AANA Anesthesia E-ssential

Anesthesia E-ssential January 30, 2015

AANA Anestehsia E-ssential 
Anesthesia E-ssential

January 30, 2015


Vital Signs

future-of-anesthesia-care-today.com Optimized for Mobile Devices
AANA members, hospital administrators, healthcare professionals, policymakers’ staff members, and patients will find accessing www.future-of-anesthesia-care-today.com more convenient than ever, now that the microsite has been optimized for use on mobile devices such as tablets and iPhones. Using responsive design techniques, the AANA Information Technology staff reconfigured the site for easy use on the go. The microsite was introduced in September 2014 as part of the AANA’s new public information campaign, “CRNAs: The Future of Anesthesia Care Today.” The site contains a wealth of information that state associations and individual members can utilize to support their public relations and lobbying efforts.




The Pulse

CPC Pulse
  • Class A and Class B
  • State Government Affairs Webinar on State GR Resources - Available Now!
  • AANA Recognition Awards Nominations Sought


  • Register Today for Fun in the French Quarter at ASF
  • Deadline for 2015 AANA Foundation Award Nominations is February 1
  • Student Scholarships Applications Now Available Online
  • Don't Miss the Early Registration for Assembly of School Faculty
  • Save the Date— Aug. 29-Sept. 1 for NAAC!
  • Register Now for AANA Hands-On Workshop
  • Early Registration Open Now for the Mid-Year Assembly
  • Save the Date--Business of Anesthesia Conference
  • AANA, APRNs Urge Congress to Permanently Repeal Medicare SGR Cuts as Key House Panel Holds Hearings
  • Contact Congress to Support Veterans Access to CRNA and APRN Care, Rural Access to CRNA Services
  • Rural Outpatient Therapy, Rural Access to Care at Issue in AANA and APRN Letter on Hospital Payment Proposal
  • Tavenner Departing CMS Leadership Post; Slavitt to Serve on Interim Basis
  • NIH Panel Issues Report on Role of Opioids in Chronic Pain Care
  • AANA and APRNs Urge Insurance Commissioners to Recognize APRNs in Affordable Care Act Health Plan Networks
  • Who is Serving on House Committees Critical to CRNAs?
  • Jan. 30 Deadline for CRNA and Student Registered Nurse Anesthetist Nominations for Service on the 2015-16 CRNA-PAC
  • To Protect and Advance CRNA Practice, the CRNA-PAC will Soon Begin its 2015 Development Campaign
  • Amendments

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.

Inside the Association

CPC Pulse

Information in this section is provided to help CRNAs keep their finger on the pulse of what’s happening with the NBCRNA’s Continued Professional Certification (CPC) program, which will launch on Aug. 1, 2016.
Class A and Class B
The NBCRNA introduced the concept of Class A and Class B requirements to the Continued Professional Certification (CPC) Program to encourage and recognize a range of continuing education alternatives. The Class A, assessed CE requirement, is not a new concept for the nurse anesthesia profession, but it is new as it relates to face-to-face meetings and other types of CE activities that have not had to provide evidence that learning has occurred. Testing is only one kind of assessment—self-assessment, demonstrations, polling, case studies, and simulations are valid forms of evaluation, depending on the type of educational activity. The AANA CE Committee will develop the standards and criteria for assessed CE. Class B recognizes alternatives for learning and encourages professional growth. Class B requirements are not assessed. They enhance the foundational knowledge of nurse anesthesia practice, support patient safety, or foster an understanding of the broader healthcare environment. If Class B activities are not readily available to the CRNA, the CPC Program is flexible and permits additional Class A activities to fulfill those requirements. To learn more, visit http://nbcrna.com/cpc/Pages/default.aspx or http://www.aana.com/

State Government Affairs Webinar on State GR Resources - Available Now!
Visit the AANA State Government Affairs webinar page for a newly released webinar titled “Introduction to State GR Resources.” This webinar, brought to you by the AANA Government Relations Committee and AANA State Government Affairs Division, features AANA GRC members Mindy Miller, CRNA, MSN, AANA GRC Chair; Don Beissel, CRNA, DNP; Mike Frame, CRNA, DMP, APRN; and Scott Rigdon, CRNA, MPH. The webinar discusses valuable state government affairs information available on the AANA website, including tool kits, templates, issue summaries and more. Take advantage of this opportunity to learn about information and resources important to CRNAs and state nurse anesthetist associations.

AANA Recognition Awards Nominations Sought
Deadline: March 15, 2015
Nominations are being sought for the following awards, which are presented during the Annual Meeting: the Agatha Hodgins Award for Outstanding Accomplishment, the Helen Lamb Outstanding Educator Award, the Alice Magaw Outstanding Clinical Practitioner Award, the Ira P. Gunn Award, the Clinical Instructor of the Year Award, the Didactic Instructor of the Year Award, and the Program Director of the Year Award. Visit the AANA website at www.aana.com/awards for more information.

Register Today for Fun in the French Quarter 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 Fun in the French Quarter event at Acme Oyster House. Click here to visit the AANA ASF registration page to learn more and purchase tickets for this event when you register for the meeting. 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!
Deadline for 2015 AANA Foundation Award Nominations is February 1
Appreciation can make a day, even change a life. Your willingness to put it into words is all that is necessary.
- Margaret Cousins
Each year the AANA Foundation presents awards at the AANA Annual Congress to individuals who have made a difference in the nurse anesthetist community. There is still time to recognize someone you appreciate. The deadline for Award nominations is Feb. 1, 2015. Click here 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.
Student Scholarships Applications Now Available Online
Deadline: March 1, 2015
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, 2015. Scholarship awards range from $1,000 to $3,000 each. In order to apply for a scholarship, you must be enrolled in a program for at least six months prior to March 1, 2015.
Don’t delay; click here to access the Student Scholarship Application webpage on the AANA Foundation website at www.aanafoundation.com.
Please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com if you have any questions.

Don't Miss the Early Registration Deadline for Assembly of School Faculty
Save $50 and register by Feb. 6. See the Preliminary Program to find out more about this exceptional conference. Something special this year: A reception celebrating the 40th Anniversary of the Council on Accreditation of Nurse Anesthesia Educational Programs (COA), sponsored by the AANA and NBCRNA, will be open to all attendees.
Register Now for AANA Hands-On Workshops
Registration is now open for the following workshops:
These popular workshops fill up fast—don’t wait to sign up. Click here to learn more about these and other AANA conferences and workshops.
Save the Date—Aug. 29-Sept. 1 for NAAC!
Our plans are coming together for what will be the most comprehensive, innovative Nurse Anesthesia Annual Congress (NAAC) ever. Be sure to save the date and plan to join us Aug. 29-Sept. 1, in Salt Lake City. To learn more about the NAAC and its location, check out the NAAC webpage and watch the video featuring President Sharon Pearce, CRNA, MSN. Registration Opens in Mid-March.
Early Registration Open Now for the Mid-Year Assembly
April 18-22, 2015
The Mid-Year Assembly, to be held this spring in Arlington, Va., is for all CRNAs and student registered nurse anesthetists interested in issues, trends, and influences related to practice and professional advocacy. Registration is now open: Click here to learn more.
Save the Date—Business of Anesthesia Conference
The Business of Anesthesia Conference will be held June 26-27, 2015, at the Grant Hotel in San Diego, Calif. Mark your calendars and don’t miss this conference, which will offer practical, fundamental continuing education related to the business aspects of anesthesia practice. Check the AANA website at www.aana.com/meetings for further information.

Medicare Releases Schedule for Transitioning Payment Models: What’s the CRNA Impact?
Medicare proposed on Jan. 26 to have 85 percent of its provider payments made in relation to healthcare quality or value outcomes by the end of 2016, moving away from straight fee-for-service payment toward applying quality measures incentives, bundled payment systems, and reimbursements to providers (usually larger institutions) based on population health. Though many CRNAs already submit reimbursements with PQRS quality measures codes included, the proposal may prove to be a game-changer for CRNAs and other providers by accelerating the use of alternative payment models.
According to a statement issued by Health and Human Services Secretary Sylvia Burwell, “HHS has set a goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50 percent of payments to these models by the end of 2018. HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value Based Purchasing and the Hospital Readmissions Reduction Programs. This is the first time in the history of the Medicare program that HHS has set explicit goals for alternative payment models and value-based payments.” The agency is also promoting the development of a “Healthcare Learning and Action Network” intended to address issues associated with new payment models.
In response, the AANA is circulating the proposal among expert CRNA members of the AANA’s Anesthesia Payment and Policy Panels for analysis and recommendations, and reaching out to Sec. Burwell to secure a place at the agency’s new Healthcare Learning and Action Network for CRNAs.
For more information, read a new Perspectives piece in the New England Journal of Medicine from Secretary Burwell. Read more about why this matters here. Read a fact sheet about the goals and Learning and Action Network here. Learn more about Better Care, Smarter Spending, and Healthier People here. A blog from Secretary Burwell is here.
AANA, APRNs Urge Congress to Permanently Repeal Medicare SGR Cuts as Key House Panel Holds Hearings
As the House Energy and Commerce Health Subcommittee held hearings Jan. 21-22 on strategies for repealing Medicare “sustainable growth rate” (SGR) cuts that threaten CRNA and physician Medicare payments this coming April 1, the AANA and other APRN organizations wrote to urge lawmakers to permanently, not temporarily, repeal the SGR once and for all.
“In the interest of the patients for whom we provide care, we strongly support Congress moving to enact legislation providing permanent SGR repeal and Medicare payment reforms,” stated the Jan. 20 letter signed by AANA and nine other APRN groups.  “Payment reforms should recognize APRNs the same as physicians in reimbursement and in the development and implementation of quality measures for payment incentives when the same quality services are provided.”
But with 21 percent cuts to CRNA and physician payment now about two months away unless Congress acts, lawmakers remain at odds over how or whether to pay for permanent SGR relief.  No funding proposal – either to pay by borrowings, by cuts to Medicare, by cuts to other programs such as the Affordable Care Act, or by tax and fee increases – appears to have sufficient traction in Congress right now.  The lack of agreement on funding makes temporary relief, which is more convenient but no less costly in the long run, more likely to be enacted.
Read our coalition letter at http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150115%20APRN%20SGR%20hearing%20letter%20FINAL.pdf (requires AANA member login and password). Read about and see a recording of the hearings at http://energycommerce.house.gov/hearing/permanent-solution-sgr-time-now
Contact Congress to Support Veterans Access to CRNA and APRN Care, Rural Access to CRNA Services
With lawmakers now back in Washington and getting the new 114th Congress under way, now is a great time to encourage your legislators to support full recognition of CRNA and APRN services in the revised Veterans Health Administration (VHA) Nursing Handbook, and to support cost-effective rural access to care delivered by CRNAs. 
Rural Outpatient Therapy, Rural Access to Care at Issue in AANA and APRN Letter on Hospital Payment Proposal
A proposal circulated by a key House health panel chairman intending to fix problems with Medicare hospital payment should extend a moratorium on physician supervision for rural outpatient therapeutic services. Lawmakers should also remove a provision authorizing cost-increasing anesthesiologist services to be paid by Medicare’s rural anesthesia passthrough program, according to a letter cosigned by AANA and nine other APRN groups.
“The APRN Workgroup applauds the inclusion of the provision titled ‘Physician Supervision’ (Sec. 207) in the HIP (Hospital Improvements for Payment) Act discussion draft,” states the letter, referring to the proposal circulated by House Ways and Means Health Subcommittee Chair Kevin Brady (R-TX). “The one-year extension of the non-enforcement instruction for direct supervision for critical access hospitals will improve patient access to therapeutic hospital outpatient services in rural America.”
The letter also addressed the anesthesiology provision in the proposal, stating, “We respectfully request the removal of the, ‘Pass-Through Payments for Anesthesiologists’ provision (Sec. 211) from the proposed HIP Act. As proposed, Sec. 211 will increase the overall cost of anesthesia delivery in rural America without improving outcomes or access for rural Americans.”
The panel is taking comments from stakeholders, and has already received a separate letter from AANA expressing concerns about Sec. 211.  The most likely course for the HIP Act is for it to be attached to legislation providing a Medicare SGR fix later this spring.
Tavenner Departing CMS Leadership Post; Slavitt to Serve on Interim Basis
Marilyn Tavenner RN MHA FACHE, the highest-ranking nurse in the Administration and the 2013 winner of the AANA National Health Leadership Award, announced Jan. 16 that she is resigning her post as CMS Administrator effective February or March. She will be succeeded on an interim basis by Andrew Slavitt, who has served as the principal deputy administrator of the agency since early 2014.
Under Tavenner’s leadership, CMS was assigned with implementing the Affordable Care Act.  Specific to CRNAs, under her stewardship the agency adopted a final rule ensuring Medicare recognition of CRNA services for Medicare patients provided within their state scope of practice (2013), clarified that AAs may not bill QZ nonmedically directed (2013), and eliminated Medicare patient co-pay for separate anesthesia services for screening colonoscopies (2014). Her departure leaves Mary Wakefield RN PhD FAAN at HRSA as the highest ranking nurse in the federal executive branch.
Slavitt came to CMS from UnitedHealth’s Optum division with about 20 years in applying information technology to clinical and health system improvement. Neither a nurse nor a physician but a Harvard MBA, he was brought aboard the agency to recover and improve the Healthcare.gov website from its troubled 2013 rollout. He will serve in an acting capacity until and unless he is confirmed by the Senate. The President has not yet officially submitted his nomination, but is expected to do so.
In response, AANA sent a letter of thanks to Tavenner and a congratulatory note to Slavitt (require AANA member login and password).
NIH Panel Issues Report on Role of Opioids in Chronic Pain Care
A new report by the National Institutes of Health (NIH) independent panel on a the role of opioids in treating chronic pain concludes that more research and development around the evidence-based, multidisciplinary approach is needed to balance patient perspectives, desired outcomes, and safety.
The report follows a September 2014 NIH workshop attended by AANA member Ladan Eshkevari, PhD, CRNA, LAc, and also concludes that individualized, patient-centered care is needed in the treatment of chronic pain. “Until the needed research is conducted, health care delivery systems and clinicians must rely on the existing evidence as well as guidelines issued by professional societies, which need to be continually updated and harmonized to reflect recent research evidence and changes in expert opinion held,” the report states. Therefore, CRNAs who perform chronic pain management procedures should monitor and familiarize themselves with the various guidelines and protocols being developed.
AANA and APRNs Urge Insurance Commissioners to Recognize APRNs in Affordable Care Act Health Plan Networks
The model law governing health plans should promote patient access to safe, cost-efficient healthcare delivery by recognizing APRNs and CRNAs to their full practice authority, according to letters that the AANA and APRN groups submitted on Jan. 12 to the National Association of Insurance Commissioners (NAIC).
The letters were in response to an NAIC request for public comments to its Health Benefit Plan Network Access and Adequacy Model Act (Model Act) which establishes standards for the creation and maintenance of networks by health carriers and assures the adequacy, accessibility, transparency and quality of health care services offered under health plan networks. The NAIC is the U.S. standard setting and regulatory support organization governed by the chief insurance regulators from the 50 states and the District of Columbia.
While noting that plans must supply a sufficient number of providers in their networks, the letters stressed the importance of the AANA-backed Provider Nondiscrimination provision of the Affordable Care Act and recommended that the Model Act include language that health carriers must align their health care network payment systems with that provision. The AANA will continue to monitor this issue for any new developments.
See the revisions to the NAIC Model Act at, http://www.naic.org/documents/committees_b_rftf_namr_sg_exposure_draft_proposed_revisions_mcpna_model_act.pdf. View the AANA’s letter here (AANA login required). View the APRN coalition here (AANA login required).


Who is Serving on House Committees Critical to CRNAs?
Most health policy critical to CRNAs moves through specific congressional committees – and members of those committees in the new 114th Congress are critical for CRNAs to know. This week we list the key House committees and key members within each committee.
House Energy and Commerce Committee: Republicans: Fred Upton, Michigan (Chairman); Marsha Blackburn, Tennessee (Vice-Chairman); Joe Pitts, Pennsylvania (Chairman, Health Subcommittee), Brett Guthrie, Kentucky (Vice Chairman, Health Subcommittee). Democrats: Frank Pallone, Jr., New Jersey (Ranking Member); Gene Green, Texas (Ranking Member, Health Subcommittee). See other members of the House Energy and Commerce Committee here.
House Ways and Means Committee: Republicans: Paul Ryan, Wisconsin (Chairman); Kevin Brady, Texas (Chairman, Health Subcommittee). Democrats: Sander Levin, Michigan (Ranking Member), Jim McDermott, Washington (Ranking Member, Health Subcommittee). See other members of the House Ways and Means Committee here.
House Veterans Affairs Committee: Republicans: Jeff Miller, Florida (Chairman); Gus Bilirakis, Florida (Vice Chairman). Democrats: Corrine Brown, Florida (Ranking Member). House Veterans Affairs Health Subcommittee members have not yet been released. See other members of the Veterans Affairs Committee here; as of Jan. 13, not all committee members have been assigned.
Jan. 30 Deadline for CRNA and Student Registered Nurse Anesthetist Nominations for Service on the 2015-16 CRNA-PAC
If you or a colleague would like to serve on the CRNA-PAC Committee, Jan. 30 is the deadline for submitting an application online.
To submit a CRNA nomination, please click here (AANA login required). To submit a student nomination please click here (AANA login required) and see the additional requirements here (AANA login required). To learn more about the CRNA-PAC Committee, go to https://www.crna-pac.com.


To Protect and Advance CRNA Practice, the CRNA-PAC will Soon Begin its 2015 Development Campaign


Led by CRNA-PAC Chair Rick Jueneman, CRNA, the CRNA-PAC is wasting no time in getting its 2015 development campaign under way as the New Year begins. State association leaders have already received information packets to start the process rolling.
Focused on building member engagement to protect and advance CRNA practice through federal advocacy, the CRNA-PAC will undertake its 2015 campaign in four major phases. With the theme of “#MyCRNACause,” the first phase involves educating AANA members about the role and benefits of the CRNA-PAC to the nurse anesthesia profession and to CRNAs, particularly in a time of major health policy and industry change. The second phase will reach out to members via email, mail and telephone to ask for their support. Third, the CRNA-PAC will undertake a new peer-to-peer Ambassador Program initiative to raise funds for both the CRNA-PAC and state PACs in 10 selected states. The campaign will conclude with “Great Moments in Time,” the CRNA-PAC gala event being held Sunday, April 19, in Washington, DC, at the Newseum.
Learn more about the CRNA-PAC or make a contribution at www.crna-pac.org (requires AANA member login and password). For more information please contact AANA Associate Director Political Affairs Kate Fry at kfry@aanadc.com.


  • The Alliance for Health Reform held a briefing in the Senate on Jan. 21 outlining the importance of APRN and nursing workforce development to the future of healthcare, which was attended by AANA staff team members. Presenters from the American Association of Colleges of Nursing and the Robert Wood Johnson Foundation urged extension of funding for Title 8 nurse workforce development programs and the Medicare graduate nursing education (GME) demonstration project. To learn more, see http://www.allhealth.org/publications/GNE-Toolkit_162.pdf.
  • Subsidized health coverage offered through federal exchanges in states is at issue in a case that the U.S. Supreme Court is scheduled to hear on March 4, 2015. The AANA is monitoring the King v. Burwell case because a Court ruling in favor of the plaintiff could eliminate federal subsidies for private plans marketed in states through federal or federally-facilitated exchanges, which is to say in most states. Such an outcome could wipe out the market for such plans and substantially disrupt coverage for several million Americans. How many? By the end of 2014, 15 million people had enrolled in ACA plans of all types including Medicaid expansions, and not quite half of them had signed up through the federal exchange, out of 330 million people in the United States. To learn more, see http://www.scotusblog.com/case-files/cases/king-v-burwell/.
  • Are you prepared for ICD-10 transition? It’s taking place Oct. 1, 2015. To learn more, see http://www.aana.com/resources2/professionalpractice/Pages/ICD-10-Transition.aspx.
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 US Citizen.



Visit the CRNA Career Center
Assistant Professor/Program Director for Anesthesia – University of Cincinnati
Cincinnati, OH


The college of Nursing is seeking to fill a clinical-track faculty position that will contribute to the teaching and research mission of the University of Cincinnati.
Read more about this position


Opioid Prescription Claims Among Women of Reproductive Age—United States, 2008–2012
The Centers for Disease Control and Prevention (CDC) reports that about 28 percent of privately insured and 39 percent of Medicaid-enrolled women of reproductive age filled a prescription for an opioid from an outpatient pharmacy each year between 2008 and 2012. Overall, opioid prescription claims were consistently higher during the study period for women with Medicaid than for women with private insurance. The most commonly prescribed opioids were hydrocodone, codeine, and oxycodone. CDC suggests that the higher frequency of opioid prescribing to persons on Medicaid could be due to differences in the prescription medications covered under their health insurance plan, differences in use of health care services, or differences in the prevalence of underlying health conditions compared with persons covered by private health insurance.

From "Opioid Prescription Claims Among Women of Reproductive Age—United States, 2008–2012"
Morbidity and Mortality Weekly Report (01/23/15) Vol. 64, No. 2, P. 37 Ailes, Elizabeth C.; Dawson, April L.; Lind, Jennifer N.; et al.


Supreme Court Will Review Lethal Injection Drug Protocol Used in Executions
The Supreme Court announced Friday that it will review the drug protocol increasingly used in executions across the country to determine whether the procedure violates the constitutional ban on cruel and unusual punishment. This will be the court's first examination of lethal injection since 2008. The case was brought by inmates who claim Oklahoma protocol violates the Constitution's prohibition on cruel and unusual punishment. Oklahoma Attorney General Scott Pruitt said his office will defend the state’s lethal injection procedures when the Supreme Court hears the issue this spring. The court last rejected a challenge to lethal injections in 2008. But the three-drug protocol used in the Kentucky case the court examined seven years ago—and employed in most of the executions at that time—is no longer available. The use of this protocol raised objections from officials in Europe, where the majority of the drugs were manufactured, and from the companies producing them, leading to a shortage. States across the country have turned to new, largely untested combinations to execute inmates.

From "Supreme Court Will Review Lethal Injection Drug Protocol Used in Executions"
Washington Post (01/24/15) Barnes, Robert; Berman, Mark


Researchers Make Breakthrough on New Class of Anesthetics
Researchers at the University of Pennsylvania took the pursuit of new anesthetics in a different direction and are now close to developing a whole new generation of the drugs—an achievement that has been four decades in the making. Historically, the tendency has been to modify existing anesthetics rather than develop a new class of them. Penn's Roderic Eckenhoff, MD, and collaborators, however, theorized that a different approach could unveil completely new anesthetic structures. Borrowing an approach often used to develop new therapeutics, they tested more than 350,000 compounds, evaluating each for its ability to bind a surrogate anesthetic binding protein target know as apoferritin. Of the 350,000 compounds analyzed, researchers identified 2,600 that had strong interactions with apoferritin. A subset of the 2,600 were selected based on structural criteria to be tested for anesthetic activity in animal studies; and of that sample, researchers determined that two of the compounds could potentially serve as anesthetics with human applications. "We are only beginning to understand the actual mechanisms that allow general anesthetics to achieve an anesthetized state, and this study is a breakthrough into that world," Eckenhoff wrote in Anesthesiology. "The anesthetics identified by this approach require further development before they can be considered for use ... However, the study results show that novel anesthetics do exist, and that we need not restrict ourselves to small modifications of existing drugs."

From "Researchers Make Breakthrough on New Class of Anesthetics"
Science 2.0 (01/20/15)


Despite Forced-Air Warming, Hypothermia Affects Patients Undergoing Surgery
Because anesthesia throws off normal control of body temperature, potentially resulting in blood loss and wound infection, it has become standard practice to actively warm surgical patients. A Cleveland Clinic study of patients who received forced-air warming looked at whether even brief periods of low body temperature elevated blood loss levels or extended hospital stays. The researchers analyzed records for about 59,000 people, finding that 64 percent of them became hypothermic during the first hour of anesthesia despite being being warmed. Additionally, although most patients returned to normal temperatures by the time the operation was over, those who experienced the most severe hypothermia were also the most likely to require blood transfusions. "This study starts a new conversation on perioperative temperature management," wrote Harriet Hopf, MD, in an editorial published along with the study in Anesthesiology. "Future studies should evaluate the effectiveness of interventions to reduce the degree and duration of intraoperative hypothermia and the effect of these interventions on the broad range of outcomes known to be temperature sensitive."

From "Despite Forced-Air Warming, Hypothermia Affects Patients Undergoing Surgery"
News-Medical (01/21/15)
Protocolized Sedation vs Usual Care in Pediatric Patients Mechanically Ventilated for Acute Respiratory Failure
The use of a sedation protocol among children undergoing mechanical ventilation for acute respiratory failure did not decrease the duration of mechanical ventilation, when compared with usual care, a new study has found. The trial, conducted in 31 pediatric intensive care units (PICUs), involved more than 2,400 children who were mechanically ventilated for acute respiratory failure between 2009 and 2013. At the intervention PICUs, a protocol was used including targeted sedation, arousal assessments, extubation readiness testing, sedation adjustment every eight hours, and sedation weaning. The control PICUs managed sedation via usual care. The patients were followed up until 72 hours after opioids were discontinued, 28 days, or hospital discharge. Overall, duration of mechanical ventilation was not different between the groups, nor were sedation-related adverse events significantly different between the two groups. The authors suggest there is a complex relationship between wakefulness, pain, and agitation, based on exploratory analyses of the secondary outcomes in the study.

From "Protocolized Sedation vs Usual Care in Pediatric Patients Mechanically Ventilated for Acute Respiratory Failure"
Journal of the American Medical Association (01/20/15) Curley, Martha A.Q.; Wypij, David; Watson, R. Scott; et al.

Tapentadol Toxicity in Children
A team of researchers from Wisconsin examined the toxic effects of tapentadol exposure in children. The drug is used to treat moderate to severe pain in adults. In the retrospective observational study, the researchers looked at data for 104 children who were exposed to tapentadol between 2008 and 2013. In all, 93 children had unintentional exposure to the drug. Most of the patients studied had no effect from their exposure, but two had life-threatening events. Side effects reported included drowsiness, lethargy, nausea, vomiting, miosis, tachycardia, respiratory depression.

From "Tapentadol Toxicity in Children"
Pediatrics (01/19/15) Borys, Douglas; Stanton, Matthew; Gummin, David; et al.

Trends in Opioid Analgesic Abuse and Mortality in the United States
New research suggests that the United States is making progress in the battle against opioid analgesic abuse. The researchers employed five programs from the Researched Abuse, Diversion, and Addiction-Related Surveillance System to describe trends between 2002 and 2013 in the diversion and abuse of oxycodone, hydrocodone, hydromorphone, fentanyl, morphine, and tramadol. According to the findings, prescriptions for opioid analgesics increased from 2002 to 2010 and then dropped slightly from 2011 to 2013. Overall, there were large increases in rates of opioid diversion and abuse from 2002 to 2010, and rates declined or flattened from 2011 through 2013. Although the rate of deaths related to opioids increased and then decreased similarly, the researchers note that reported nonmedical use of the drugs did not change much among college students.

From "Trends in Opioid Analgesic Abuse and Mortality in the United States"
New England Journal of Medicine (01/15/15) Vol. 372, No. 3, P. 241 Dart, Richard C.; Surratt, Hilary L.; Cicero, Theodore J.; et al.


Progress Being Made in Infection Control in U.S. Hospitals; Continued Improvements Needed
The Centers for Disease Control and Prevention (CDC) reports that progress is being made in the battle against health care-associated infections, though more work is needed to increase patient safety. The "National and State Healthcare-Associated Infections Progress Report" looks at how each state and the U.S. overall are doing in eliminating six types of infections that hospitals must report to the CDC. There was a 46 percent decrease in central line-associated bloodstream infections between 2008 and 2013, a 19 percent decrease in surgical site infections related to 10 procedures tracked in the report, a 6 percent increase in catheter-associated urinary tract infections since 2009, and an 8 percent reduction in methicillin-resistant Staphylococcus aureus bloodstream infections between 2011 and 2013.

From "Progress Being Made in Infection Control in U.S. Hospitals; Continued Improvements Needed"
CDC News Release (01/14/15)
Hospitalized Children Benefit From Antibiotic Stewardship Programs
Research from Children's Mercy Hospital in Kansas City, Mo., shows that children in hospitals with antibiotic stewardship programs (ASPs) go home sooner and are less likely to be readmitted. Over the course of the five-year study, the ASP reviewed children's health records to determine whether the antibiotic prescribed was appropriate. The average length of stay was 68 hours with no 30-day readmissions for children without complex chronic care issues when the recommendations were followed, while the average stay for patients whose doctors rejected the pharmacist's recommendations was 82 hours, with 3.5 percent of children readmitted within 30 days. The findings were presented at IDWeek 2014.

From "Hospitalized Children Benefit From Antibiotic Stewardship Programs"
Anesthesiology News (01/05/15)

The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain
A new study looked at the effectiveness and risks of long-term opioid therapy for chronic pain in adults. The researchers—from Oregon Health & Science University, Portland, OR, and University of Washington, Seattle—evaluated randomized trials and observational studies that involved adults with chronic pain who had been prescribed long-term opioid therapy and that compared opioid therapy to placebo, no opioid, or nonopioid therapy; different dosing strategies; or risk mitigation strategies. The authors concluded that there was not enough evidence to assess the effectiveness of long-term opioid treatment for improving chronic pain and function. They note that the risk for some harms associated with long-term opioid treatment appears to be dose-dependent.

From "The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain"
Annals of Internal Medicine (01/13/15) Chou, Roger; Turner, Judith A.; Devine, Emily B.; et al.

Most Kids Feel Mild Pain From Subcutaneous MTX
Researchers from the University of Toronto report that most children and adolescents with rheumatic disorders experience mild pain from weekly subcutaneous methotrexate (MTX) injections. Side effects accompanying MTX injections also are associated with higher pain scores. When procedural pain goes uncontrolled in children, this can lead to needle phobia, increased pain sensitivity in adulthood, and avoidance of medical treatment. The researchers conducted an observational prospective study of 41 patients, aged four to 17 years, who were receiving subcutaneous injections of MTX for at least four weeks. Almost three-fourths of the participants had juvenile idiopathic arthritis, with a mean duration of therapy with subcutaneous MTX of 2.5 years. Two patients had discontinued subcutaneous MTX because of intolerance of the injections. Nine patients reported moderate pain and two reported severe pain. Sixty-one percent of study participants experienced at least one clinical adverse effect—most commonly nausea and vomiting, but also fatigue, anorexia, headache, and oral ulcers. Families often used ice application to the injection site, comfort positions (hand holding or hugging), distraction techniques, and the promise of a reward to control pain associated with MTX. The study results are published in Pediatric Rheumatology.

From "Most Kids Feel Mild Pain From Subcutaneous MTX"
MedPage Today (01/05/15) Kuznar, Wayne

Elderly Patients Often Receive Too Much Anesthesia for Endoscopy
To gauge whether induction anesthetics are dose-adjusted for ambulatory gastrointestinal procedures to account for age and, if so, whether doing so increases hypotension, investigators from Yale School of Medicine reviewed anesthesia records for 799 adults. Induction doses of propofol and fentanyl were compared across age groups as well as across American Society of Anesthesiologist (ASA) classes 1 to 4, which classify severity of illness. The researchers also identified changes in mean arterial pressure (MAP) within these parameters. For fentanyl, they found that dosing was the same across age brackets but went up as the ASA class rose. Meanwhile, patients younger than 65 received less propofol than those older than that, except in ASA classes 1 and 2—in which case they received like amounts. Even with lower doses, however, elderly patients suffered marked declines in MAP. "Our take-home point is that propofol dosing is not appropriately adjusted for age and for ASA classes 1 and 2, and with propofol dose adjustments, MAP changes are still significant in older patients," summarized Vicki Bing, BS. Her colleague, lead author Shamsuddin Akhtar, MD, added that it appears ASA class is more likely than patient age to influence dosing decisions. "We think there are opportunities to decrease the dose, and [clinicians] should not only be looking at ASA class but also age," he concluded. "There's more room for reducing the dose in the elderly, especially patients above age 80."

From "Elderly Patients Often Receive Too Much Anesthesia for Endoscopy"
Anesthesiology News (01/01/15) Vol. 41, No. 1 Helwick, Caroline
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