uncovered a more exact way to determine anesthetic dosage, which varies from person to person but is critical for patient safety and successful sedation. Current standards recommend an initial dose based on patient weight, gradually increased until the patient slips out of consciousness; but this approach can be problematic for those with medical conditions that might be exacerbated by the potentially adverse effects of a sedation agent. A study reported in PLOS Computational Biology, however, suggests that brain wave patterns prior to sedation may be a better indicator of appropriate dose. The University of Cambridge team administered propofol to 20 healthy volunteers, using an electroencephalogram (EEG) to observe how patterns of brain activity changed as dosage climbed. To signal consciousness, participants pushed one of two designated buttons when cued by a particular sound; some reached sedation before maximum dose was delivered, while others remained awake. Analysis of the EEG readings revealed that study subjects with more alpha wave activity before receiving anesthesia required more propofol to sedate them. "These findings could lead to more accurate drug titration and brain state monitoring during anesthesia," the researchers concluded.

From "Brain Wave Activity Can Predict Your Optimal Dosage of General Anesthesia"
Medical Daily (01/18/16) Scutti, Susan

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Retina Can Reflect Anesthesia Injury in Infants

Researchers have found that the retina is key to detecting anesthesia-related brain damage in babies, a previously elusive undertaking. The team, including colleagues from George Washington University and Children's National Medical Center, suspects that activity in the retina reflects brain activity. Their study involved mice pups whose retinas were examined after an hour of exposure to either isoflurane or regular room air. Among other results, the investigators discovered that the anesthetic activated the intrinsic apoptosis pathway in the inner nuclear layer (INL) and that amacrine cells within the INL, which underwent cell death in both sets of mice, were likely targets of isoflurane-induced apoptosis. "Because the retina provides a window to the central nervous [system] and can be imaged noninvasively, our findings create an opportunity to explore anesthesia-induced neuronal degeneration in the developing retina as a potential surrogate for neurotoxicity in the brain," the researchers write in Anesthesia & Analgesia. "Ultimately, we may be able to develop a noninvasive imaging modality to determine whether anesthesia-induced neuronal apoptosis occurs in infants and children."

From "Retina Can Reflect Anesthesia Injury in Infants"
HCPLive (01/15/16) Geyer, Sherree

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Ultrasound Guidance Lowers Risks of Thoracic Nerve Block Technique for Mastectomy

Researchers have found a way to mitigate the risk of a serious complication associated with thoracic paravertebral nerve block (TPVB) following breast cancer surgery. A type of regional anesthesia, TPVB does a remarkable job of managing pain after mastectomy but may be underused because of the potential for pneumothorax. The condition develops when tissue lining the lungs—the pleura—is accidentally punctured, allowing air to enter the chest cavity and create the threat of lung collapse. To determine if ultrasound guidance makes TPVB safer, investigators at Massachusetts General Hospital analyzed their experience with 856 women who underwent mastectomy from 2010 through 2013. Using ultrasound along with traditional nerve block, which relies on anatomical landmarks to identify the injection site, anesthesia providers were able to confirm correct needle placement before administering local anesthetic. In the case of more than 14,000 thoracic spinal nerve injections reviewed, not a single one resulted in pleural puncture or pneumothorax. "Thoracic paravertebral nerve block is a technique that many consider to be high risk," noted Steven L. Shafer, MD, editor-in-chief of Anesthesia & Analgesia, which published the findings. "This study provides convincing evidence that, with ultrasound guidance and in experienced hands, TPVB is not a high-risk procedure."

From "Ultrasound Guidance Lowers Risks of Thoracic Nerve Block Technique for Mastectomy"
Newswise (01/14/16)

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Sharp Rise in Opioid Use in Pregnancy May Contribute to NAS Increase

Increased use of prescription opioids during pregnancy may be a contributing factor in the rising rates of neonatal abstinence syndrome (NAS), writes Nora D. Volkow, director of the National Institute on Drug Abuse in an editorial. It is estimated that 14 percent to 22 percent of women in the United States receive an opioid prescription during their pregnancy. Meanwhile, the nationwide incidence of NAS rose from 1.20 to 3.39 per 1,000 live births between 2000 and 2009. Volkow notes that the potential effects of opioid exposure during pregnancy on infants' developing brains are not known, though animal studies have shown an association between opioid exposure in utero to congenital defects in the central nervous system. Volkow recommends that opioids be used only for pregnant women with severe pain that cannot otherwise be controlled. "If long term use is unavoidable, such as for women in need of buprenorphine or methadone maintenance therapy for heroin addiction, then careful assessment and monitoring should be undertaken to minimize the risk of overdoses, NAS, and misuse," she concludes.

From "Sharp Rise in Opioid Use in Pregnancy May Contribute to NAS Increase"
BMJ (01/12/16) Volkow, Nora D.

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Direct Relationship Found Between Immediate Post-op Pain in Peds and Persistent Pain

Researchers in Italy say pediatric patients who feel acute pain in the first few hours following surgery often suffer for up to six months more. The study involved 264 participants who received general or regional anesthesia for a urologic, abdominal, or orthopedic procedure. Pain assessments were carried out at one and three hours postoperatively; every four hours after that until discharge; and one, three, and six months later. The investigators discovered that nearly 73 percent of patients with persistent postoperative pain had experienced acute pain in the first three hours after their operation. "In other words," explained Valeria Mossetti, MD, "if they don't experience acute pain, they don't get persistent postoperative pain." She and her colleagues at a Turin hospital speculated that anesthetic approach could be a factor. "Since we noticed a lower incidence of persistent postoperative pain in previous data from literature, we can assume that regional anesthesia techniques also offer an advantage in prevention," Mossetti said.

From "Direct Relationship Found Between Immediate Post-op Pain in Peds and Persistent Pain"
Anesthesiology News (01/08/16) Vlessides, Michael

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

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