Anesthesia E-ssential

AANA Anesthesia E-ssential, July 25, 2019

Vital Signs

AANA Welcomes New Senior Director of Education and Practice

Brett Morgan, DNP, CRNA, officially joins the AANA as Senior Director of Education and Practice as of Oct. 15, 2019, but will be in attendance for the 2019 Annual Congress in Chicago in August, and the Joint Committee Conference in September. Here are five things to know about him:
  • He is currently an assistant professor and the director of the Duke University School of Nursing's Nurse Anesthesia Program, Durham, N.C.
  • He maintains a clinical practice, providing anesthesia care for office-based surgical procedures throughout central North Carolina.
  • He is an advisor to the nonprofit organization Health Volunteers Overseas.
  • He has been active for a long time in his state association, having served as president of the North Carolina Association of Nurse Anesthetists (NCANA) in 2015-2016.
  • He currently lives in Durham, N.C., with his five-year-old twin daughters.
Welcome aboard Dr. Morgan!

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Due to Complete Your CPC 2-Year Check-In by July 31? Deadline Approaching

If you recertified or initially certified on or before July 31, 2017, you will be due to complete your CPC 2-year Check-in by July 31, 2019. Check in on the NBCRNA portal at If you are not sure of your certification date, you can either log on to your NBCRNA account or click on the “Verify Credential” button at the top of the website and enter your name in the search. Find out more about the simple, online 2-year Check-in at
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Webinar: Enhanced Recovery Update and CRNA Leadership Opportunities

Monday, August 12, 6:30-7:30 p.m. CST, Hyatt (Atlanta Room)/webinar

Join the Enhanced Recovery Shared Interest Group panel live from the AANA Annual Congress for a presentation, discussion, and Q&A regarding the latest enhanced recovery guidelines, intraoperative patient management, and CRNA leadership experiences in implementing enhanced recovery initiatives.

Not able to attend in person? Register for the webinar and be a part of the discussion!
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Hot Topics

Agenda, Background Materials, Live Stream Info Available for Annual Business Meeting

The 2019 Annual Business Meeting of the AANA will take place on Saturday, Aug.10, 2019, at 1:15 p.m., in the Hyatt Regency Chicago hotel. This meeting will be live streamed for viewing by members who cannot attend.

See agenda, background materials and live stream information. (Requires Member Log in)
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Enrich Your Clinical Skills and Obtain Additional Class A CE Credits with Your Selection of Pre-Congress Workshops

The Pre-Congress Workshops take place Friday, Aug. 9, at the AANA Congress in Chicago. The workshops are:
  • 2019 Peer Assistance and Wellness Workshop Program - Full Day; 7.25 Class A CE Credits
  • Ultrasound-Based Acute and Chronic Pain Procedural Workshop - there is a morning and an afternoon session to choose from; 4.00 Class A CE Credits
  • Ultrasound-Guided Peripheral Nerve Blocks: A Focused Review and Clinical Applications - Full Day; 7.25 Class A CE Credits
  • Obstetrical Regional Anesthesia - A Focused Review and Clinical Applications - Full Day; 7.25 Class A CE Credits
  • Fundamentals in Perioperative Transesophageal Echocardiogram (TEE) Workshop - there is a morning and an afternoon session to choose from; 4.00 Class A CE Credits
Learn more and register now.
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NewsMakers: CRNAs Peterson and Dahl Give Nurses An OR Peek for Anesthesia Career Day

Jessica Peterson, PhD, MS, CRNA, and Michelle Dahl, MS, BSN, CRNA, gave 20 college nursing students and practicing nurses a peek at their role in the operating room during Anesthesia Career Day at the Mayo Clinic Health System Center for Advanced Medicine and Surgery in LaCrosse, Wis.

The career clinic combined classroom and hands-on learning, with attendees donning scrubs and masks for the operating room tour and simulation exercises. Read more.
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Meetings and Workshops

Sunrise Breakfast Symposia

Sunrise Breakfast Symposia: Ultrasound-guided Regional Anesthesia
Monday, Aug. 12, 6-7:30 a.m.
Location: Crystal Ball C, West Tower, Lobby Level, Hyatt Regency Chicago
(Breakfast is provided.)


Presented by:
Pacira logo
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SRNAs: Join Envision Physician Services for Anesthesia College Bowl Reception

On Monday, Aug. 12, 2019, following the Anesthesia College Bowl at the AANA 2019 Annual Congress in Chicago, there will be a reception for student registered nurse anesthetists (SRNAs) in the Crystal Ball B&C rooms in the West Tower at Lobby Level in the Hyatt Regency Chicago hotel from 7:30-9:30 p.m.

Be sure to register for the Anesthesia College Bowl Reception with Envision Physician Services to receive an exclusive wristband for "no-wait" access at the reception. Space is limited. More information.

Supported by Envision Physician Services.
Envision Physician Services
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AANA Member Benefits

Coming Soon a Premier Event!
AANA Learn ERAS® Webinar Series Explores Opioid Alternatives

In the first of its kind, the AANA is hosting a live webinar series concerning the various aspects of Enhanced Recovery After Surgery® (ERAS) protocols. CRNAs can advocate for patients by educating themselves and other healthcare providers about the importance of ERAS.

The knowledge to drive change.

This unique webinar series will empower you to champion ERAS protocols for your facility. You’ll hear directly from experts in your field and walk away with tips and insights for engaging your team and implementing and measuring an ERAS pathway. You’ll be armed with the knowledge you need to reduce the need for opioids, improve patient outcomes and reduce costs. No doubt you’ll have questions—and there will be time to ask them at the end of each webinar.

You can help solve the opioid crisis.

CRNAs are pain management experts who are uniquely qualified to help solve this problem using ERAS protocols. Be sure to attend the ERAS webinar series and become a change agent for your healthcare organization. Sign-up Today!

Learning outcomes for the webinar series.

Series details and dates:

Webinar 1: View from 30,000 feet: Why should I embrace enhanced recovery?
Speaker: Lynn Reede
Live webinar date: Wednesday, July 31, 2019 from 7 p.m. - 8 p.m. CDT

Webinar 2: Integrating multimodal pain management techniques into my practice
Speaker: Josh Newman
Live webinar date: Sept. 25, 2019

Webinar 3: Metrics to assess your enhanced recovery program for continued improvement and team engagement
Speaker(s): Carol Schmidt
Live webinar date: Oct. 30, 2019

Webinar 4: Lessons learned: Meet the interprofessional team
Speaker: Laura Ardizzone, Kara Douglas, and Josh Magnuson
Live webinar date: Dec. 4, 2019

Recognition: Supported by:

Pacira logo
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CRNA: Hospital for Special Surgery, West Palm Beach, Florida

In keeping with our commitment to expand the HSS brand, HSS in collaboration with Orthopedic Anesthesia & Pain Specialists, Florida, PA. (OAPS) offers an exciting opportunity in West Palm Beach, Florida. OAPS seeks CRNAs who thrive in an environment of collegiality, innovation, and recognition.

We know that work/life balance is important to you... we offer a unique contract/per diem/call schedule designed to provide daily AM coverage in an outpatient surgical setting.

Coupled with outstanding compensation and clinical affiliations, this is an opportunity you must explore!

The HSS Palm Beach Ambulatory Surgery Center, LLC, part of a new facility (currently under construction and scheduled to open later this year), will serve as the premier center of excellence for orthopedic surgery in the region. As part of a comprehensive initiative to deliver both surgical and non-surgical care across multiple specialties, we will provide advanced imaging, a physician clinic, and rehabilitation and sports performance. The state-of-the art facility located in West Palm Beach, will span more than 50,000 square feet, and will reside in close proximity to the airport and major roads. Learn more.
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CRNA: American Anesthesiology/MEDNAX, Macon, Georgia

We are seeking a full-time CRNA to join our world class anesthesia team at American Anesthesiology Associates of Georgia in Macon.
  • Full array of anesthesia services provided at The Medical Center Navicent Health, a Level-I trauma center
  • Facilities include 34 ORs and several ancillary suites, along with a freestanding outpatient facility
  • Anesthesia services include: general surgery, cardiac, pediatrics, OB service, ortho, trauma, plastics, ENT, transplants and neurosurgery
  • The practice consists of 16 anesthesiologists and 58 anesthetists including Certified Anesthesiologist Assistants and CRNAs that work together in a care team model
  • The schedule is 5 days/week with 8-hour shifts
  • Very limited call schedule with only one weekend and one holiday on-call a year
Located in the center of the state, Macon is the economic engine of central Georgia. With an exciting musical heritage, picturesque architecture, and a rich historical past, Macon has some of the best sights and activities. Sample the mouthwatering soul food and check out Macon signature dishes at local restaurants in a city where a night out means fine dining, drinks, or dancing, but also a moonlit walk among old Southern mansions, a Broadway play, or a live show at the birthplace of Southern rock. Victorian-style mansions, ancient Indian mounds, recreational activities, cultural heritage and friendly people come together to create the New Southern lifestyle. Learn more.
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Hospital-Employed CRNA Opportunity at Level I Trauma Center: Carle Physician Group, Urbana, Illinois

Carle Physician Group is seeking an additional CRNA to join our team of 50 CRNAs at our main campus in Urbana, Illinois.
  • 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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CRNA: Envision Physician Services, New London, Connecticut

Envision Physician Services has an exciting new opportunity for qualified CRNAs to join our team in New London, CT! This is a full-time opportunity to join the well-established group of 11 physicians and over 20 CRNAs. We also will consider part-time candidates who will commit to 24 hours per week. The practice covers Lawrence Memorial Hospital in New London as well as 2 surgery centers in the region. The New London area is located on the coast in Southeastern Connecticut and is centrally located between Boston and New York City.

For more information about these opportunities, please contact Jenny Wimsatt, Senior Clinical Recruiter at W: 615.695.1771 C: 954.383.7256 or email Looking forward to connecting with you! Learn more.
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Professor/Associate Professor of Anesthesiology: Barry University, Hollywood, Florida

Barry University, College of Nursing and Health Sciences, entry-level DNP in Anesthesiology Program, is seeking a full-time faculty member for the Hollywood classroom with travel to four (4) other geographical classroom sites. This position also would involve teaching didactic courses in the Post-Master's Doctor of Nursing Practice (DNP) with a Specialization in Anesthesiology. Both programs utilize innovative curricula through technology-mediated synchronous and asynchronous instruction. The entry-level DNP Program is a full-time, 36-month intensive residency program with students located in five geographical locations. The locations are Ocala, Orlando, Tampa, West Palm and South Florida. Faculty must be flexible to teach from all locations as needed but primarily the South Florida location.

The Post Master's DNP with a Specialization in Anesthesiology is a 24-month, part-time completion DNP program utilizing blended distance learning. The Post Master's DNP Program requires synchronous webinars, scholarly project advising, and face-to-face meetings with students. Some administrative responsibilities are also expected with this role. Learn more.
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Certified Registered Nurse Anesthetist: Memorial Health System, Springfield, Illinois

This position embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision and values. Our CRNAs administer general, regional, and MAC anesthesia to patients of all ages and any ASA status. The CRNAs work in a collaborative team environment with 50 CRNAs, 21 Anesthesiologists and 12 Anesthesia Techs to assist with room turnover and stocking. The CRNAs serve as Clinical Instructors for SIUE and Millikin/Decatur Nurse Anesthesia programs.

Due to our continued growth, Memorial Medical Center has multiple needs for Certified Registered Nurse Anesthetists. Positions are available full time in the Main OR, CVOR or as a split 50/50 between Main OR and CVOR. 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.

Music Can Be a Viable Alternative to Medications in Reducing Anxiety Before Anesthesia

To alleviate patient anxiety before receiving peripheral nerve block, researchers say music can be used in place of sedatives. The team at Penn Medicine randomized 157 surgical patients to either receive an injection of midazolam immediately before the block procedure or to listen to a calming, eight-minute song through noise-canceling headphones. Based on before-and-after measurements, both interventions triggered similar changes in anxiety levels. While earlier work has demonstrated the efficacy of music before surgery compared with oral sedatives, the new experiment is the first to compare the approach with an intravenous medication. The findings offer a viable alternative to IV drugs, which are associated with respiratory problems and paradoxical effects such as hostility and agitation. The midazolam recipients in the Penn Medicine study did report higher levels of satisfaction with their experience and fewer issues with communication, but the researchers suspect that may be explained by the use of the noise-canceling headphones and the fact that they did not standardize the volume of music or allow patients to choose the music. The study appears in Regional Anesthesia & Pain Medicine.

From "Music Can Be a Viable Alternative to Medications in Reducing Anxiety Before Anesthesia"
ScienceDaily (07/19/19)

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Intranasal Sufentanil Versus Intravenous Morphine for Acute Severe Trauma Pain

In cases of acute traumatic pain, researchers asked whether intranasal sufentanil (INS) might offer an alternative to intravenous morphine (IVM)—which is common but takes longer to deliver relief. Establishing IV access requires time, while the IN route is fast and easy. With that in mind, a prospective study was designed to determine if INS could reduce pain intensity as effectively as IVM. The emergency departments (EDs) of half a dozen French hospitals served as the backdrop for the project, which ultimately included 136 patients randomly assigned to receive INS and IV placebo or IVM and IN placebo. The main outcome was total decrease in numerical pain rating scale at 30 minutes after first administration, which proved to be comparable for both intervention arms. The results confirm the non-inferiority of INS to IVM for the treatment of acute traumatic pain in the ED setting, with the possibility for time savings. Meanwhile, although INS was not associated with serious adverse events in this small trial, larger studies are needed to confirm its safety.

From "Intranasal Sufentanil Versus Intravenous Morphine for Acute Severe Trauma Pain"
PLoS Medicine (07/16/19) Blancher, Marc; Maignan, Maxime; Clapé, Cyrielle; et al.

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Sex-Dependent Prolongation of Sciatic Nerve Blockade in Diabetes Patients

Knowing that diabetes can influence how long a nerve block lasts, researchers used a small sample of patients to stratify differences based on diabetes status and gender. The group from Peking Union Medical College enrolled 34 individuals with diabetes and 52 without the condition in their prospective trial. All participants received subgluteal sciatic nerve block ahead of lower-limb surgery. Sensory block, as gauged by the Semmes-Weinstein monofilament test, lasted 19.8±6.0 hours in the patients with diabetes—significantly longer than the 15.6±5.1 hours observed in patients who did not have diabetes. Based on dorsal and plantar flexion of the foot, meanwhile, motor block also persisted much longer in diabetes patients, at 19.5±8.1 hours versus 14.8±5.7 hours in patients without diabetes. The effect was evident only among females with diabetes, however, with nerve block lasting for about the same amount of time in male participants—whether they had diabetes or not.

From "Sex-Dependent Prolongation of Sciatic Nerve Blockade in Diabetes Patients"
Regional Anesthesia and Pain Medicine (07/19) Tang, Shuai; Wang, Jin; Tian, Yi; et al.

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A Dedicated Respiratory Function Monitor to Improve Tidal Volume Delivery During Neonatal Anesthesia

Anesthesia workstations are equipped with respiratory function monitors that are usually inaccurate at tidal volumes used for babies, but researchers suspected that a device designed specifically for infants could improve neonatal outcomes. To test the theory, they worked with 65 babies younger than three months who were intubated for surgery. Half of the infants were attended to by clinicians with visual access to the display of a Phillips NM3, Acutronic Florian, or Novametrix Ventcheck respiratory function monitor that had been integrated into the circuit after intubation. A matched group of neonates were cared for by clinicians blinded to the monitor display. Researchers found that 55.6 percent of expired tidal volumes measured in the intervention group were within the target range of 4 to 8 mL/kg, compared to 51.7 percent in the control group. Expired tidal volume was also less likely to drop below 4 mL/kg in the intervention group, which also had to endure fewer inflations. Tidal volumes above or below the desired level are common during neonatal anesthesia; however, the study indicates that including an accurate respiratory function monitor could reduce the risk of exposure to such activity.

From "A Dedicated Respiratory Function Monitor to Improve Tidal Volume Delivery During Neonatal Anesthesia"
Pediatric Anesthesia (07/19) Atkins, William K.; McDougall, Rob; Perkins, Elizabeth J.; et al.

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Comparison of Supreme Laryngeal Mask Airway Versus Endotracheal Intubation for Airway Management During General Anesthesia for Cesarean Section

Researchers compared the use of endotracheal intubation (ETT)—the standard of care for the obstetric airway—with laryngeal mask airway (LMA), which is growing in popularity. The study included 920 women with similar patient profiles, each of whom was undergoing elective cesarean section under general anesthesia. After randomization, half received airway management with ETT and half with Supreme LMA (SLMA). The primary endpoint was insertion success on the first try, which was comparable between the two groups. Time to effective ventilation was quicker with SLMA; but other secondary endpoints, including maternal and fetal outcomes, were not significantly different. The study results affirm airway guidelines that recommend LMA as a second-line approach to airway management in the obstetric setting.

From "Comparison of Supreme Laryngeal Mask Airway Versus Endotracheal Intubation for Airway Management During General Anesthesia for Cesarean Section"
BMC Anesthesiology (07/08/19) Yao, Wei Yu; Li, Shi Yang; Yuan, Yong Jin; et al.

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A Promising New Anesthetic — Discovered with Help From a Computer

In pursuit of a better anesthetic, a team led by Edward Bertaccini, MD, turned to technology. The researchers were aware that propofol acts on gamma-aminobutyric acid (GABA) receptors—which typically respond to GABA, a small molecule that quiets neuronal activity. They used a molecular modeling program to identify compounds that enhance GABA function, finding 12 in all and obtaining 11 of them commercially. In lab tests, all 11 compounds activated GABA receptors in brain tissue and successfully anesthetized tadpoles. One in particular, compound BB, exhibited the greatest potency—and promise. "It's just as good—if not better—at putting rats to sleep, and it's much better at keeping blood pressure up," reports Bertaccini, who published the study in the Proceedings of the National Academy of Sciences. Additional research is in the pipeline to ensure that compound BB is safe and effective.

From "A Promising New Anesthetic — Discovered with Help From a Computer"
ScienceBlog (07/17/19)

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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:

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Park Ridge, IL 60068
Phone: (855) 526-2262 (toll-free)/(847) 692-7050
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Attn: Cathy Hodson
E–ssential Editor
July 25, 2019