Anesthesia E-ssential

AANA Anesthesia E-ssential, July 11, 2019

Vital Signs

Did You Complete Your CPC Two-Year Check-in Yet? Deadline for Many: July 31

If you recertified or initially certified in 2017 on or before July 31, you are likely due to complete your two-year check-in—the next step in the CPC Program—by July 31 this year. It takes just a few minutes and can be completed from your phone, tablet or computer. The two-year check-in is important in part because NBCRNA’s accreditors require NBCRNA to evidence how we are assured that a certificant still qualifies to hold the credential between renewal cycles.

While the two-year check-in is an easy and valid way to demonstrate that this requirement is being met, it is also important as it allows for the confirmation of active practice and licensure, and provides CRNAs with an opportunity to maintain and update essential information such as contact information, so you can be contacted with important information and deadline alerts regarding your credential.

Not sure of your deadline? See the chart on the NBCRNA website. Not sure when you recertified? Click "verify credential" in the top right corner of the NBCRNA website. Complete the simple, online two-year check-in today:
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You Too? AANA Provides Sexual Harassment Resources

Sexual harassment can happen in any workplace. In a May 2016 JAMA article, 30% of academic medical faculty women reported personally experiencing sexual harassment. What can be done? Workplace policies addressing sexual harassment can help protect employees. Visit under the Wellness in the Workplace page to find preventive information and support for sexual harassment survivors and those who stand with them. #MeToo #NoMore
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USP <797> Revisions Take Effect December 1, 2019

USP <797> Pharmaceutical Compounding Sterile Preparations has recently been revised, with an effective date of December 1, 2019. You can find information about the revisions, including Frequently Asked Questions and the revised standards, at The AANA is in the process of reviewing and analyzing the revisions and implications for anesthesia professionals and plans to release resources addressing the revisions for members. In the meantime, the current version of USP <797> is in effect until December 1, 2019.

The United States Pharmacopeial Convention (USP) publishes these voluntary standards, which may be adopted by federal agencies, states, accrediting agencies, and facilities.

For questions, comments, or feedback on USP <797>, please contact AANA Professional Practice at
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Hot Topics

2018 MIPS Performance Feedback Report Is Available

The Performance Feedback Report for the 2018 Performance Year is now available through the Quality Payment Program (QPP) website login. CRNAs can review their merit-based incentive payment system (MIPS) scores and the payment adjustment amounts that will be applied in 2020. The Centers for Medicare & Medicaid Services (CMS) prepared a  fact sheet that explains the details of the report. If you have a question about the payment adjustment factor, you can request a Targeted Review from July 1 through September 30, 2019. An FAQ document about the Targeted Review also is available on the QPP website.
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Your Membership Matters – Renewal Is Now Open!

As the current membership period comes to a close, we would like to thank you for your continued commitment to the AANA! For the upcoming 2019-2020 membership period, the AANA will continue to shed more light on the indispensable, quality anesthesia care that you provide and will develop new continuing education products to help you throughout your career.

We hope you'll join us for another year so that we may continue to work together to advance patient safety, practice excellence, and the CRNA profession.

Renew online today!
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Hurry! Deadline is July 15!
Council on Accreditation (COA) Seeks Nomination for Director Opening

The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is seeking nominations for a University Administrator Director. Candidates must be available to attend three-day COA meetings, typically held in January, May and October. The term of office is three years, beginning Fall 2019 through Fall 2022. The elected candidate then would be eligible to be considered for reelection to a second three-year term. The deadline to apply is July 15, 2019. For position criteria and application requirements, please visit
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The Future of Nursing 2020-2030: Town Hall and Twitter Chat

In preparation for the next Town Hall meeting in Philadelphia, the Future of Nursing 2020-2030 Committee will be holding a Twitter chat on "Payment and Care for Complex Health and Social Needs" on Wednesday, July 17 from 3-4 p.m. ET. Follow @theNAMedicine and use the hashtag #Nursing2030Chat2 to participate.

For more information, visit:
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NewsMaker: SRNA Kirk Butler Named 2019 Pat Tillman Scholar

University of Minnesota student registered nurse anesthetist Kirk Butler, BSN, CCRN, is among the 60 national recipients selected for the 2019 Pat Tillman Scholars. Butler, from Sikeston, Mo., is applying his education and military experience to become a Certified Registered Nurse Anesthetist with the goal of addressing chronic pain issues faced by the veteran community. Learn more.
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Meetings and Workshops

AANA 2019 Annual Congress: August 9-13, 2019, Chicago

#AANA2019 features more than 140 expert speakers, Keynote Speaker Noah Galloway, and 116 sessions in eight educational tracks. Plus, you can choose from seven Pre-Congress Workshops, including Obstetric Regional Anesthesia. Earn up to 22.50 Class A CE credits with up to 10.00 Pharmacology credits while meeting CPC requirements at the biggest networking event in nurse anesthesia!
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Explore the Career Fair at Annual Congress and Get a FREE Professional Headshot!

CRNA Careers is hosting an all-new career fair this year at Annual Congress! Open to all Annual Congress attendees and no appointments necessary. Whether you’re new to the field or looking for a change, join us in Chicago to meet with seasoned recruiters from highly esteemed institutions, including:
  • American Anesthesiology
  • Carle
  • Envision Physician Services
  • North American Partners in Anesthesia
  • TeamHealth
  • The University of Maryland Medical Center
  • UF Health Shands and
  • U.S. Anesthesia Partners
Recruiters will be available to provide expert advice and help you determine your next career steps. Free professional headshots will be available on a first-come, first-served basis. Learn more.

Career Fair Schedule
Sunday, August 11: 9:00 a.m. – 6:00 p.m.
Monday, August 12: 9:00 a.m. – 2:00 p.m.
Tuesday, August 13: 8:00 a.m. – 10:00 a.m.

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Anesthesia Business Seminar September 9, 2019 – Learn from Two Successful CRNA Entrepreneurs

Do you feel limited in your practice? Do you dream of practicing independently? If you want to go out on your own, but don’t know the business side of anesthesia, here’s your chance to learn from Juan Quintana and Larry Hornsby, former AANA presidents, who both have launched multimillion-dollar anesthesia group practices.

Access to Instructors, Quintana and Hornsby
Juan Quintana, DNP, MHS, CRNA, and Larry Hornsby, CRNA, of International Anesthesia Seminars, have partnered with AANA to offer an eight-week online seminar to teach CRNAs how to lead and succeed in starting and operating an anesthesia practice.

Opportunities Are There for CRNAs Who Are Ready
“With so much transition in healthcare, business opportunities are out there for CRNAs, but you don’t get a business education in anesthesia school,” said Quintana. Hornsby added, “There is no book or manual out there, and we’ve built successful businesses through trial and error. We are passionate about helping other CRNAs mitigate their risk and succeed.”

University-level Curriculum for AANA Members Only
Quintana and Hornsby are bringing their university-level course to members only through AANA’s online education platform, AANALearn®. The average cost for online college-level courses is $300-$400 dollars per hour. This seminar is offered to AANA members for just $75 per hour. Participants will earn 16 CE credits and leave the course with an actionable business plan and a certificate of completion from AANA.

The next session will begin on September 9, 2019. Registration is now open, and seats are limited. Reserve your spot!
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Ultrasound-Guided Peripheral Nerve Block Workshop, September 21-22, 2019

This workshop will be held September 21-22, 2019, at AANA national headquarters in Park Ridge, Ill.

Instructors include:
  • Kennett D. Radford, PhD, CRNA;
  • Charles A. Reese, PhD, CRNA, CAPT, NC, USN(ret);
  • Donald L. Van Dam, DNP, CRNA
Expand your skills and expertise in using upper and lower extremity nerve block anesthesia using ultrasonography. The program will include case studies and hands-on demonstration, return demonstration, and skill validation. Register by August 21 for early bird savings.
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New! AANA Leadership Summit, November 8-10, 2019, Naples, Florida

Empower your leader within. Join us for unparalleled networking and leadership development for CRNAs by CRNAs. State association leaders, chief CRNAs and administrators, practice owners and managers, facility leaders, and aspiring leaders, this is the meeting for you. Check out the luxurious Naples Grande Beach Resort. You must be registered for the meeting to get the discounted housing rate. Reserve your spot today!
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AANA Learn: CRNA Education Made Easy
APM Reimbursement Educational Series: Module 1 Free to Members

Have you accessed Introduction to Alternative Payment Models (APMs) and Value-based Contracting? This topic is so complex, yet so important for nurse anesthetists to understand that Module 1 is free for AANA members—with the whole series just $99!

New Topics
Check out what’s new in nurse anesthesia online education, including AANA Journal courses.

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AANA Member Benefits

Respiratory Compromise: How Will You Know?

Learn how monitoring for respiratory compromise can help decrease complications for your patients. With this FREE course, you’ll gain a better understanding of the latest best practices to sharpen your skills and provide the best care for your patients.

As a member, you’ll earn 1 FREE Class A Credit plus 0.5 credit in Pharmacology/Therapeutics.

Learning objectives:
  1. Discuss the importance of monitoring ventilation using capnography to decrease the occurrence of respiratory compromise.
  2. Outline sedation and anesthesia techniques that may mitigate the risk of respiratory compromise.
Get Started Today! Visit

Supported by Medtronic.

This course has been prior approved by the AANA for 1.00 Class A CE credit; AANA Code Number: 1037860. AANA designates this program as meeting the criteria for up to 0.5 CE Credit in Pharmacology/Therapeutics. Course Expiration Date: 6/30/2022.
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Taking Out a Personal Loan: When it Makes Sense, When it Doesn't

There are many reasons to get a personal loan, from consolidating other debts to making major purchases. Plus, they can be used for broad reasons, like taking a vacation, making them very attractive. Our Taking Out A Personal Loan guide takes you through situations when it makes sense and when it doesn’t, covering how they work, various considerations, and tips for finding the right personal loan for your needs. Learn more.

Laurel Road Personal Loan

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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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CRNA: Anesthesia Services, PA, Newark & Seaford, Delaware

For over 30 years, ASPA’s commitment to excellence in patient care is what has enabled us to remain the largest anesthesia group in Delaware and one of the largest private practice anesthesia groups in the country. ASPA is the exclusive anesthesia provider for Christiana Care Health System, home to Delaware’s only Level I trauma center as well as Delaware’s only Level III Neonatal Intensive Care Unit.

In addition to the care we provide at Christiana Care facilities, we also provide anesthesia care for patients at Nanticoke Memorial Hospital, two additional Ambulatory Surgery Centers, and two Sedation Dentistry Centers. Our Anesthesia Care Team is comprised of 40+ board certified anesthesiologists, over 100 Certified Registered Nurse Anesthetists, and an administrative support team.

In 2015, ASPA administered a total of more than 67,000 anesthetics involving all surgical specialties across its facilities. Due to ASPA’s continued expansion, we are actively recruiting Certified Registered Nurse Anesthetists. In this role, you will help lead the transformation of perioperative services, provide the highest quality of patient-centered care and help create value for all ASPA stakeholders. Learn more.
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Nurse Anesthetist: Fox Chase Cancer Center, Philadelphia, Pennsylvania

As one of the first cancer hospitals in the country, Fox Chase Cancer Center has been a national leader in cancer treatment, research, and prevention for more than 100 years. Fox Chase Cancer Center, part of the Temple University Health System, is committed to providing the best treatment options for our patients and delivering that care with compassion.

CRNAs at Fox Chase provide anesthesia for complex surgical oncology patients. They enjoy a broad scope of practice including central neuraxial and other regional blocks in a supportive and collegial anesthesia care team environment.

We are proud of the excellent working relationship that exists between Anesthesiologists and CRNAs in order to provide the highest level of care to our patients. New grads are welcome as we provide an extensive mentorship and orientation program, which enables the acquisition of skills and integrates new providers into our team. Our staff is actively involved in teaching SRNAs. Learn more.
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University of Missouri's CRNA Team: Enterprise Medical Services, Columbia, Missouri

University of Missouri Department of Anesthesiology is seeking additional CRNAs to join their dynamic academic health center in mid-Missouri, home to the only children's hospital and Level I Trauma Center between St. Louis and Kansas City. A tremendous opportunity to join a group of energetic, self-motivated and culturally diverse faculty and staff with a strong commitment to support the growth in surgical volumes and expansion of surgical facilities.

Home to the University of Missouri (MU), and two other colleges, Columbia is an educational center with an eclectic feel. It serves as a medical, technological and cultural base for central Missouri. Columbia's non-student population is around 120,000. Columbia is well known for its cultural events and venues and is consistently recognized as one of the top places to live in the U.S. Learn more.
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CRNA: Lexington Medical Center, Columbia, South Carolina

Lexington Medical Center is rated as one of the Top 25 Best Hospitals to Work for in the U.S., the heart of LMC is our 438-bed modern state-of-the-art facility. Winning the prestigious, “Summit Award” from Press Ganey for outstanding patient satisfaction, “Consumer Choice Award” from the National Research Corporation, all contribute to our reputation for giving our patients the highest quality care.

We are located in the heart of the Midlands, right outside of Columbia, SC, and one of the most successful integrated healthcare systems in the Southeast. As the third largest employer in the Midlands, we invite you to be a part of our ongoing success and join our team! The job responsibilities for Certified Registered Nurse Anesthetists at Lexington Medical Center must be performed under medical supervision. CRNAs provide anesthesia services for all patients from birth through geriatrics. Anesthesia services are provided for all types of patients incorporating pre-anesthesia, intra-op anesthesia, post anesthesia and emergency airway intervention. Learn more.
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CRNA: Banner Health, Fallon, Nevada

With 28 hospitals in six western states, Banner Health is one of the nation's most respected and awarded health systems in the country. We have an exceptional opportunity for a qualified CRNA to join our expanding team at Banner Churchill Community Hospital (BCCH) in Fallon, NV. BCCH is a 40-bed JCAHO accredited hospital providing comprehensive and emergency care, serving 45,000+ including an ambulance service that covers more than 5,900 square miles.

Fallon offers a moderate year-round climate and is just a short drive from both Reno and Lake Tahoe. Fallon offers a wealth of lifestyle advantages including a rustic, rural small-town charm of 45,000, along with a recreational wonderland of outdoor sports, such as boating, fishing, hiking, biking, skiing, hunting, horseback riding and off-roading and NO STATE INCOME TAX! Join the Banner Health Team, where you’ll have the time to connect with your patients, your practice, your family and the great outdoors! We offer dedication to work/life balance unmatched in our industry. Meaning you get to spend more time doing what you love. That’s HEALTH CARE made easier, LIFE made better! Learn more.
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How Does Your Career Grow?

Are you looking to further your career? CRNA Careers is a valuable resource to help you both in your job search and with your career advancement. It's more than a job board. CRNA Careers is where those searching for fulfillment, opportunity, and challenges go to find helpful career tips, search for jobs, and upload anonymous resumes to be found by recruiters and employers.

Here's how to grow your career on CRNA Careers:

  • Seek and find the best jobs in your industry.
  • Set up job alerts to be notified when the jobs you're looking for are posted on the site.
  • Upload your anonymous resume and allow employers to contact you.
  • Access career resources and job searching tips and tools.

Growing your career requires regular care and cultivation. CRNA Careers has the tools to move your career toward your goals. 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.

Ketamine Infusions for Chronic Pain

In hopes of gaining additional insight into the long-term effects of intravenous ketamine for the treatment of chronic pain, researchers examined evidence from seven randomized controlled trials. Each of the studies compared 48-hour outcomes with IV ketamine versus placebo in patients with neuropathic, non-neuropathic, or mixed pain. For the purpose of the meta-analysis, the primary endpoint was the lowest recorded pain score 48 hours after the intervention ended. Based on trial data for 211 participants, the findings indicated that IV ketamine provides significant short-term analgesic benefit in individuals with refractory chronic pain; however, they lacked robust evidence of a benefit beyond two weeks. The data also suggested that a greater effect could be achieved with high-dose versus low-dose ketamine therapy. The authors of the meta-analysis recommend larger-scale, multi-site studies with longer follow-up periods, noting that these will help better target patient populations and identify the optimal treatment protocol.

From "Ketamine Infusions for Chronic Pain"
Anesthesia & Analgesia (07/19) Vol. 129, No. 1, P. 241 Orhurhu, Vwaire; Orhurhu, Mariam Salisu; Bhatia, Anuj; et al.

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Opioid Use Reduced When IV Ketorolac Added to Epidural Morphine Post-Cesarean

While researchers have previously studied the opioid-sparing effect of ketorolac in spinal anesthesia, until now they have not done so in the specific context of morphine-based epidurals. Led by John Kowalczyk, MD, of Harvard Medical School, the team worked with 58 women scheduled for cesarean section with combined spinal-epidural anesthesia. Patients received epidural morphine plus either IV ketorolac or placebo, as dictated by randomized assignment, immediately after delivery and cord clamp. The primary outcome—total hydromorphone dose in the first 24 hours after delivery—was much lower among the ketorolac recipients. The secondary endpoint of estimated blood loss, however, was comparable between the ketorolac group and the controls, as was the change in blood pressure compared with baseline readings. The exception to that finding was observed at 12 hours after delivery, at which point patients who received ketorolac had lower systolic blood pressure than the patients who received placebo. Therefore, the researchers conclude, adding ketorolac to epidural morphine curtails opioid use without increasing blood pressure or estimated blood loss. The study, presented at the 2018 meeting of the American Society of Anesthesiologists, was conducted when Kowalczyk was at Case Western Reserve University School of Medicine.

From "Opioid Use Reduced When IV Ketorolac Added to Epidural Morphine Post-Cesarean"
Anesthesiology News (07/09/19) Vlessides, Michael

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Regional Anesthesia Is Associated with Less Patient Satisfaction Compared to General Anesthesia Following Distal Upper Extremity Surgery

Dutch researchers designed a prospective study in hopes of identifying ways to improve patient satisfaction after anesthesia, which may be influenced by the anesthesia provider's choice of technique. The sample population included 243 patients scheduled for elective distal upper extremity surgery under general or regional plexus anesthesia. Investigators asked participants to rate their satisfaction on postoperative day one and identify the primary source of dissatisfaction with the selected anesthetic technique. During follow-up telephone interviews, nearly 80 percent of all patients said they were "'fully satisfied" with the provider's chosen anesthetic strategy. While only 5.5 percent of patients who underwent general anesthesia did not feel "fully satisfied," nearly a third of the other participants were less than 100 percent content. The main reasons, the regional anesthesia patients reported, were "insufficient anesthesia prior to surgery" and "the discomfort of having a long-lasting insensate extremity postoperatively." To optimize patient satisfaction following regional anesthesia delivery, the team from Erasmus University Medical Centre Rotterdam recommends directing more attention to preoperative patient counseling and addressing the issues of block failure and prolonged postoperative sensory and motor block.

From "Regional Anesthesia Is Associated with Less Patient Satisfaction Compared to General Anesthesia Following Distal Upper Extremity Surgery"
BMC Anesthesiology (07/02/19) Vol. 19, No. 115 Droog, Wouter; Hoeks, Sanne E.; van Aggelen, G. Peter; et al.

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A Checklist to Improve the Quality of Central Venous Catheter Tip Positioning

Central venous catheter insertion, routinely performed by anesthesia providers, can lead to serious complications if the tip is placed too high or too low. After a case of tissue necrosis occurred at Royal Brisbane and Women's Hospital in Australia in 2016 due to flawed central venous catheter positioning, anesthesia specialists there launched a quality improvement project. The effort paired standardized care with a new perioperative checklist aimed at preventing repeat episodes of malpositioning. To test the protocol, the team compared outcomes in 84 patients exposed to the intervention in 2017 against outcomes in a like number of patients who underwent the procedure in 2016 before the intervention was implemented. Under the new protocol, the rate of central venous catheter tip malpositioning declined to 5.6 percent from 9.2 percent. Other observed benefits of the checklist included improved documentation of sterility measures, insertion depth, and post-insertional documentation of tip position on chest radiograph.

From "A Checklist to Improve the Quality of Central Venous Catheter Tip Positioning"
Anaesthesia (07/01/19) Vol. 74, No. 7, P. 896 Hade, A.D.; Beckmann, L.A.; Basappa, B.K.

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Oxygenation Impairment During Anesthesia: Influence of Age and Body Weight

Researchers know that sedation with midazolam can expose or exacerbate limb motor dysfunction in patients with brain tumors, but an interventional study sought to learn more about the mechanism underlying those effects. The investigation included 15 patients with supratentorial eloquent area gliomas and 17 healthy controls matched by age. The participants' motor and sensory functions for upper extremities were assessed before and after mild sedation with midazolam and again after reversal with the benzodiazepine antagonist flumazenil. The glioma patients completed the Nine-Hole Peg Test 26.5 seconds slower than baseline with their nondominant hand and 13.7 seconds slower than baseline with their dominant hand after midazolam administration, but flumazenil reduced the delay to 1.2 and 1.5 seconds, respectively. Task completion with the dominant and nondominant hands of the control patients, meanwhile, slowed by 2.9 and 1.7 seconds, respectively, after midazolam but recovered to 0.2- and 1.3-second lags, respectively, upon flumazenil administration. The results demonstrate the effect of motor coordination deficits in upper limbs among individuals with eloquent area gliomas who receive mild midazolam sedation. However, they suggest that motor dysfunction in this patient population is mediated by aminobutyric acid and is a reversible abnormality.

From "Oxygenation Impairment During Anesthesia: Influence of Age and Body Weight"
Anesthesiology (Summer 2019) Vol. 131, No. 7, P. 46 Lin, Nan; Han, Ruquan; Hui, Xuan; et al.

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Use of General Anesthesia Increases Complication Risk After Revision TKA

New evidence ties the use of general anesthesia during knee replacement surgery to an elevated risk of postoperative complications. Researchers tapped into the American College of Surgeons-National Surgical Quality Improvement database, which allowed them to match and compare patients who had a total knee replacement under general anesthesia with those who received spinal anesthesia for the procedure. Based on multivariate analysis, they determined that the general anesthesia group was more prone to unplanned readmission, discharge to a facility rather than home, transfusion, deep surgical site infection, longer operative time, and prolonged duration of stay. "Ultimately, what we hope that readers take away from our paper is that anesthetic choice is likely dictating a component of risk for their patients," said lead investigator Jacob Wilson, MD. "As a result, when possible and clinically appropriate we recommend use of spinal anesthetic over general anesthesia for revision arthroplasty patients." The findings are published in the Journal of Arthroplasty.

From "Use of General Anesthesia Increases Complication Risk After Revision TKA"
Healio (06/28/2019) Tingle, Casey

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News summaries © copyright 2019 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:

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
July 11, 2019
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