Anesthesia E-ssential

AANA Anesthesia E-ssential, July 26, 2018

Vital Signs

Two-year Check-in Deadline Approaching – July 31

For most CRNAs who recertified or initially certified in 2016 on or before July 31, the deadline to complete their quick two-year check-in is July 31, 2018. More than 80 percent of all CRNAs due to complete this next step in the CPC Program have already done so.

Don’t wait—only days remain before the July 31 deadline. Complete your Check-in here: Not sure of your deadline? See the chart on Not sure when you recertified? Click "verify credential" in the top right corner of the NBCRNA website If you’ve already checked-in or are not due this year, remind your colleagues.
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Hot Topics

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: Distinguished Guest Speaker at SANN: CRNA John Bing

Congratulations to AANA Region Director John Bing, who was invited to be the distinguished guest speaker at the second convention of the Society of American Nepalese Nurses (SANN) on July 21, 2018.

SANN is a not-for profit 501(c)(3) organization that has hundreds of life members and many chapters in USA. SANN runs many programs such as blood drives, CPR training, health fairs with a focus on preventive health care, mental health awareness, and stress management programs in the communities. The convention will be formally inaugurated by the honorable ambassador of Nepal on July 21, 2018.
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Meetings and Workshops

Practice Leadership Assembly Improves Business and Practice Accumen

The Practice Leadership Assembly, held November 9-11, 2018, in Rosemont, Illinois, covers anesthesia practice models, chronic pain management, reimbursement, leading beyond anesthesia, mitigating daily practice risks, understanding malpractice insurance, engaging your staff, negotiating contracts and RFPs, healthcare IT, business savvy, and healthcare entrepreneurship. Plus, attendees will join us for a reception at the AANA national headquarters on Friday evening. This new assembly is designed to give current and prospective business owners, as well as practice and facility leaders, the insight and confidence to lead the way in a rapidly changing healthcare environment. Learn more about the Assembly.
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Tap into Technology at the AANA 2018 Annual Congress

Held September 21 - 25, 2018, at the Hynes Convention Center in Boston, the 85th AANA Annual Congress promises to deliver the latest research, technology, clinical and practice information. Nurse anesthetists can acquire CE credits, network with peers from around the country, and update or refresh their technical and practice skills. Maximize your CE opportunities with a Pre-Congress Workshop (additional registration required). If you haven't registered yet, it's not too late. We hope to see you at the 85th AANA Annual Congress.

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

Nationwide: Open Water Safety Tips

Now that summer is here, it is the perfect time to think about kids and water safety. Learn more about how to prevent accidents.
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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.

Doctors Raise Alarm About Shortages of Pain Medications

Anesthesia providers and others nationwide are facing significant shortages of injectable opioids, which are regularly used for pain control in hospital emergency departments and other critical care settings. An informal survey of almost 2,500 anesthesia providers conducted by the American Society of Anesthesiologists (ASA) found that 98 percent of respondents said they "regularly experience drug shortages at their institutions." More than 95 percent noted those shortages affect the way they treat their patients. There is reason for concern, according to ASA president Jim Grant, MD. He says when anesthesia providers begin work each day, "we go in [asking], 'What do we have today, what don't we have today?'" One reason behind the shortages is pharmaceutical industry consolidation. According to Matt Kuhn with the global pharmaceutical giant Fresenius Kabi, the manufacturing process for sterile injectable drugs is complicated, and while they have increased production and added workers, "one company is not going to be able to completely fulfill all the market needs for clinicians and their patients." The federal government, meanwhile, is grappling with an opioid addiction and overdose crisis by trying to control supply. And although the Food and Drug Administration (FDA) is under pressure to address the injectable opioid shortage, the agency cannot order a manufacturer to make any product. For now, FDA is focusing on expanding the number of suppliers and searching for and expediting approval of additional sources.

From "Doctors Raise Alarm About Shortages of Pain Medications"
NPR Online (07/20/18) Goodwyn, Wade

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Study Finds Link Between Anesthesia, Surgery and Subtle Cognitive Decline in Older Adults

The results of a new study suggest there is a link between general anesthesia and surgery and a "subtle decline" in memory and thinking skills in older adults. Using data from the Mayo Clinic Study of Aging, researchers investigated whether surgery and anesthesia exposure up to two decades prior to study enrollment or anesthesia exposure post-enrollment was associated with cognitive change. The more than 1,800 participants were between the ages of 70 and 89 years at the time of enrollment. The findings indicated the decline in brain function was slight; however, for patients with pre-existing mild cognitive impairment or those with already low cognitive function who are considering surgery with general anesthesia, the discovery could have more impact. "We need to be sure that patients considering surgery, and their families, are properly informed that the risk of cognitive dysfunction is possible," said the Mayo Clinic's Juraj Sprung, MD, PhD, senior author of the study. "In addition, alternative strategies should be discussed with patients before surgery is undertaken for those deemed to be at high risk." Reporting in the British Journal of Anaesthesia, the researchers stressed that it was impossible to know whether the decline was caused by anesthesia, surgery, or underlying conditions that necessitated surgery.

From "Study Finds Link Between Anesthesia, Surgery and Subtle Cognitive Decline in Older Adults" (07/19/2018)

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Hypotension After Induction of General Anesthesia: Occurrence, Risk Factors, and Therapy

Researchers from the Czech Republic sought to characterize hypotension after induction of general anesthesia (GAIH) in a group of more than 660 adults undergoing elective non-cardiac surgery under general anesthesia (GA). They defined the hypotension as a reduction in mean arterial pressure of at least 30 percent compared with the first measurement in the operating room before GA induction. Participants' blood pressure was measured at the time of endotracheal intubation and then at 5 and 10 minutes after. The data show that nearly 3 percent of the patients had GAIH at all times measured, while 36.5 percent had it for at least one of the time points. Factors found to affect the risk of GAIH include age, the degree of hypertension upon arrival in the operating room, and diabetes. The most frequently used intervention to correct GAIH was bolus fluids, which was effective 96.4 percent of the time.

From "Hypotension After Induction of General Anesthesia: Occurrence, Risk Factors, and Therapy"
Journal of Anesthesia (07/19/18) Jor, Ondrej; Maca, Jan; Koutna, Jirina; et al.

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Development of Multimodal Analgesia Pathways in Outpatient Thyroid and Parathyroid Surgery and Association With Postop Opioid Prescription Patterns

A recent study sought to assess trends in adoption and adherence to institutional multimodal analgesia (MMA) protocols after thyroid and parathyroid surgery. Additionally, the team from Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha, examined the association of institutional multimodal (nonopioid) analgesia protocols with opioid use and physician prescribing patterns following these surgeries. While MMA has demonstrated efficacy in controlling postoperative pain in patients undergoing some other kinds of surgery, concerns about use of nonsteroidal anti-inflammatory drugs and a perceived fear of bleeding or hematoma have limited their use in head and neck surgery. The cohort study involved more than 500 adults who underwent thyroid and parathyroid surgery between 2015 and 2017. According to the data, the frequency of postoperative opioid prescriptions dropped to 1.9 percent in 2017, down from 13.1 percent in 2015. In addition, adherence to the MMA protocol rose from none of 122 cases in 2015 to 87.7 percent of 162 cases in 2017. The likelihood of an opioid prescription on discharge decreased, meanwhile. In all, only one postoperative hematoma was recorded—and this patient was found to have been involved in a high-speed motor vehicle collision prior to returning to the hospital with a neck hematoma. For individuals undergoing thyroid and parathyroid surgery, adoption and adherence to an MMA protocol increased over the study period and was linked to a reduction in the prescription of opioids after surgery. "Availability of effective nonopioid MMA pathways may favorably influence physician prescribing practices and avoid unnecessary opioid prescriptions," the researchers conclude.

From "Development of Multimodal Analgesia Pathways in Outpatient Thyroid and Parathyroid Surgery and Association With Postop Opioid Prescription Patterns"
JAMA Otolaryngology–Head & Neck Surgery (07/19/2018) Militsakh, Oleg; Lydiatt, William; Lydiatt, Daniel; et al.

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Prevalence of Preoperative Opioid Use and Characteristics Associated With Opioid Use Among Patients Presenting for Surgery

Preoperative opioid use was reported in about 23 percent of patients undergoing surgery, according to new research. The cross-sectional, observational study assessed the prevalence of preoperative opioid use among 34,186 individuals being operated on at a tertiary care academic medical center. Hydrocodone bitartrate, tramadol hydrochloride, and oxycodone hydrochloride were the most common opioids used. Independent associations with preoperative opioid use included being 31-40 years of age, use of tobacco, illicit drug use, higher pain severity, depression, and having a greater number of medical comorbidities. The types of procedures where preoperative opioid use was most common were orthopedic and neurosurgical spinal procedures, while preoperative opioid use was least common among individuals having thoracic procedures. "These data provide important insights into this complicated patient population that would appear to help guide future preoperative optimization and perioperative opioid-weaning interventions," the authors write.

From "Prevalence of Preoperative Opioid Use and Characteristics Associated With Opioid Use Among Patients Presenting for Surgery"
JAMA Surgery (07/11/2018) Hilliard, Paul E.; Waljee, Jennifer; Moser, Stephanie; et al.

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A New Kind of Tool for the Most Common Anesthesia Emergencies

A new iOS application aims to provide up-to-date information on common anesthesia emergencies, such as hypoxemia or airway failure. Developed by Anthony Clark, MD, an anesthesia resident at the University of California, San Diego, the Anesthesia Emergencies app features three sections: anesthesia emergencies, other common problems, and helpful guides. Clark explains that "during [his] first year of anesthesia residency, [he] found that many of our textbooks went through basic sciences of anesthesia but failed to give a concise, step-by-step approach to managing 'real life,' daily emergencies." He then made a list of notes and algorithms on how to manage potential emergencies for his cases, and that stockpile of information was eventually turned into a phone app that was launched last year. The app has been updated several times to include data on pediatric equipment sizes, vital signs, and drug doses, for example.

From "A New Kind of Tool for the Most Common Anesthesia Emergencies"
Anesthesiology News (07/23/18) DePeau, Deanna

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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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Attn: Cathy Hodson
E–ssential Editor
July 26, 2018
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