Anesthesia E-ssential

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Vital Signs

AANA Names Randall Moore II New CEO

Randall Moore II, DNP, MBA, CRNA, has been named the new Chief Executive Officer of the AANA. Moore will succeed current CEO Wanda Wilson, PhD, CRNA, who announced her upcoming retirement earlier this year. 
A longtime AANA member, Moore served as the AANA treasurer in 2016-17 and before that as a region director on the AANA Board of Directors for two years. He is also a member of the Illinois Association of Nurse Anesthetists. 
For the last two years Moore has worked as the director of Perioperative and Anesthesia Services at Passavant Area Hospital in Jacksonville, Illinois, where he managed a $35 million budget and more than 100 employees. Moore is also a retired commissioned officer of the U.S. Army Reserve with more than 22 years of military service. Retiring at the rank of Major, Moore served as an infantryman, combat medic, and CRNA during that time frame. He had several experiences serving as an active duty CRNA with the Army, including with Forward Surgical Teams in Afghanistan providing combat casualty care in austere locations.
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Hot Topics

AANA Board Announces New Director, Region 2

Effective July 23, Angela Mund, DNP, CRNA, of Mount Pleasant, South Carolina, is the new Director, Region 2, on the AANA Board of Directors. She replaces Dina Velocci, DNP, CRNA, ANP, who resigned from the Board on Friday wit​​h one year remaining on her two-year term. 
As a candidate in the most recent election for Director, Region 2, Mund was eligible to fill the vacated position. The Board approved her appointment on Saturday, July 22.  
A longtime member of the AANA, Mund has served on numerous AANA committees. She was elected to and chaired the Resolutions Committee in 2010-11 and was elected to be the Region 4 representative on the Nominating Committee in 2008-09. Mund has also served on the Political Action Committee (CRNA-PAC) as chair in 2015-16 and treasurer in 2014-15; as a faculty delegate to the Education Committee (2011-13); and as a member of the Federal Services Ad Hoc Committee (2007-09).  
Mund has been equally active with the South Carolina Association of Nurse Anesthetists, accepting appointments to numerous committees and serving as the SCANA president in 2012-13. 
Mund will serve as Director, Region 2, through Aug. 31, 2018.
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AANA Releases Enhanced Recovery after Surgery (ERAS) Pathway Document

At their July meeting, the Board of Directors adopted Enhanced Recovery after Surgery. This document offers key recommendations for anesthesia professionals to implement and continually improve ERAS pathways across the continuum of care from before admission to return home. Research has consistently shown that adoption of ERAS leads to significant improvements in patient satisfaction, outcomes and reduction in cost of care. The document emphasizes the importance of a structured, collaborative, multidisciplinary approach accompanied by education and awareness campaign to successfully integrate ERAS into practice. Topics covered in this document include: patient’s interdisciplinary team; culture and leadership; ERAS pathway development; ERAS pathway implementation; measuring quality and compliance to improve pathway; and addressing implementation challenges.
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FDA Adds Immediate-Release Opioids to REMS Program

The Food and Drug Administration (FDA) is expanding the Risk Evaluation and Mitigation Strategies (REMS) program to include immediate release (IR) opioid medications, according to FDA Commissioner Scott Gottlieb, MD, who made the announcement at the start of a regularly scheduled meeting in Washington, DC. The updated REMS program will also be expanded to include opioid prescriber training for other healthcare professionals including nurses and pharmacists.  FDA will modify its existing "blueprint" for prescriber education by broadening pain management education, as well as including non-pharmacologic treatment for pain and non-opioid alternatives, and expanding education on opioid use disorders.

These measures were supported by the AANA in a AANA Comment ER LA Opioid Analgesics REMS to the FDA.   Read more
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There's a New Way to Participate in the Business of the AANA!

The new electronic voting on the proposed bylaw amendments and resolutions will begin with the September 2017 AANA Business Meeting. On Saturday, Sept. 9, 1 p.m. PDT, the AANA Business Meeting will be live streamed with access through AANA's website. On Sunday, Sept. 10, all eligible voting members of the association will receive an email allowing them to vote on the proposed bylaw amendments and resolutions. You will also have access to a recording of the debate on the specific issue. Voting will be open for 24 hours. Be sure to update your email address in AANA's records, and watch for your voting email on Sunday, Sept. 10.


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2017 Proposed Bylaw Amendments and Resolution will be available online on Tuesday, August 1

The 2017 proposed AANA amendments and resolution to be discussed and voted upon at the September 9, 2017, AANA Business Meeting will be posted online on Tuesday, August 1. If you do not have online access, you may request that a hard copy be mailed to you via a message to or phone (847) 655-1101.
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Professional Practice

Updated AANA Policies

 At their July meeting, the Board of Directors approved updates to two AANA policies: Policy on Evidence-Based Process for Practice Related Documents and Policy on Requests for Endorsement of Documents Developed by External Organizations.
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Capnography Monitoring Required for Office-Based Surgery Practices in New York

According to The Joint Commission, the New York State Department of Health Office of Quality and Patient Safety is requiring office-based surgery practices to provide end-tidal carbon dioxide monitoring using capnography for patients receiving moderate sedation, deep sedation and general anesthesia. The Joint Commission will begin reviewing compliance with this regulation in New York, effective January 31, 2018.  Practices will need to comply, unless capnography is made impossible or restricted by the nature of the patient, procedure, or equipment. The end-tidal CO2 alarm should be audible to monitoring staff and capnography should be documented at frequent intervals in the record. The Joint Commission notes that capnography monitoring has been found to decrease the number of adverse events, including apnea and hypoxia. Learn more, including The Joint Commission standards that will be scored
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Meetings and Workshops

Registration Open for Spinal/Epidural Workshop with Obstetric Essentials
October 25-28, 2017, Park Ridge, IL

This comprehensive workshop combines enrollment for two of our most popular live CE activities, the Essentials of Obstetric Analgesia/Anesthesia Workshop and the Spinal and Epidural Workshop.  
Earn valuable Class A CE credits and stay current with expert lectures and hands-on instruction.
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#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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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.

Preoperative Opioid Users More Likely to Be on Pain Medications After ACL Surgery

Patients recovering from anterior cruciate ligament (ACL) repair typically need postoperative opioids for no longer than three months. However, according to a new study, patients still taking the medication five months after the procedure likely were already filling opioid prescriptions before it. Researchers at University of Iowa Hospitals and Clinics worked from a sample of nearly 5,000 ACL surgeries performed between 2007 and 2017. Almost 35 percent of the patients were classified as preoperative opioid users, having filled a prescription in the three months before undergoing ACL repair. The investigators found that nearly 7 percent of patients were still taking opioids for pain three months post-surgery, and roughly 5 percent were still filling prescriptions a year later. "We hope that our research will help contribute additional information to the baseline opioid medication demand data and continue to increase our knowledge of how to better cope with addiction and pain management following surgery," said study lead Chris Anthony, MD.

From "Preoperative Opioid Users More Likely to Be on Pain Medications After ACL Surgery" (07/24/2017)

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Ketamine as an Adjunct to Opioids for Acute Pain in the Emergency Department

Ketamine appears to be a safe and effective solution for treating acute pain in the emergency department, when used to supplement opioid therapy. The single-site study involved emergency patients who continued to experience moderate-to-severe pain even after receiving narcotic painkillers. In all, 53 participants were randomly assigned to 0.1 mg/kg of ketamine and 63 were allocated to placebo before being given additional opioid analgesia, if needed. Researchers measured pain levels, satisfaction with pain control, adverse effects, sedation level, and need for additional pain medication over the following two-hour period. Patients in the ketamine group reported lower pain scores, needed fewer repeat doses of analgesia, and subsequently had lower overall opioid dose compared to the placebo-takers. Satisfaction with pain management was comparable with both sets of participants. Those in the ketamine cohort experienced significantly more side effects—including dizziness and light-headedness—but the side effect profile was deemed manageable.

From "Ketamine as an Adjunct to Opioids for Acute Pain in the Emergency Department"
Academic Emergency Medicine (07/19/17) Vol. 24, No. 6, P. 676 Bowers, K.J.; McAllister, K.B.; Heitz, C.

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Localized Nerve Anesthesia a Viable Option for Pain Control in Pediatric SCD Patients, Study Suggests

Continuous peripheral nerve block (cPNB) has emerged as a possible strategy for pain relief during vaso-occlusive crisis (VOC) in children with sickle cell disease (SCD). The technique, a promising alternative to low-dose ketamine and continuous epidural analgesia—which are effective but also have several adverse effects—was demonstrated in the case study of a teenage male with SCD. The study authors report that administering local anesthetics continuously via cPNB was effective, immediately dropping the boy's pain score from 9 on a 10-point scale down to 3 and then moderating it at a level of 0 to 2 throughout the remainder of the day. As a result, doctors were able to curtail the patient's opioid needs by 30 percent. Resolution of the VOC episode took less time than with usual treatment, which in turned shortened hospitalization time. Use of cPNB also was deemed generally safe, with few adverse effects. "We believe cPNBs to be an effective therapy for localized refractory pain during an acute VOC in the pediatric population that can reduce inflammation, improve pain control, decrease opioid usage, and allow faster recovery with preservation of motor functions," the authors write in A&A Case Reports.

From "Localized Nerve Anesthesia a Viable Option for Pain Control in Pediatric SCD Patients, Study Suggests"
Sickle Cell Anemia News (07/19/17) Melão, Alice

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Ultrasound-guided Bilateral Superficial Cervical Plexus Block Is More Effective Than Landmark Technique for Reducing Pain From Thyroidectomy

In Indonesia, researchers compared two approaches to pain relief for patients undergoing thyroidectomy. All 36 study participants underwent bilateral superficial cervical plexus block, a type of regional anesthesia that delivers analgesia both during and following surgery, and all received patient-controlled analgesia with morphine afterwards. However, half of the patients were randomly assigned to receive ultrasound-guided block, while block was facilitated in the other half via landmark technique. Intraoperative opioid rescue was required 81.2 percent of the time in the landmark group versus 44.4 percent in the ultrasound group. Morphine consumption also was markedly higher six and 24 hours postoperatively in the landmark patients compared with the ultrasound patients; in fact, none of the participants in the ultrasound group required PCA after three hours post-surgery. Lastly, pain scores—although similar between the two groups at three hours after the procedure—were much lower among the ultrasound patients at six and 24 hours post-surgery. Based on the findings, the investigators from Udayana University conclude that bilateral superficial cervical plexus block more effectively controls pain when performed under ultrasound guidance compared with landmark technique.

From "Ultrasound-guided Bilateral Superficial Cervical Plexus Block Is More Effective Than Landmark Technique for Reducing Pain From Thyroidectomy"
Journal of Pain Research (07/17) Vol. 2017, No. 10, P. 1619 Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gede; Aribawa, I Gusti Ngurah Mahaalit; et al.

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Radiofrequency Denervation May Provide Substantive Relief for Thoracic Facet Joint Pain

Pain specialists in Sweden may have identified an effective way to treat pain in the thoracic facet joints, which has been tricky to date. While there is some evidence to support the use of a type of nerve block known as radiofrequency denervation, the process is hindered by inter- and intra-individual variability in the innervation of thoracic facet joints. To address this complication, the technique entails placing double injections of bupivacaine at each level of the transverse process and making multiple lesions on each nerve through radiofrequency denervation. The team has successfully used the approach for years at their clinic. An observational study comparing quality of life (QOL) in patients with thoracic facet joint pain who had the procedure versus patients whose lumbar and cervical facet joint pain was treated with traditional nerve block/radiofrequency denervation also appears to support the modified technique. The investigation included 178 participants with lumbar facet joint pain, 82 with thoracic facet joint pain, and 55 with cervical facet joint pain. Effective pain relief was achieved in 65 percent or more of the patients at three months followup. Health-related QOL scores were comparable across all three groups of patients at followup three, six, and 12 months after treatment; and QOL improvements lasted a year or longer for 51 percent of the cervical patients, 49 percent of the thoracic patients, and 47 percent of the lumbar patients. The findings, reported in Pain Medicine, are promising for the treatment of chronic thoracic facet joint pain but need to be confirmed through larger, randomized controlled trials.

From "Radiofrequency Denervation May Provide Substantive Relief for Thoracic Facet Joint Pain"
Clinical Pain Advisor (07/10/17) Rapposelli, Dee

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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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