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See How AANA Connect Has Grown!
New Communities Introduced this Summer

AANA Connect, the exclusive online community for AANA members, provides a secure, professional environment where CRNAs can discuss a spectrum of clinical topics and network with thousands of colleagues across the nation. And we’ve grown.

Now AANA Connect features eight topic-based communities where you can reach colleagues with the same practice issues and interests as you.
 
Communities Currently Open to All Members
  • All Member General Community
  • Practice Management Community
  • Critical Access Hospital/Rural NEW
  • Simulation NEW
  • Pain Management NEW
Communities Exclusive to Specific Member Types
Members must meet the criteria outlined in each community.
  • Program Administrators and Assistants Community NEW
  • SRNA Community
  • State Peer Advisors NEW
Coming in August
  • Annual Congress Community
To view the selection of communities available to you, log on to AANA Connect and select My Communities from the Communities dropdown menu. 
 
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Hot Topics


New Report on Pain Management and the Opioid Epidemic

A new report from the National Academies of Sciences, Engineering, and Medicine, Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use, states that a sustained, coordinated effort is necessary to stem the still-escalating prevalence of opioid-related harms, including a culture change in prescribing for chronic noncancer pain, aggressive regulation of opioids by the U.S. Food and Drug Administration, and multi-pronged policies by state and local governments. However, the report also counsels against arbitrary restrictions on access to opioids by suffering patients whose health care providers have prescribed these drugs responsibly. Read the report.
 
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Opana ER Removed from Market

Endo International PLC is voluntarily pulling Opana ER off the market at the request of the U.S. Food and Drug Administration (FDA). Opana ER is the first opioid drug that the FDA has sought to remove from the market due to abuse. The FDA’s recommendation was based on its concern that the benefits of the drug may no longer outweigh its risks.                      
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Your Membership Matters!

Enrollment is now open for the membership period of September 1, 2017, through August 31, 2018. Renew today at www.aana.com/renewal and continue to be part of the more than 50,000 members-strong voice of the American Association of Nurse Anesthetists. Installment payments and automatic renewals available!
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Meetings and Workshops


#AANA2017: Get Inspired, Connect with Colleagues, Grow Your Knowledge

Join us Sept. 8-12 in the heart of Seattle for unparalleled networking and evidence-based education featuring seven educational tracks and critical topics like non-opioid anesthesia and pain management. Earn up to 27.25 Class A CE credits with 13.75 pharmacology credits.
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Register Now for the Fall Leadership Academy
November 3-5, Rosemont, Ill.

AANA Fall Leadership Academy features expert speakers in five educational tracks including Business and Facility Leadership, Federal Political Director, State Grassroots Advocacy, State President-elect, and State Reimbursement Specialist. Hone and develop leadership skills for your practice, state, and business. Plus, you'll expand your network of colleagues around the country.
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Registration Open for Upper and Lower Extremity Block Workshop

Expand your skills and expertise in upper and lower extremity block anesthesia through this hands-on workshop, to be held Oct. 7-8, 2017, in Park Ridge, Ill. The program will include case studies, hands-on demonstrations, return demonstrations, and skill validation.
 
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Jobs


Visit www.crnacareers.com
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.

Nerve Blocks Reduce Acute and Chronic Pain After Inguinal Hernia Repair

A recently reported study compared pain relief in patients undergoing inguinal herniorrhaphy via transversus abdominis plane (TAP) block versus patients having the procedure under iliohypgastric/ilioinguinal nerve block (IHINB). Comparative studies of the two approaches are limited, often conflicting, and lack data on pain control beyond the first post-surgical day. The team from Turkey enrolled 90 participants in their open-label investigation, randomizing them equally to TAP block, IHINB, or subarachnoid block as a control. Pain scores, measured periodically in the first 48 postoperative hours as well as one month and six months later, were lower among the TAP and IHINB patients than the controls. In addition, participants who received the nerve blocks took more time to report pain and were less likely to need additional analgesia. While outcomes with the two techniques were generally similar, the researchers did discover that TAP block provided greater acute pain relief at 24 hours than IHINB and also did not require as much anesthetic volume. Still, chief investigator Onur Okur, MD, and his colleagues concluded that either approach is safe and effective for inguinal hernia repairs. They report their findings in the Journal of Anesthesia.

From "Nerve Blocks Reduce Acute and Chronic Pain After Inguinal Hernia Repair"
Clinical Pain Advisor (07/12/17) Wong, Crystal

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Research Shows Areas for Improvement During Medical Emergencies Training

As part of a new study, more than 250 board-certified anesthesia providers enrolled in continuing education coursework on emergency training agreed to be videotaped and rated on their performance. Each volunteer engaged in two 20-minute standardized simulated medical crisis scenarios using mannequins, with a second caregiver arriving to assist at about the midpoint. Although he emphasized that anesthesia care in this country is safer than ever, primary investigator and lead study author Matthew Weinger, MD—a professor at Vanderbilt University Medical Center—said the results showed that there is room for improvement. For the encounters included in the study, 80 percent of critical actions were executed and 75 percent of performances were rated as average or better. However, the simulations also highlighted specific areas where clinicians could do better—including escalating therapy when initial response fails, enlisting the help of a team member, taking advantage of available resources such as calling for help, and adhering to evidence-based guidelines. "The results suggest that processes and tools that enhance the ability of clinicians and teams to respond to acute events could be strengthened," noted co-investigator David Gaba, MD, a professor of anesthesiology at Stanford University.

From "Research Shows Areas for Improvement During Medical Emergencies Training"
Newswise (07/12/17)

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Study Sheds Light on Reducing Opioid Use in Abdominal Wall Reconstruction

A study involving 93 consecutive patients identified factors associated with narcotic demand following abdominal wall reconstruction. According to the analysis, chronic preoperative use of opioids and the presence of transfascial sutures were associated with higher postoperative opioid doses and prolonged hospitalizations. Patients who underwent neuraxial analgesia, however, required lower doses of the drugs after the surgery. "Epidural analgesia reduces postoperative narcotic requirement and may be especially beneficial in patients at highest risk for postoperative pain," the researchers reported in Plastic and Reconstructive Surgery—Global Open. The researchers added that intraoperative administration of high-dose opioids, which also was tied to greater post-surgical use, should be minimized so that patients do not develop a tolerance for the medication.

From "Study Sheds Light on Reducing Opioid Use in Abdominal Wall Reconstruction"
Healio (07/12/2017) Volansky, Rob

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Monitoring Pulse Rate Before C-Section Improves Maternal Health

Although women being prepared for cesarean section often are given medication to avoid drops in their blood pressure, new evidence suggests this extra step is not universally necessary. The drugs are intended to prevent nausea, vomiting, and dizziness that can occur following the spinal block; but they also have been known to elevate blood pressure to dangerously high levels in mothers and cause oxygen deprivation or acidosis in babies. Researchers in Spain believe, however, that monitoring pulse rate before spinal anesthesia can provide information indicating whether or not the additional medication is needed. In a study reported this month in the Annals of Biomedical Engineering, they used an electrocardiogram sensor and pulse photo plethysmograph sensor attached to the finger to track changes in the vital signs of 105 patients. Most of the 51 participants who did not receive preventative blood pressure medication developed hypotension, according to investigators, who stressed that the focus should be on identifying patients whose blood pressure holds at normal levels despite spinal block and c-section.

From "Monitoring Pulse Rate Before C-Section Improves Maternal Health"
United Press International (07/11/17) Wallace, Amy

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Efficacy of Single-Injection Unilateral Thoracic Paravertebral Block for Post Open Cholecystectomy Pain Relief

Researchers from the University of Gondar in Ethiopia theorized that thoracic paravertebral block (PVB), which has been shown to improve pain following both thoracotomy and mastectomy, would do the same for open cholecystectomy patients. A total of 50 participants, half of whom were randomized to single-injection thoracic PVB, completed the study last year and were included in the final analysis. The remaining patients were assigned to a control group, who underwent conventional general anesthesia and whose pain was managed with systemic opioid analgesics. Primary endpoints were recorded during the first 24 hours after the abdominal surgery. Within that time frame, lower pain scores, both at rest as well as with movement or coughing; less morphine and tramadol consumption; and a longer stretch of time until first postoperative analgesic requirement were documented in the intervention group as opposed to the control patients. The investigators conclude that thoracic PVB, in the context of multimodal analgesia, offers cholecystectomy patients superior pain relief for up to 24 hours postoperatively compared to usual care.

From "Efficacy of Single-Injection Unilateral Thoracic Paravertebral Block for Post Open Cholecystectomy Pain Relief"
Local and Regional Anesthesia (07/17) Vol. 2017, No. 10, P. 67 Fentie, Demeke Yilkal; Gebremedhn, Endale Gebreegziabher; Denu, Zewditu Abdissa; et al.

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Neurologic Complications More Likely With Epidural Particulate Steroid Injections

Byungkwan Hwang, MD, and his colleagues at Texas Tech University Health Sciences Center are believed to be the first researchers to pursue accurate complication rates for epidural injections. Their retrospective study extracted data from the Health Insurance Record Review and Assessment Service database from 2009 to 2013. Based on nearly 10 million epidural injections administered at hospitals or clinics during that period, they found that epidural injections with steroids are associated with a higher rate of stroke, spinal cord infarction, and death than epidural injections without steroids. The complication rate for the former was 1.38 per 100,000 person-days compared with 0.75 for the latter. However, the investigators clarified, complications are more heavily connected to particulate steroids like methylprednisolone or triamcinolone, occurring at a rate of 1.52 per 100,000 person-days. Soluble steroids, such as dexamethasone or betamethasone, meanwhile, are about as safe as nonsteriod epidural injections, with a complication rate of 0.84 per 100,000 person-days. The findings were presented at the 2017 annual meeting of the American Academy of Pain Medicine.

From "Neurologic Complications More Likely With Epidural Particulate Steroid Injections"
Anesthesiology News (07/07/17) Kronemyer, Bob

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Anesthesia E-ssential is an executive summary of noteworthy articles of interest to nurse anesthetists. It is distributed bimonthly 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
llacey@aana.com
July 20, 2017
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