Anesthesia E-ssential

AANA Anesthesia E-ssential, July 19, 2018

Hot Topics

Will Your Assets Be Protected?

Understanding CRNA malpractice insurance can be challenging. Ensuring you have coverage when you need it shouldn’t be. Learn what to consider when choosing a malpractice insurance company.
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Paying Attention to Your Physical Well-Being

Healthcare professionals are dedicated to helping others with their health, but often their own well-being can suffer. AANA has a collection of resources to support your physical well-being. It can be as simple as keeping cool and safe this summer or getting enough sleep, or as complex as managing chronic pain or working with a disability. Learn more.
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Get Answers to Your Malpractice Insurance Questions

Have a question regarding your malpractice insurance coverage? Whether you have a policy with us or not, AANA Insurance Services is a resource to all membership. Contact us today!
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NewsMaker: CRNA Brian McKelvy Running for Office in Tennessee

Brian McKelvy, CRNA, APRN, is running for County Commissioner, District 5, in Columbia, Tennessee. He has lived in Columbia for 21 years, and is running to help keep the county schools fiscally responsible and accountable, improve the working relationship with city governments, and to keep the county business friendly. Learn more about his candidacy
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NewsMakers: Together, CRNAs Ron and Deb Myers Gave 60 Years to Piedmont Medical Center

Husband and wife CRNAs Ron and Deb Myers of Rock Hill, South Carolina, have dedicated a combined 60 years to the anesthesia department at Piedmont Medical Center, also in Rock Hill. The center celebrated their joint retirement last month. Read more in The Herald.
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Meetings and Workshops

AANA 2018 Annual Congress: Tap into the Power of Technology

The 85th AANA Annual Congress will be held September 21 - 25, 2018, at the Hynes Convention Center in Boston, Massachusetts.                      
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Upper and Lower Extremity Nerve Block Workshop

Expand your knowledge and skills in peripheral nerve blocks with didactic and hands-on training. The workshop is held August 18-19, 2018, in Park Ridge, Illinois.
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NEW! Practice Leadership Assembly Debuts

The new Practice Leadership Assembly will be held November 9-11, 2018 in Rosemont, Illinois. Current and aspiring business owners, as well as practice and facility leaders, will gain insight and confidence to lead the way in a rapidly changing healthcare environment.

See all upcoming events on our AANA Meetings & Workshops page.
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AANA Member Benefits

Nationwide: Home Automation is Everywhere!

Learn more about how smart appliances and home automation systems can make your life easier and reduce energy costs with this short video from AANA Member Advantage Partner Nationwide.

Nationwide Home Automation
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Visit to view or place job postings


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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.

Outpatient Opioid Prescriptions for Children and Opioid-Related Adverse Events

Researchers characterized opioid use in children not suffering from a major chronic condition or substance abuse disorder and not admitted to a hospital or institution for a prolonged time or on a permanent basis. To identify an appropriate sample population, the team from Vanderbilt University searched Tennessee Medicaid records for patients aged 2–17 years that matched this description. They confirmed more than 1.3 million outpatient opioid prescriptions in this patient demographic during a 15-year period ended in 2014, for an annual mean prevalence of 15 percent. The evidence indicated that dental work was the No. 1 reason for opioid prescriptions in children without major medical issues, followed by outpatient procedures/surgeries, trauma, and infections. Opioid-related adverse events—signified by a visit to the emergency department, hospitalization, or death—occurred in 437 cases, or one for every 2,611 opioid prescriptions. Adverse events—more than 71 percent of which were related to the therapeutic use of the opioid in question—also became more common with higher age and higher doses.

From "Outpatient Opioid Prescriptions for Children and Opioid-Related Adverse Events"
Pediatrics (07/16/18) Chung, Cecilia P.; Callahan, S. Todd; Cooper, William O.; et al.

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6 Strategies for Improving Anesthesia Patient Handoffs

Medical facilities increasingly are taking steps to address hand-off errors, including for anesthesia patients. One hospital in Texas, for example, was able to cut its error rate in half through sustainable behavior changes. The first step under Midland Memorial Hospital's six-stage plan was preparation—which entailed collecting baseline data on hand-off quality indicators, developing a quality improvement plan, and designating items for a new protocol and checklist. From there, administrators delivered instruction to providers and then solicited their recommendation on how to make the program better. The last three phases of the protocol included boosting, or helping providers maintain and build on their effectiveness; formalizing, or officially incorporating the protocol into hospital policy; and refreshing, or coaching new perioperative staff as well as offering continuing education to current personnel.

From "6 Strategies for Improving Anesthesia Patient Handoffs"
Becker's ASC Review (07/18) Stewart, Angie

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The Effect of Xenon-Augmented Sevoflurane Anesthesia in Children Undergoing Cardiac Catheterization

Xenon promises, for a number of reasons, to be a wise anesthetic choice for children who have cardiovascular challenges. Not only has the gas demonstrated both cardio- and neuroprotective traits in adults, the hemodynamic impact from its use is negligible compared with other anesthetics. Additionally, it is attractive for pediatric use because of its potential to protect organs. To investigate further, researchers in Belgium designed a pilot trial centered around a population of 40 children no younger than age four years and no older than 12. The participants, all of whom had congenital heart disease and were undergoing cardiac catherization, were randomly allocated to xenon-augmented sevoflurane anesthesia or sevoflurane only. Hemodynamic effect, as evaluated by intraprocedural anesthetic depth and respiratory profile, was similar between both sets of patients. Moreover, xenon-augmented sevoflurane anesthesia was associated with reduced intraoperative need for ephedrine. In addition, when compared to a healthy control group of age- and gender-matched children with no anesthesia exposure, the sevoflurane and xenon sevoflurane groups performed similarly on neurocognitive tests as the controls—except in the area of alertness. That early impairment, however, disappeared after 24 hours.

From "The Effect of Xenon-Augmented Sevoflurane Anesthesia in Children Undergoing Cardiac Catheterization"
Pediatric Anesthesia (07/18) Devroe, Sarah; Lemiere, Jurgen; Van Hese, Laura; et al.

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Parenteral Opioids May Be Effective for Reducing Pain During Childbirth According to Cochrane Review

Results of a Cochrane review point to parenteral opioid medications as a viable pain relief agent during labor, but the quality of the evidence is poor. A total of 61 studies were analyzed as part of the review which, among other findings, indicated that intramuscular pethidine achieved pain reduction overall as well specifically during labor. Other evidence showed that women were less likely to need additional analgesia after receiving an opioid treatment first. Although opioid therapy was consistently tied to maternal nausea, vomiting, and drowsiness, there was little data to suggest any harm to the mother or neonate from using the drugs during labor. Because most of the included studies were not blinded, however, the quality of the evidence was not as strong.

From "Parenteral Opioids May Be Effective for Reducing Pain During Childbirth According to Cochrane Review"
Clinical Pain Advisor (07/11/18) May, Brandon

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CHRM3 rs2165870 Polymorphism Is Independently Associated with Postop Nausea and Vomiting, But Combined Prophylaxis Is Effective

The Apfel score is a good predictor of postoperative nausea and vomiting (PONV), but it may not capture patients who potentially are genetically predisposed to the complication. Researchers in Germany investigated whether the Apfel score and the genetic variation in question, M3 muscarinic acetylcholine receptor (CHRM3) rs2165870 polymorphism, independently contribute to PONV risk. Additionally, the team wondered if preventative measures could lower the incidence of PONV in patients who score low on the Apfel scale but present with high genetic risk. More than 450 surgical patients with rs2165870 genotypes GG, GA, and AA were recruited for the prospective study. Each participant was randomly assigned to one of four treatment arms: acustimulation/dexamethasone, acustimulation/vehicle, sham acustimulation/dexamethasone, or sham acustimulation/vehicle. The results indicated that the CHRM3 polymorphism and the Apfel score independently predict risk of PONV, which affected 37 percent of the study sample. Dexamethasone and acustimulation offered some prophylaxis against PONV in this patient population, each dropping the risk by 30% alone among AA genotype carriers with low Apfel scores. Combining the two therapies was much more effective, however, lowering the risk by 86 percent.

From "CHRM3 rs2165870 Polymorphism Is Independently Associated with Postop Nausea and Vomiting, But Combined Prophylaxis Is Effective"
British Journal of Anaesthesia (07/01/2018) Vol. 121, No. 1, P. 58 Klenke, S.; de Vries, G.J.; Schiefer, L.; et al.

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Perioperative Peripheral Nerve Injury After General Anesthesia

U.S. and Canadian researchers teamed up for a review of recent studies targeting perioperative peripheral nerve injury (PNI), which occasionally presents in patients who have undergone general anesthesia. Based on the literature, the colleagues from the University of Washington and the University of Western Ontario agreed that PNI can be blamed on a number of possible reasons, although improper positioning of patients is often—and often wrongly—singled out. Its multifactorial nature makes the complication difficult to predict and prevent, they agree. The incidence of PNI, the researchers report, varies widely according to type of surgery, age and risk factors, and whether PNI was diagnosed retrospectively or prospectively. Cardiac, neurosurgical, and some orthopedic procedures appear to be more inclined toward PNI development than other types of operations; while injuries to the brachial plexus and ulnar nerves are the most common. The review authors recommend that future studies examine the interaction between different mechanisms of insult, severity, and duration of injury as well as underlying neuronal reserves. Meanwhile, new advances in monitoring could allow for earlier detection of at-risk patients and tailor patient management.

From "Perioperative Peripheral Nerve Injury After General Anesthesia"
Anesthesia & Analgesia (07/18) Vol. 127, No. 1, P. 134 Chui, Jason; Murkin, John M.; Posner, Karen L.; et al.

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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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E–ssential Editor
July 19, 2018
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