Anesthesia E-ssential

AANA Anesthesia E-ssential, January 9, 2020
 
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National CRNA Week
 

Vital Signs


Hurry! Sunday is Last Day!
Scope of Nurse Anesthesia Practice Available for Open Comments Through Jan. 12, 2020

The draft Scope of Nurse Anesthesia Practice is available for member review and open comment through Jan. 12, 2020. Visit www.aana.com/OpenComment (login required).

The updated Scope of Nurse Anesthesia Practice broadly defines the CRNA’s professional role; education, licensure, certification, and accountability; anesthesia practice; leadership; and engagement in advocacy and policymaking. Please send feedback directly to practice@aana.com.
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Accepting Applications for Post-Graduate Advanced Pain Management Fellowship

The Advanced Pain Management Fellowship at the Texas Christian University School of Nurse Anesthesia, in partnership with AANA, is now accepting applications. The post-graduate CRNA fellowship in advanced pain management takes a holistic and multimodal approach in individualizing treatment plans to manage pain, optimize functional ability, and reduce suffering. The program includes online courses and hands-on clinical practice. The deadline to apply for the cohort beginning Fall 2020 is April 1. Learn more.
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Hot Topics


Final Days! Order CRNA Week Promotional Materials by Monday, Jan. 13!

Show your National CRNA Week (Jan. 19-25) pride - get a CRNA Week t-shirt or coffee mug to promote your profession! Order now while supplies last!


2020 National CRNA Week T-shirts

Be sure to see the other CRNA Week merchandise in the AANA Bookstore also: travel mugs, pens, buttons, hats, and more!
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GRC Chat: What to Do in the Beginning of a Legislative Session

The AANA Government Relations Committee (GRC) invites you to attend one of the upcoming GRC chats on "What to Do in the Beginning of a Legislative Session." The program will be presented on two separate occasions to accommodate CRNAs in different time zones. Members of the GRC will provide practical advice on what to do in the beginning of the legislative session. Attendees will have the opportunity to participate, share ideas and ask questions. 
  1. January 13, 2020, 6-7 p.m., CST
    Please join my meeting from your computer, tablet or smartphone.
    https://global.gotomeeting.com/join/646882853

    You can also dial in using your phone.
    United States: +1 (872) 240-3412

    Access Code: 646-882-853
     
  2. January 14, 2020, 9-10 p.m., CST
    Please join my meeting from your computer, tablet or smartphone.
    https://global.gotomeeting.com/join/544767837

    You can also dial in using your phone.
    United States: +1 (312) 757-3121

    Access Code: 544-767-837
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Gain Inspiration: State Leadership Workshop – Newport Beach, California

When: March 7-9, 2020
Location: Hyatt Regency Newport Beach

Join us in Newport Beach, Calif., for a day-and-a-half workshop that will inspire leaders to:
  • Conduct an effective crucial conversation and how to influence change for positive outcomes.
  • Describe the applied skills in emotional intelligence and how this relates to your role as a state leader.
  • Develop strategies for improving association board governance.
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The Joint Commission’s 2020 Ambulatory Care National Patient Safety Goals

The Joint Commission’s 2020 National Patient Safety Goals (NPSGs) for ambulatory healthcare are focused on solving problems in patient safety. In short, effective January 1, 2020, the goals are:
  • Identify patients correctly by using two forms of identification (e.g., name and date of birth).
  • Before blood transfusions, ensure the correct patient will receive the correct blood.
  • Prevent surgical and invasive procedure mistakes by conducting a preprocedure verification process, marking the correct procedure site, and performing a time out before the procedure.
  • Prevent healthcare-associated infections by following hand hygiene guidelines from the World Health Organization or the Centers for Disease Control and Prevention, setting goals for improving hand hygiene, and improving hand hygiene based on the goals.
  • Prevent surgical site infections by implementing evidence-based practices.
  • Prevent medication errors by being extra cautious with patients who use blood thinners, labeling all medications before procedures, and recording and conveying correct information about medications that the patient is taking, including resolving discrepancies.
Learn about the details of goal implementation, including the Elements of Performance.
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FY2021 CRNA-PAC Committee - New Application Deadline is now April 30, 2020!

CRNAs and SRNAs interested in serving on the CRNA-PAC Committee beginning in the 2021 AANA fiscal year are encouraged to submit an application through the AANA online committee submission form located on the aana.com committee page

Responsibilities of Committee members include:
  • Setting the CRNA-PAC income and expenditure policy;
  • Participate in fundraising duties;
  • Reviewing open-seat and challenger candidates for federal office; and
  • Volunteering at CRNA-PAC events and national meetings.
Committee members are expected to attend two in-person meetings per year (Joint Committee Conference in September 2020 and Mid-Year Assembly in April 2021) and conference calls on an as-needed basis.

If you have any questions, please contact Catharine Harris, AANA Associate Director of Political Affairs, at charris@aanadc.com or call (202) 741-9087.

Disclaimer
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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Do You Know an Outstanding CRNA? Nominate Your Colleague for an AANA Recognition Award!

Nomination Deadline: March 15, 2020.
Do you work with an outstanding program director, didactic instructor, or clinical instructor? Do you know someone who has spent a lifetime advancing the practice of nurse anesthesia as a practitioner, educator, clinician, or advocate? Consider nominating your colleague for one of the national AANA recognition awards.

Visit Recognition Awards for details on the:
  • Agatha Hodgins Award for Outstanding Accomplishment,
  • Helen Lamb Outstanding Educator Award,
  • Alice Magaw Outstanding Clinical Anesthesia 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.
Nomination deadline is March 15, 2020.
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NewsMaker: CRNA Adam Schneider Manages Pain Due to Chronic Migraines

Adam Schneider, DNP, CRNA, NSPM-C, provides pain management services at Horizon Health in Paris, Ill. Among his responsibilities is to administer "Botox injections to decrease the symptoms and frequency of chronic migraine headaches," according to an article on WIBQ, the local radio station's website.

"Botox treatments are safe and effective for reducing - and even preventing - chronic migraines," Schneider said. "The injections enter the nerve endings, blocking the release of chemicals involved in pain transmission to the brain." Learn more.
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NewsMaker: CRNA John Paju is an "Unlikely Smuggler"

"John has written a book about his foray into smuggling Bibles behind the Iron and Bamboo curtains during the 1970s and 1980s – at great risk of their lives," according to the Ukiah Daily Journal (Ukiah, Calif.). The book, called "Unlikely Smuggler," details Paju's exploits as a young man.

"[Paju] explained, 'I tell the youth my stories to show them positive life-changing possibilities within their own lives.'

"He assisted in the unveiling of the 'People’s Temple' deception prior to the Jonestown Massacre." Learn more.
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NewsMaker: CRNA Kristen Beck Interviewed as Young Leader in The Paducah Sun

Kristen Beck, MSN, CRNA, was interviewed recently in The Paducah Sun, speaking about challenges and leadership.

When asked what the biggest challenge is for a young leader, Beck responded, "Time Management. I feel like I can communicate for many fellow peers in the same position as myself concerning this topic. Balancing a growing family, a profession, and overseeing a non-profit have forced me to further assess each endeavor presented instead of automatically answering with 'yes.' Valuing quality over quantity has been a learning lesson for me personally." Learn more.
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NewsMaker: CRNA Jessica Peterson Helps Train SRNAs via La Crosse Partnership

Jessica Peterson, PhD, MS, CRNA, APNP, is the program director for the Mayo Clinic Health System La Crosse-Franciscan Healthcare School of Anesthesia in La Crosse, Wis. The school partners with Viterbo University School of Nursing and several area hospitals to effectively train the next generations of CRNAs.

“Our school would not be the same caliber without UW-L and Viterbo — we wouldn’t be able to fill that void of the curriculum,” Peterson said recently to the La Crosse Tribune. Learn more.
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NewsMaker: CRNA Chris Bender is a Man of Vision

Chris Bender, DNAP, CRNA, APRN, has helped develop anesthesia that does not require IV sedation, and seeks to make the anesthesia process more comfortable and less invasive for the patient.

"I'm co-inventor of a sedation pill that we use for surgery," he told the Yankton, S.D., Press & Dakotan. "We use the sedation pill for cataract surgery first." Learn more.
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AANA Meetings: Refresh Your Knowledge and Make New Connections


Come Meet Your Future

Earn Class A CE credits, build your support network, and meet AANA leaders. To view all upcoming live events, visit AANA.com/Meetings
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Assembly of Didactic and Clinical Educators: Register Today!

Join us in Braselton, Ga., at the Château Élan Winery & Resort for the premier nurse anesthesia educational program forum: the Assembly of Didactic and Clinical Educators (ADCE). Meet with leading educators in the field and help define the future of the CRNA profession!

When: February 19-22, 2020
Location: Château Élan Winery and Resort, Braselton, Ga.
Early Registration Savings: Save up to $100.00*

*Resort reservations for ADCE include FREE shuttles to/from Hartsfield-Jackson International Airport.

Wide-Range of Topics include:
  • Leadership to improve faculty/student satisfaction and academic outcomes.
  • Common legal issues faced within nurse anesthesia education.
  • Doctoral curriculum and scholarship.
  • Challenges of clinical education amid production pressure.
  • Health and wellness of faculty and students.
  • Research, and more!
More about the Château Élan - Southern charm meets luxury French splendor with 3,500 acres of grapes, spa treatments, gourmet dining, and golf.
  • Wine tours and tastings held daily.
  • Spa mansion with 14 spa suites.
  • 7 onsite restaurants.
  • 45 holes of championship golf.
Register Today!
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Mid-Year Assembly 2020: Advocate for Your Profession on Capitol Hill

When: April 18-22, 2020
Location: Renaissance Washington D.C. Downtown, Washington, D.C.

The Mid-Year Assembly is the most important nurse anesthesia advocacy meeting. Join us on Capitol Hill as we gather, rally, and impress the importance of nurse anesthesia on our legislators.

Register Today!
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Ultrasound-Guided Peripheral Nerve Block Workshop

When: March 28-29, 2020
Location: AANA National Headquarters, Park Ridge, Ill.

Earn 12 Class A CE credits and refresh your knowledge of ultrasound-guided peripheral nerve block techniques. This weekend workshop features expert lectures, hands-on instruction, and group discussions of representative clinical cases. Register now for advance registration rates.
Get Details or Register
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Save the Date! Spinal Epidural with Obstetric Essentials Workshop

When: April 30-May 2, 2020
Location: 
Cincinnati, Ohio (University of Cincinnati College of Nursing)

Earn 23.50 Class A CE credits with 4.25 Pharmacology/Therapeutics credits with expert lectures and hands-on instruction. Topics include: normal and abnormal physiology of pregnancy, pharmacology, analgesia/anesthesia techniques, clinical applications of spinal and epidural anesthesia procedures, and introduction to the application of ultrasound using live models.
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AANA 2020 Annual Congress: The Power of the Past. The Force of the Future.

When: August 14-18, 2020
Location: San Diego Convention Center, San Diego, Calif.

Join us in sunny San Diego this August for AANA 2020 Annual Congress! Earn significant Class A CE and pharmacology credits with diverse and cutting-edge anesthesia lectures and hands-on Pre-Congress Workshops (registration required). You'll be inspired by our stellar lineup of expert speakers, including keynote Laura Schwartz, former White House Director of Events! This year's theme, "Power of the Past. Force of the Future." recognizes the power of the past in paving the way for a CRNA workforce that will be the force of the future!

While registration opens in March, you can sign up for email updates now, so you won't miss a thing!
Get details
Sign up for updates
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Call for Abstracts
AANA Leadership Summit 2020: Abstract Submissions Open in January

AANA members are invited to submit an abstract for consideration to present at the AANA Leadership Summit, November 13 - 15, 2020, the only leadership conference for CRNAs, led by CRNAs. Get exposure to CRNA leaders from various practice settings and levels of leadership on the conference website for up to six months. Plus, all speakers are listed on the official AANA Leadership Summit mobile app. Build your reputation as an expert speaker while elevating your thought leadership.

Details to come — Watch your inbox!
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Foundation and Research


AANA Foundation – Call for Review Committee Members; Respond by January 31, 2020

The Foundation is currently looking for CRNAs to serve on the Research and Scholarship Committees. The Research Committee reviews applications for research grants, fellowships and poster sessions. The Scholarship Committee reviews student scholarship applications. The Board of Trustees makes funding decisions based on the recommendations of these committees. If you are interested, please submit a statement of interest along with your CV to foundation@aana.com by January 31, 2020.
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AANA Member Benefits


Innovation Lab Offers Free Obstetrics Hands-on Cadaver Lab and Workshop

This free course is for the healthcare professional seeking to advance a platform enhancing patients' experiences after surgery. Lectures, hands-on workshops on fresh frozen human cadavers, and live-model scanning are included.

When: Jan. 25, 2020, 8:30 a.m. - 1:30 p.m.
Where: Embassy Suites hotel, Grapevine, Texas

Objectives include:
  • Describe the opioid epidemic as it specifically relates to the women's health arena.
  • Review legislative movement toward opioid minimization.
  • Outline society guidelines addressing a multimodal approach for postsurgical care in obstetrics and gynecological procedures.
  • Analyze the scientific literature that supports opioid avoidance.
  • Build out an interactive multimodal and enhanced recovery pathway.
  • Use a cadaveric model focused on surgical techniques applicable to addressing pain management in C-section as well as vaginal, open and minimally invasive surgeries.
  • Demonstrate skill in ultrasound-guided transversus abdominis plane blocks, including live model scanning and cadaveric real-time application.
Register and learn more.
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Jobs


CRNA Jobs: Locum Tenens and Permanent Placement Opportunities Across the Country

United Anesthesia – Various Locations. United Anesthesia has been a leading CRNA and Anesthesiologist Locum Tenens and Permanent Placement firm in the country for 40 years. By specializing in only anesthesia placement, we can partner with you to find the ideal situation to suit your strengths, your priorities, your dreams. Your dedicated personal coordinator is looking forward to your call! Learn more.
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Certified Registered Nurse Anesthetists: Medical Management Associates, Inc., Georgia

Busy, Multi-Location Pain Management Practice in Atlanta/Stockbridge, Georgia Seeks Two Certified Registered Nurse Anesthetists (CRNAs) for Fast-Paced, Growing Practice.

Large pain medicine specialty practice seeks two (2) CRNAs to provide services at our multi-location, freestanding ASCs in the Stockbridge, Newnan, Griffin, Smyrna, Johns Creek and Duluth areas of Atlanta.

A rapidly-growing practice providing quality care in a caring and efficient environment. This is a great opportunity as you will have the ability to grow with our practice.

Will consider motivated new graduates or experienced CRNAs. Must have experience using an EHR and be conscientious and caring.

If you are a dedicated medical professional with a strong work ethic, a caring demeanor and a desire to learn, we would like to meet you. Requires the ability to work in a fast-paced, complex environment. Learn more.
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CRNA: Banner Health, Nebraska

Nebraska isn't for everyone, but if you enjoy unique adventures, beautiful scenery, calm pace of life, and a solid compensation package, this opportunity is just right for YOU!

Banner Health is one of the largest non-profit healthcare systems in the country with twenty-eight hospitals, six long term care centers and an array of other services, including family clinics, home care services and home medical equipment, in six Western states.

We have an excellent opportunity for a dynamic CRNA to join our highly trained team!
  • CRNA-only practice model
  • Responsible for performing general, regional, and monitored anesthesia services including Ultrasound-guided block, and OB
  • Experience preferred
  • One week on, one week off, one week call
Ogallala Community Hospital (OCH) is an 18-bed critical access hospital committed to meeting the healthcare needs of western Nebraska and was one of four Banner Health facilities named HealthStrong™ Top 100 Critical Access Hospitals scoring best among critical access hospitals on the iVantage Health Analytics’ Hospital Strength Index™. The Hospital Strength Index is a comprehensive rating of critical access hospitals, and results recognize the Top 100 Critical Access Hospitals that provide a safety net to communities across rural America. Service area 15,653.

Banner Health offers a competitive salary and recruitment incentives along with an industry leading benefits package that provides security for you and your family:
  • Comprehensive medical, dental, vision and pharmacy plans
  • Paid time off plans
  • Eligible for benefits coverage within 30 days
  • Financial savings resources
  • Career advancement and optimal work/life balance
  • Employee Discounts
Learn more.
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Certified Registered Nurse Anesthetists: Northwell Health, New York

Northwell Health Anesthesia is seeking Certified Registered Nurse Anesthetists to join our academic multi-disciplinary team and community based practices throughout Long Island, Westchester, and Manhattan. A rapidly-growing service of Northwell Health, Northwell Health Anesthesia cares for over two million patients annually, with vast resources and services, while firmly committed to serving the needs of our local community. This is a great opportunity as you will have the ability to grow within one of the largest health systems in the Northeast, and the ability to advance to become a leader of a division/department.

We utilize an Anesthesia Care Team model to maximize quality of care and provide an ongoing AANA approved in-house education program for CRNA development at our academic centers. Hospital based positions will present opportunities to assist in teaching and evaluation of SRNAs. We are currently seeking CRNA talent for our hospitals and free standing ambulatory surgical centers. CRNAs are able to practice to their full extent of their training in one of our 35 service locations. All shifts are available which includes 8, 10, 12, 16 and 24 hours depending on the practice location.

Northwell Health is New York State’s largest healthcare provider and private employer, with 23 hospitals, more than 600 outpatient facilities and nearly 15,000 affiliated physicians. We care for over two million people annually in the New York metro area and beyond, thanks to philanthropic support from our communities. Our 66,000 employees – 15,000-plus nurses and 4,000 employed doctors, including members of Northwell Health Physician Partners – are working to change health care for the better. We’re making breakthroughs in medicine at the Feinstein Institute for Medical Research. We're training the next generation of medical professionals at the visionary Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Hofstra Northwell School of Graduate Nursing and Physician Assistant Studies. Learn more.
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Certified Registered Nurse Anesthetists: Dartmouth-Hitchcock Medical Center, New Hampshire

Are you a dedicated CRNA and wish to pursue a career within a collaborative Anesthesia Care Team? Are you interested in a setting where SRNA clinical rotations and Resident training make a dynamic and challenging teaching environment in which to work and grow?

If so, Dartmouth-Hitchcock's Department of Anesthesiology is growing and looking for additional CRNAs to join the team!

What Dartmouth-Hitchcock can offer:
  • Academic appointment as an Instructor of Anesthesiology from the Geisel School of Medicine at Dartmouth College.
  • Positive workplace culture with career advancement opportunities.
  • The quintessential New England experience – Four season living!
  • No income or sales tax.
  • Communities which have been ranked consistently as one of the best places in the U.S. to live and work.
Our practice:
  • D-H is a Tertiary Care referral center with a Level-1 Trauma verification from the American College of Surgeons.
  • 60+ CRNAs - Working in an ACT Model with both an SRNA and Resident training program.
  • The Department of Anesthesiology at D-H provides anesthesia services for over 35,000 cases/year.
  • Services include, General Surgery, Trauma, Maxillofacial, Neurosurgery, Thoracic, Transplant, Vascular and Orthopedics.
Destinations like Boston, New York, the seacoast and ski country are within driving distance, the opportunities - both career and personal - truly make New Hampshire the ideal place to work and play.

Minimum Qualifications:
  • Master’s Degree from an accredited nurse anesthesia education program.
  • Two years of experience as a Nurse Anesthetist.
Required Licensure/Certification Skills:
  • Current New Hampshire RN license required.
  • Certified Registered Nurse Anesthetist (CRNA) required.
CV and cover letter should be addressed to:
Caitlin Vecchio Taylor
Physician Recruiter, Talent Acquisition

Dartmouth-Hitchcock Medical Center is an equal opportunity/affirmative action employer with a strong commitment to diversity. In that spirit, we are particularly interested in receiving applications from a broad spectrum of people, including women, persons of color, persons with disabilities, veterans or any other legally protected group. Learn more.
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Hospital-employed CRNA Opportunity at Level I Trauma Center, Carle Physician Group, Illinois

Carle Physician Group is seeking an additional CRNA to join our team of 50 CRNAs at our main campus in Urbana, Illinois.

Position Details Include:
  • Join an autonomous and team-centered department of 50 CRNAs that perform over 19,500 cases annually at an established research and teaching hospital.
  • Call 1:20 (call included in 40-hour work week).
  • Three subgroups of 10 CRNAs cover OB, Pediatric, and Heart cases.
  • Perform a wide variety of cases and procedures to include: General, Spinal, Epidurals, IV Regionals, CVP, PA Invasive Monitors and A-lines.
Education Requirements: Master's or Doctorate degree in Nurse Anesthesia.

Licensure/Certification Requirements: Current Illinois CRNA license.
Learn more.
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CRNAs: Join Duke University Hospital, Durham, North Carolina

We have immediate opportunities for CRNAs to join our growing teams. With 957 inpatient beds, here you will find comprehensive diagnostic and therapeutic facilities including a regional emergency/trauma center; a major surgery suite containing 51 operating rooms; an endo-surgery center; an ambulatory surgery center with nine operating rooms and an extensive diagnostic and interventional radiology area.

Duke University Hospital includes the following specialties, each offering new and exciting opportunities in both adult and pediatric using the latest technological advancements, including two intraoperative MRI suites and two intraoperative CT suites.
  • General Surgery
  • Cardiothoracic
  • Orthopedics
  • Plastics
  • Neurosurgery
  • Otolaryngology Head & Neck (ENT)
  • Gynecology
  • Urology
  • Robotics
  • Transplant
U.S News & World Report named Duke University Hospital #1 in North Carolina and #1 in the Raleigh-Durham area in 2018-19. Duke University Hospital is ranked in the top 20 nationally for seven adult specialties, including cardiology and heart surgery, nephrology, ophthalmology, orthopedics, pulmonology, rheumatology, and urology.

To be considered, we require a master's degree from a nurse anesthesia program, a current or compact RN licensure in North Carolina, and certification by the NBCRNA as a Certified Registered Nurse Anesthetist. Learn more.
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CRNACareers

CRNACareers.com - The New Year is Here! What Will 2020 Bring for Your Career?

Maybe you need a change of scenery or a new challenge. 2020 is here with new opportunities and goals to keep your career stimulated, and jobs for which you are uniquely qualified. Find the new you on CRNACareers.com!

  • Search and apply to locum tenens or permanent positions at industry-leading facilities.
  • Upload your resume anonymously and allow employers to contact you.
  • Set up job alerts to receive notifications on new openings.
  • Access free career resources to assist with resume and interview preparation.

Learn more today!

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Healthcare Headlines

Healthcare Headlines is for informational purposes, and its content should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

Chronic Atypical Antipsychotic Use Is Associated with Reduced Need for Postoperative Nausea and Vomiting Rescue in the Postanesthesia Care Unit

Researchers at Atlanta's Emory University investigated whether chronic atypical antipsychotic therapy, which has been shown to curb nausea and vomiting triggered by chemotherapy, might also be effective following surgery under anesthesia. Based on 2014-2017 data from a single facility, the team identified 154 elective noncardiac operations where patients were receiving olanzipine, aripiprazole, or risperidone. A second study cohort consisted of 308 matched cases where the surgical patients did not receive chronic administration of those agents. The primary outcome of interest was the need for rescue antiemetics in the postanesthesia care unit, the likelihood of which was lower for the atypical antipsychotic therapy group. The results of the retrospective investigation underscore the need for prospective studies to establish the safety and efficacy of using atypical antipsychotics as prophylaxis against postoperative nausea and vomiting.

From "Chronic Atypical Antipsychotic Use Is Associated with Reduced Need for Postoperative Nausea and Vomiting Rescue in the Postanesthesia Care Unit"
Anesthesia & Analgesia (01/20) Vol. 130, No. 1, P. 141 Jabaley, Craig S.; Gray, Dennis; Budhrani, Guarav S.; et al.

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Effect of Intravenous Dexamethasone on the Anesthetic Characteristics of Peripheral Nerve Block

Healthy volunteers participated in a study that measured the dose-response effect of intravenous dexamethasone on duration of peripheral nerve block. Each of the 18 individuals underwent two median nerve blocks: one alongside a saline infusion and one alongside 2, 4, or 8 mg of I.V. dexamethasone. Investigators, representing institutions in Canada and the United Kingdom, were primarily interested in how long it would take for normal pinprick sensation to return. The outcome turned out to be similar, regardless of whether the block was performed with saline or dexamethasone, and regardless of the dexamethasone dose. However, the researchers also observed that area under the curve for thermal quantitative sensory testing suggested a prolonged time to return of cold detection threshold and warm detection threshold. The clinical value of those findings, however, is unclear.

From "Effect of Intravenous Dexamethasone on the Anesthetic Characteristics of Peripheral Nerve Block"
British Journal of Anaesthesia (01/20) Vol. 124, No. 1, P. 92 Short, Anthony; El-Boghdadly, Kariem; Clarke, Hance; et al.

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The Performance of a Postinduction Fentanyl Test in Identifying Severe Obstructive Sleep Apnea Syndrome

Researchers examined whether a postinduction fentanyl test could effectively screen kids for severe obstructive sleep apnea syndrome (OSAS), which is associated with greater sensitivity to opioids. The team from Shanghai's Fudan University chose the intervention based on previous evidence showing a correlation between sensitivity to intraoperative fentanyl and reduced postoperative opioid demand. To investigate, the prospective trial recruited 104 children scheduled for elective adenotonsillectomy. The patients—who had undergone sleep study evaluations—received intravenous fentanyl prior to endotracheal intubation, with respiratory measurements taken before and after the test. Based on a 50 percent or greater drop in respiratory rate, the test identified OSAS with a sensitivity of 87 percent, specificity of 88 percent, positive predictive value of 85 percent, and negative predictive value of 89 percent. The findings indicate that a postinduction fentanyl test is a good tool for detecting severe OSAS and early, respiratory-related adverse events in children having their tonsils removed.

From "The Performance of a Postinduction Fentanyl Test in Identifying Severe Obstructive Sleep Apnea Syndrome"
Pediatric Anesthesia (01/20) Vol. 30, No. 1, P. 57 Wu, Ru; Wang, Xuan; Zhuang, Peijun

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App Improves Post-op Pain Control, Reduces Opioid Use

Using a smartphone app following discharge helped knee replacement patients steadily reduce their opioid use and manage their pain, a Dutch study has found. A total of 33 participants received standard care during the first two weeks after total knee arthroplasty, with 38 others receiving usual care plus the mobile app. Patients using the app—which made recommendations about pain drug use, exercise, and rest based on the user's entered pain levels—consumed 23 percent fewer opioids and 15 percent less paracetamol during the study period than the patients who received standard care. Routine use of the technology lowered opioid demand even more and improved pain control both during activity and at night. Researchers presented their findings at the 2019 Euroanaesthesia Congress in Vienna.

From "App Improves Post-op Pain Control, Reduces Opioid Use"
Anesthesiology News (01/02/20)

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Efficacy and Safety of Prophylactic Use of Ketamine for Prevention of Postanesthetic Shivering

Meta-analysis authors synthesized evidence from 16 randomized controlled trials to evaluate the use of ketamine as prevention against shivering. Data for nearly 1,500 study participants revealed that, compared with placebo, ketamine lowered the incidence rate of post-anesthetic shivering. Ketamine also reduced hypotension and bradycardia, but it did not improve the rate of nausea and vomiting compared with placebo. Meanwhile, patients who received higher doses of ketamine experienced hallucinations more often. Although ketamine outperformed placebo in this setting, the team from Jiangsu, China, found that it was not superior to comparator pharmacologics in curbing post-anesthetic shivering.

From "Efficacy and Safety of Prophylactic Use of Ketamine for Prevention of Postanesthetic Shivering"
BMC Anesthesiology (12/30/19) Vol. 19, No. 245 Zhou, Yang; Mannan, Abdul; Han, Yuan; et al.

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Awake Tracheal Intubation: Difficult Airway Society Guidelines

New guidance on awake tracheal intubation (ATI) is now available from the Difficult Airway Society (DAS). The low-risk approach has a high success rate, with a failure rate of just 1-2 percent, yet continues to be underutilized in the setting of predicted difficult airway. With a goal toward supporting clinical practice and helping lower the threshold for applying awake tracheal intubation when appropriate, the society recommends action any time predictors of difficult airway management are present. Use of a checklist or other cognitive aid is highly advisable, the guideline authors suggest. Additionally, they caution against using sedation as a substitute for inadequate airway topicalization—although they agree that minimal sedation can be helpful, preferably when administered by an independent practitioner. DAS calls for no more than three intubation attempts, meanwhile, and stipulates that clinicians should not proceed with anesthesia induction until correct tracheal tube position is verified through both visual confirmation and capnography. The guidelines also emphasize the importance of all other departments supporting anesthesia providers in achieving and maintaining proficiency in awake tracheal intubation.

From "Awake Tracheal Intubation: Difficult Airway Society Guidelines"
Specialty Medical Dialogues (12/29/19) Baranwal, Medha

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News summaries © copyright 2020 SmithBucklin



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

Anesthesia E-ssential is for informational purposes, and its contents should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

If you are interested in advertising in Anesthesia E-ssential contact HealthCom Media at 215-489-7000.

For more information on AANA and Anesthesia E-ssential, contact:

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222 S. Prospect Avenue
Park Ridge, IL 60068
Phone: (855) 526-2262 (toll-free)/(847) 692-7050
Fax: (847) 692-6968

Attn: Cathy Hodson
E–ssential Editor
chodson@aana.com
January 9, 2020