Anesthesia E-ssential

AANA Anesthesia E-ssential
CRNA Week 2018

Vital Signs

The Joint Commission Issues 2018 Hospital National Patient Safety Goals

The 2018 National Patient Safety Goals (NPSGs) for hospitals include:
  • Use a minimum of two patient identifiers when providing care.
  • Eliminate transfusion errors related to patient misidentification.
  • Report critical results of tests and diagnostic procedures on a timely basis.
  • Label all medications, medication containers, and other solutions.
  • Reduce the risk of harm from anticoagulant therapy.
  • Maintain and communicate accurate patient medication information.
  • Improve the safety of clinical alarm systems.
  • Adhere to Centers for Disease Control and Prevention (CDC) or World Health Organization (WHO) hand hygiene guidelines and set goals for improving hand hygiene.
  • Follow evidence-based practices for preventing healthcare-associated infections due to multidrug-resistant organisms and central line-associated bloodstream, surgical site, and indwelling catheter-associated urinary tract infections.
  • Identify patients at risk for suicide.
  • Correctly identify the patient, the appropriate surgical or invasive procedure, and the correct site of the procedure.
  • Conduct a preprocedure verification process; mark the procedure site; and perform a time-out before the procedure. 
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Hot Topics

CPC Program 2-Year Check-In Opens April 2018

The CPC Program 2-year Check-in window will be open April – July 2018 for those who recertified or originally certified in 2016. This is your next step in the CPC Program. What does this involve? It will be simple and quick, and include pre-populated fields for confirmation. By checking in, you will confirm current licensure and practice, update contact information, pay the same fee as in the past for the upcoming two years of certification, and check your CPC Program compliance progress (Class A, B, and optional Core Modules). 

Reminders will be sent with a link to the check-in portal. Regular updates on the 2-year Check-in are scheduled to ensure a seamless process. Visit for CPC Program resources, videos, a toolkit, and more information.
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ATTN State Presidents! Nomination Deadline for Daniel D. Vigness Federal Political Director Award is Jan. 15

Is your state's Federal Political Director (FPD) awesome? Then nominate him or her for the Daniel D. Vigness Federal Political Director Award, which is presented during the AANA Mid-Year Assembly in April 2018. Named for the late Dan Vigness, CRNA, of South Dakota, the first AANA FPD of the Year, this honor recognizes a CRNA who has been involved in federal political campaigns, developed close working relationships with federal officials, led successful CRNA advocacy efforts, helped contribute and raise funds for the CRNA-PAC, and helped recruit CRNAs to participate in political campaigns. Learn more and submit a nomination through the AANA website.
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Call for Candidates: Delegate to Education Committee

The AANA Education Committee is seeking candidates interested in serving on the committee as a delegate. The deadline for receiving completed candidate packets is Jan. 15, 2018. The election will be held, and the winner announced, at the Assembly of School Faculty in February 2018.
The candidate information packet is available on the AANA website.
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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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Professional Practice

The Joint Commission and AHRQ Release Ambulatory Surgery Safety Toolkit

The Joint Commission and the Agency for Healthcare Research and Quality (AHRQ) released a toolkit to help ambulatory surgery centers (ASCs) comply with national patient safety goals.  
  • Is tailored to ASCs and reflects facility-specific needs.
  • Is aimed at applying principles and methods from AHRQ’s Comprehensive Unit-Based Safety Program (CUSP) to prevent surgical site infections and other complications.
  • Includes resources used by ASCs that participated in the AHRQ Safety Program for Ambulatory Surgery project.
  • Stresses improved teamwork, communication and patient safety culture. 
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Joint Commission Survey Focus Area: Culture of Safety

In 2018, Joint Commission surveyors will  increasingly focus on the safety culture at accredited organizations.  Accreditation standards require leaders to establish and maintain a culture of safety and identify improvement areas.  Staff must be comfortable reporting safety issues to leadership.  While culture of safety is already embedded in leadership standards, The Joint Commission reportedly plans to add this focus to medical staff standards in 2018.  
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Meetings and Workshops

Register Now for the Assembly of School Faculty
Feb. 15 - 17, 2018
The Scottsdale Resort at McCormick Ranch

Registration is now open for the only forum that brings all nurse anesthesia educational programs together in one place to discuss and define the future of the profession. If you are passionate about nurse anesthesia education, the Assembly of School Faculty is the must-attend meeting of the year. Find out more, and register now!
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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. A full job description can be found here.
Interested candidates should submit an application to the AANA Executive Unit at by Jan. 31, 2018. Student applicants should submit a letter of permission from their program administrator along with their application. Additional criteria for student applicants can be found at
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.

Preoperative Warming vs. No Preoperative Warming for Maintenance of Normothermia in Women Receiving Intrathecal Morphine for Cesarean Delivery

An Australian study investigated a possible preventative intervention against hypothermia in women receiving spinal anesthesia in preparation for surgical childbirth. Intrathecal morphine has a suspected role in perioperative heat loss, which affects a substantial portion of mothers delivering via cesarean section, so the researchers hypothesized that preoperative warming might be a solution. For the prospective trial, they recruited 50 healthy women scheduled for elective C-section and performed intravenous fluid warming for all of them. However, some participants were randomized to 20 minutes of full-body forced air warming while others received no preoperative warming at all. Based on between-group comparisons of aural temperature change in the mothers at the beginning and end of the procedure, the researchers concluded that the brief period of preoperative warming did not prevent hypothermia. For expecting mothers receiving intrathecal morphine ahead of C-section, they surmised, a mix of preoperative and intraoperative warming techniques may be more effective.

From "Preoperative Warming vs. No Preoperative Warming for Maintenance of Normothermia in Women Receiving Intrathecal Morphine for Cesarean Delivery"
Anesthesia & Analgesia (01/18) Vol. 126, No. 1, P. 183 Munday, Judy; Osborne, Sonya; Yates, Patsy; et al.

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Prevalence of Potentially Distracting Noncare Activities and Their Effects on Vigilance, Workload, and Nonroutine Events During Anesthesia Care

A Vanderbilt University-led investigation centered around whether nonclinical distractions on the part of anesthesia professionals impact the quality of actual care they provide. Working in an academic medical setting, video was recorded by a trained observer who then performed behavioral task analysis. Anesthesia workload and vigilance were randomly measured—the latter based on response time to a red alarm light—while postoperative interviews with participating anesthesia providers identified possible nonroutine events. One or more self-initiated distractions of a personal and/or educational nature were documented in 171 of 319 cases (54 percent), with personal Internet and email use being the most frequent occurrences. Although common, most distractions took place during anesthesia maintenance, represented just 2 percent of total case time, and lasted a median 2.3 seconds. Workload ratings were markedly lower during distraction-containing case periods, and vigilance latencies were significantly longer when there were no distractions. Self-initiated distractions were rarely correlated with nonroutine events: three distractions were temporally associated with, but did not cause, adverse events. The study results indicate that anesthesia providers who rely on sound judgment can self-manage nonclinical activities without any deterioration in quality of care. Going forward, however, the researchers recommend training in distraction management.

From "Prevalence of Potentially Distracting Noncare Activities and Their Effects on Vigilance, Workload, and Nonroutine Events During Anesthesia Care"
Anesthesiology (01/18) Vol. 128, No. 1, P. 44 Slagle, Jason M.; Porterfield, Eric S.; Lorinc, Amanda N.; et al.

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Millennials Prefer Changes Over Pain Meds

Survey results indicate that Millennials who experience chronic pain will treat it differently than previous generations, which rely heavily on pharmacological solutions. Rather, the research suggests, adults between the ages of 18 and 36 prefer lifestyle changes including exercise, improved diet, weight loss, and smoking cessation. According to the American Society of Anesthesiologists, which commissioned the poll, members of this demographic were half as likely as Baby Boomers to have used opioids for pain management. About a fifth of those who did, meanwhile, wished they had not. Millennial use of opioids is problematic for a number of reasons, the survey discovered, with these individuals more likely to procure the drugs through inappropriate channels, more likely to believe it is okay to take them without a prescription, and less likely to safely dispose of unused supply. Because Millennials report experiencing acute and chronic pain at rates of 75 percent and nearly 60 percent, respectively, learning effective management is critical.

From "Millennials Prefer Changes Over Pain Meds"
Fort Wayne Journal Gazette (IN) (01/01/18)

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Predictors Identified for Anesthetic Duration in Common Pediatric Surgeries

Researchers have pinpointed predictors for prolonged anesthetic duration in pediatric surgeries, which could help identify patients at risk for anesthetic neurotoxicity. Study co-authors Anna Klausner, MD, and Caleb Ing, MD, of New York-Presbyterian/Columbia University Medical Center searched the National Anesthesia Clinical Outcomes Registry database for records of children who underwent anesthesia for one of the 10 most common inpatient operations performed in the United States—including appendectomy, burn debridement/graft, and inguinal hernia repair. Nearly 140,000 records were included in the research, and the median duration of anesthesia varied widely from one procedure type to the next. The investigators used Poisson regression to evaluate the relationship between duration of anesthesia and patient- and hospital-level covariates. They found that children with physical status III and IV had significantly longer procedures compared with patients classified under physical status I, and patients younger than a year old and between ages one and three years had significantly longer procedures versus patients older than 10 years. Additionally, surgeries performed at university hospitals took longer than those done at surgery centers and small community hospitals. Based on the findings, Ing said, "We can no longer maintain that certain procedures are free from neurotoxicity risk if duration is proven to be a factor." In addition, Klausner reported at the International Anesthesia Research Society 2017 annual meeting, "there are potential implications for booking times and operating room efficiency."

From "Predictors Identified for Anesthetic Duration in Common Pediatric Surgeries"
Anesthesiology News (12/20/17) Doyle, Chase

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Chemical From Cactus-Like Plant Shows Promise in Controlling Surgical Pain

Resiniferatoxin (RTX), found in a cactus-like plant indigenous to Morocco, has been shown to block postoperative incisional pain in animals, raising hopes for human benefits. The molecule's pain-numbing mechanisms work through the skin's nerve endings rather than, like opioids, through the brain. And unlike local anesthetics—which block all nerve activity—RTX selectively targets the incision site for as long as 10 days while preserving muscle function as well as sensations like touch and vibration. Testing in live humans is currently underway at the National Institutes of Health, which is conducting a Phase I clinical trial for patients with severe cancer-related pain.

From "Chemical From Cactus-Like Plant Shows Promise in Controlling Surgical Pain"
ScienceBlog (12/24/17)

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Challenges in Minimizing Post-Surgical Opioid Use

Stanford University investigators have shown that while perioperative administration of gabapentin does not resolve postoperative pain faster than placebo, it does wean surgical patients off opioids more quickly. Among 422 study participants, those who received 10 doses of gabapentin stopped opioid use in about 25 days—a full week sooner than control patients. The effect was limited, however, with no significant between-group difference in opioid cessation by postoperative day 90. Still, the researchers wrote in JAMA Surgery, "Identifying gabapentin as an important adjuvant to promote definitive opioid cessation rather than merely reducing immediate postoperative opioid requirements has important and timely clinical implications in the context of the national epidemic of opioid overdose deaths and addiction." Meanwhile, a retrospective analysis appearing in the same publication adds to mounting evidence that patients are discharged with opioid prescriptions they do not necessarily need after an operation. With a study population of more than 18,000, the investigators discovered that almost half of the patients received an opioid prescription upon release from the hospital even though they did not need it. The risk of overprescription—defined as an opioid prescription at discharge despite lack of opioid use during the last 24 hours as an inpatient—was greatest for obstetric and gynecologic procedures, followed by orthopedic work and plastic surgery. The only exception was pediatric surgery. The researchers surmised that "prescribers who routinely care for patients undergoing more invasive surgical procedures may be more accustomed to regularly prescribing opioids and thus may be less vigilant about identifying patients who are not taking opioids at the time of hospital discharge." In an invited commentary to the study, the University of Pittsburgh's Patrick Varley, MD, and Brian Zuckerbraun, MD, offered a framework to decrease opioid use in pain management. Under the banner of REDUCE, they recommend recognizing risk factors, educating patients, discussing a plan to make recovery tolerable rather than pain-free, using multimodal analgesia, controlling prescribing, and early referral to pain specialists.

From "Challenges in Minimizing Post-Surgical Opioid Use"
MedPage Today (12/15/17) Lou, Nicole

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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 4, 2018
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