AANA Anesthesia E-ssential, July 29, 2016

Vital Signs

VHA APRN Comment Period Concludes with Unprecedented Response from Supporters of CRNAs, APRNs – What’s Next?
The 60-day comment period concluded July 25 for the Veterans Health Administration (VHA) proposal expanding veterans’ access to care through full practice authority for CRNAs and other APRNs. In doing so, it shattered records for public comments to the agency, with supporters for CRNAs and other APRNs being heard loud and clear. Now, the agency must analyze all of the comments, and the AANA is joining with other groups in support of finalizing and implementing the proposal.
In numbers never before accomplished by the AANA, CRNAs and SRNAs submitted comments by the thousands upon thousands, as did our state associations of nurse anesthetists, the profession’s accreditation, certification and recertification bodies, and the Association of Veterans Affairs Nurse Anesthetists.
All told, the VHA received some 167,000 comments – more than 25 times the total number of comments that the agency had received on all regulatory proposals since 2006. The bulk of the comments were favorable to the proposal by a margin of about 3:2. Among veterans commenting, veteran supporters appeared to outnumber veteran opponents by about a 3:1 ratio. Over 100 news articles and op-eds covered the issue, with AANA members echoing our message across social media tagged with #CRNAs4Vets. Crucially, at least six major veterans and military service organizations like the Iraq and Afghanistan Veterans of America expressed support for expanding veterans access to care through APRN full practice authority. Citizen groups like AARP with its 3.5 million Veteran members, industry organizations like the American Hospital Association with over 130 of its members being VA hospitals, and the professional staff of the Federal Trade Commission all joined AANA in strong support of the rule.
Agency analysis of the comments will take time, so the AANA is urging the VHA to complete its analysis and publish the final rule promptly and timely so that America’s veterans can receive the prompt and timely excellent healthcare that they deserve and have earned. When Congress returns to Washington in September and after the elections, the AANA, CRNAs and our allies must remain at the ready to thwart anti-CRNA language that might crop up behind closed doors as part of any must-pass budget or veterans legislation. Once it is published as a final rule, it will likely take effect 60 days thereafter, and then the VHA will undertake an implementation process.
To all the CRNAs and SRNAs who took part in the Veterans Access to Quality Healthcare Alliance campaign, on behalf of America’s veterans, thank you!
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CPC Facts

Need a Personal CPC Program Presentation? CPC Program Speakers Available
From January through November 2016, the NBCRNA has more than 50 CPC Program presentations scheduled, presenting live to CRNAs at state meetings, continuing education conferences, and hospital groups. NBCRNA has also given Skype-type webinars to smaller groups. Request a speaker for your meeting, or show the CPC Program video to your group and schedule a follow-up Q&A webinar session. For more information and resources about the NBCRNA's CPC Program, which will launch on Aug. 1, 2016, go to the cpc-facts.aana.com and NBCRNA websites.
More than 22,000 CRNAs have already recertified (“even-year” certificants) and entered into the CPC Program in advance of the official launch. Many have already started earning their Class A and B credits.
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Hot Topics

VA Proposed Rule: Post Comment Period Press Release Presents Supportable Facts and Data
A post comment period press release posted on Newswise July 28 by the AANA publicized the overwhelming and largely positive public response to the VA’s proposed rule during the 60-day comment period that closed July 25. More than 1,000 media views were recorded in the first two hours after the release was posted.
The release was, in part, a response to an American Society of Anesthesiologists press release that offered a flimsy, unsupportable interpretation of the comment letters database on the regulations.gov website.
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2016 Proposed Bylaw Amendments and Resolutions will be available online on Monday, August 1
The 2016 AANA Bylaws and Standing Rules proposed amendments and Resolutions to be discussed and voted upon at the September 11, 2016, AANA Business Meeting will be posted online on Monday, August 1. See the business meeting agenda. In the event a member does not have online access, you may request that a hard copy be mailed to you via a message to mscheuermann@aana.com or phone (847) 655-1101.
Please note: The Sunday, September 11, 2016, AANA Business Meeting will be live streamed at approximately 8:15 am EDT accessible via a link on the business meeting page. Member sign in to the AANA website is required for access; however, there is no need for advance registration. This stream will be presented in "listen and view only" mode. There is no provision for online participation or voting due to current requirements in the AANA Bylaws. Please note that individual Internet speeds and locations may affect video quality during the live stream.
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CPC Core Module 2 Preview Posted Online
AANA has posted a video online previewing CPC Core Module 2: Applied Clinical Pharmacology. See how this self-paced, interactive, online continuing education activity helps busy nurse anesthetists stay up to date with evidence-based content covering clinical pharmacology.
This module is the second of four. AANA members can purchase all four and save up to 50 percent of the nonmember price. Visit AANA Learn for more information at AANA Learn.
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36th Annual PR Recognition Awards: Call for Entries
The deadline is quickly approaching to submit your 2016 PR Recognition Award entries. These prestigious awards– five in all – are judged by the AANA Communications Committee and presented during the Opening Ceremonies at the Nurse Anesthesia Annual Congress.
Guidelines for entries can be found at Recognition Awards.
All entries need to be submitted electronically by end of business on Aug. 5, 2016.
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Your Membership Matters!
Enrollment is now open for the membership period of September 1, 2016, through August 31, 2017. Renew today and continue to be part of the nearly 50,000 members-strong voice of the American Association of Nurse Anesthetists. Installment payments and automatic renewals now available!
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The Biggest Event in Nurse Anesthesia is Less Than Two Months Away! Are you Registered?
August 19 is the last day to register online for the AANA Annual Congress. Join us Sept. 9-13 at the historic Washington Marriott Wardman Park for nurse anesthesia's premier educational, professional, and social event! Just take a look at the lineup of top-notch sessions and unparalleled networking events on the schedule at a glance. 
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Save on Exclusive DC Sightseeing Tours While You're at #AANA2016
Make your free time in DC count, and see our nation's capital like you've never seen it with one of three sightseeing tours arranged just for Annual Congress attendees. Choose from:
  • Distinctive District City Tour
  • Honoring our Nation's Memorials - Arlington National Cemetery
  • Twilight Tour of DC Monuments and Landmarks
Several times and days are available for your convenience.
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Professional Practice

New Practice Management Resources: Practice Models; Change in Employment Arrangement
At the July Board meeting, the Board of Directors approved two new documents.
  • AANA Statement on the Most Cost-Effective and Safe Anesthesia Practice Models highlights the most-cost effective anesthesia practice models and makes recommendation on how these models should be used in practice.
  • Changes in Anesthesia Group Management or Employment Arrangement is intended to serve as a guide for CRNAs and CRNA groups who are faced with a transition in their employment arrangement. (Member login required to access.)
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Urgent Need for CRNA Volunteers to Ecuador
Community Cares For Kids (CCK) is in need of CRNA volunteers for a mission trip to Ecuador on August 27-September 30, 2016. See the Community Cares For Kids website for details. Surgeries focus on plastics and orthopedic specialties, including cleft lip-palate repair, ear deformities, club foot deformities, burns, and more. CCK will pay for airfare from New York, Atlanta, and Miami to and from Ecuador. If flying from different region, the difference in price (if any) will be responsibility of volunteer. CCK will pay for 4 start hotel room (2 volunteers/room). Breakfast is provided. For more information, contact Susan J. Collini, CASC, RT, RDMS, RDCS at scollini@collini.com or (570) 674-6522
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Updated Practice Documents: Informed Consent; Substance Use Disorder; Pain Management
At the July Board meeting, the Board of Directors approved four updated documents. Here is the list:
  • Informed Consent for Anesthesia Care summarizes the ethical and legal concepts of informed consent for anesthesia, describes the elements of informed consent, and provides recommendations for engaging in the informed consent process for anesthesia services.
  • CRNA Advanced Practice Registered Nurses (CRNAs should not be referred to as “mid-level practitioners,” “nonphysicians,” “physician extenders,” “dependent practitioners,” or “allied health practitioners”) asserts that CRNAs are licensed, independent practitioners who are not extenders of physicians or dependent on physicians to provide anesthesia services.
  • Addressing Substance Use Disorder for Anesthesia Professionals offers key recommendations specific to substance use disorder in anesthesia professionals as well as considerations for developing a facility policy around addressing substance use disorder, impairment and drug diversion in the workplace.
  • A Holistic Approach to Pain Management Integrated Multimodal and Interdisciplinary Treatment provides an overview of the holistic, patient-centered, multimodal pain treatment and management CRNAs provide across the continuum of pain and in all clinical settings.
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Meetings and Workshops

Have You Registered Yet for 11th Annual Fun 5K Walk/Run at #AANA2016?
The 11th Annual Fun 5K Walk/Run at the #AANA2016, supported by CNA and Northstar Anesthesia, will be held Tuesday, September 13. Haven't signed up for the event yet? Proceeds go to the AANA Foundation's Jan Stewart Memorial Fund to help support future speakers in the series. Family and friends are welcome to join.
Get your t-shirts! AANA 2016 5K Walk/Run commemorative t-shirts are now available for purchase. Note: shirts are not included in the 5K Walk/Run event registration.
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Pre-Congress Workshops — Earn Even More CE at #AANA2016!
Plan to attend the Pre-Congress Workshops on Friday, September 9, to make the most of your meeting. Expand your skill set or simply stay current and earn additional Class A CE credits with a Pre-Congress workshop. Sign up for one of these specialty workshops:
  • Airway on Demand
  • Neuraxial Regional Anesthesia-Epidural
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Registration Open Now for Fall Leadership Academy
Learn to lead at any level, in all practice settings, at the Fall Leadership Academy: November 11-13, 2016, in Rosemont, Ill. Featuring more than 20 expert speakers and five educational tracks, Fall Leadership Academy is designed to expand your leadership skills as well as your network of colleagues.
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Save the Dates for These Popular Hands-On Workshops
Visit Meetings for further information and to register!
Upper and Lower Extremity Nerve Block Workshop
  • AANA Foundation Learning Center
  • September 24-25, 2016
Jack Neary Pain Management Workshop II
  • Rosemont, IL
  • October 29-30, 2016
Essentials of Obstetric Analgesia/Anesthesia Workshop
  • AANA Foundation Learning Center
  • November 2, 2016
Spinal and Epidural Workshop
  • AANA Foundation Learning Center
  • November 3-5, 2016
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Foundation and Research

Shake It for a Cause Dance Party: Attention all Students!
Tickets for the Shake It for a Cause Dance Party are only $25! Join the Foundation on Sunday, September 11, 2016, from 9:30 – 11:45 pm at Washington Marriott Wardman Park. If you’re planning to attend Stepping Out in DC, the dance party ticket is included! If you’ve already registered for Annual Congress, contact Margaret Brennan at (847) 655-1180 to purchase a ticket.
You don’t want to miss it!
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AANA Foundation Fundraiser: Shake It for a Cause Dance Party
The Foundation is all about you joining us on Sunday, September 11 from 9:30 – 11:45 pm at the Shake It for a Cause Dance Party at Washington Marriott Wardman Park. Tickets are $50 for CRNAs and $25 for students. If you’re planning to attend Stepping Out in DC, the dance party ticket is included.. If you’ve already registered for Annual Congress, contact Margaret Brennan at (847) 655-1180 to purchase a ticket.
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Foundation Fundraiser Features Capitol Steps
Capitol Steps will be performing at the AANA Foundation fundraiser Stepping Out in DC on Sunday, September 11, 2016, from 7:00 – 11:45 pm at Washington Marriott Wardman Park. Ticket includes dinner, drinks, entertainment, and the Dance Party. We’re in DC during an election year with the Capitol Steps, so for this patriotic event, wearing red, white or blue seems appropriate, or you can even dress as your favorite politician! If you’ve already registered for Annual Congress, contact Margaret Brennan at (847) 655-1180 to purchase a ticket.
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Federal Government Affairs

Senate Blocks Consideration of Legislation Funding the VA
On July 14, one day before heading into a seven week recess, the U.S. Senate for a second time blocked consideration of the Fiscal Year (FY) 2017 Military Construction, VA, and Zika appropriations bill, due to what Senate Democrats saw as inadequate funding for combating the Zika virus.
This delay likely places Military Construction, VA, and Zika appropriations funding and report language into the fall Continuing Resolution (CR) before the new federal fiscal year begins on Oct. 1 and into an omnibus appropriations package either late this calendar year or in the spring, depending on the CR’s duration. Advisory report language negotiated by House and Senate lawmakers accompanying the conference report on H.R. 2577 is neutral on the VHA APRN issue.
The AANA continues to advocate for the inclusion of pro-CRNA language in this legislative package, and will update members as the process continues this fall.
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Making CRNA Voices Heard: AANA Participating in Republican and Democratic National Conventions
Policy leaders and influencers from around the country saw the AANA and CRNAs in Cleveland, Ohio, for the Republican National Convention, July 18-21, and in Philadelphia, Pa., for the Democratic National Convention, July 25-28. Led by President Quintana, the AANA delegation attended political events and policy forums with leaders from inside and outside the healthcare industry, and from both major political parties.
The highlight of AANA’s activities were health policy luncheons on July 19 at the RNC and July 26 at the DNC, developed in partnership with the American Nurses Association, Walgreens, the American Podiatric Medical Association, and our media partner, Real Clear Politics. The keynote address at the RNC event was former Health and Human Services Secretary and Wisconsin Governor Tommy Thompson. At the DNC, Clinton and Obama health policy advisor Chris Jennings headlined the program.
The AANA used social media to update membership daily about our activities at the national political conventions on Facebook and on Twitter. See a little of what AANA saw below.
Republican National Convention
From top: (1) The AANA put CRNA issues front and center. (2) Ohio CRNAs met former HHS Secretary and Wisconsin Gov. Tommy Thompson, right center. (3) AANA President Juan Quintana, DNP, MHS, CRNA, met Senate Finance Committee Chairman Orrin Hatch, R-UT, whose committee addresses CRNA reimbursement and federal regulations affecting practice. (4) President Quintana met Sen. Mike Rounds, R-SD, lead GOP cosponsor of Senate legislation supporting CRNA and APRN Full Practice in the VHA (S 2279). (5) The balloon drop followed the acceptance speech of the Republican presidential nominee, Donald Trump.  
Democratic National Convention
From top: (1) CRNAs were heard at the Democratic National Convention. (2) CRNAs and student nurse anesthetists from Pennsylvania joined President Quintana at the AANA-cosponsored titled Decoding 2016: The Future of Healthcare. (3) American Nurses Association President Pamela Cipriano, PhD, RN, NEA-BC, FAAN, has worked with AANA President Quintana supporting veterans access to quality healthcare. (4) U.S. Rep. Jerry Nadler, D-NY, told President Quintana how he led efforts for coverage of APRN services in the New York state legislature in the late 1970s. (5) President Quintana and Frank Purcell from the AANA Washington office heard President Clinton’s speech July 26 where he acknowledged the role of nurse practitioners. Hillary Clinton’s address accepting the Democratic nomination for President took place July 28.
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AANA Joins the Better Medicare Alliance
The AANA Board of Directors has voted to make the AANA an ally organization of the Better Medicare Alliance (BMA), a coalition that includes healthcare providers, insurers and business groups that support Medicare Advantage (MA) as an option under Medicare. The coalition works to mobilize individuals and organizations and offer them information about the value of Medicare Advantage and promote the value and experience evident in Medicare Advantage through reliable discussion with members of Congress and other elected officials, leaders in government and the private and non-profit sector, and members of the media. The AANA’s involvement in the BMA would allow the profession to build relationships with health plans in support of the triple healthcare aims of improving patient experience of care, improving population health and reducing health care costs. It would also help the association promote patient access to CRNAs practicing to the full extent of their education and skill
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The House and Senate are on Recess until after Labor Day
See your lawmakers at home! If you plan to see your legislators in Washington or at home, let us know by emailing info@aanadc.com. You can access the House calendar here and the Senate calendar to see where your members of Congress will be this summer and fall.
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The following is an FEC required legal notification for CRNA-PAC
Gifts to political action committees are not tax deductible. Contributions to CRNA-PAC are for political purposes. All contributions to CRNA-PAC are voluntary. You may refuse to contribute without reprisal. The guidelines are merely suggestions. You are free to contribute more or less than the guidelines suggest and the association will not favor or disadvantage you by reason of the amount contributed or the decision not to contribute. Federal law requires CRNA-PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. Each contributor must be a US Citizen.
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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.
Propofol as Safe as Traditional Anesthesia for GI Endoscopy
Cleveland Clinic researchers believe propofol is just as safe and effective for gastrointestinal (GI) endoscopies as remifentanil and other traditional anesthesia agents. The risk of cardiopulmonary adverse events is not significantly different between it and the other sedatives, according to their systematic review of published studies. The meta-analysis ultimately included 27 randomized controlled trials comparing the incidence of hypotension, arrhythmia, and hypoxia with propofol versus traditional anesthesia. A total of 2,518 patients were enrolled in the studies, with roughly half receiving propofol and half sedated with fentanyl, midazolam, pethidine, meperidine, and/or remifentanil. Using propofol was not shown to increase complications even during advanced procedures and was actually shown in simple procedures to lower the risk by nearly 40 percent.
From "Propofol as Safe as Traditional Anesthesia for GI Endoscopy"
Healio (07/26/2016)
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Effect of Skin Infiltration With Ropivacaine on Postoperative Pain in Patients Undergoing Craniotomy
Chinese researchers conducted a prospective, double-blind trial to study local anesthetic infiltration in craniotomy patients. The approach, which has been used for postoperative pain management after a number of other surgeries, delivers anesthesia to the skin at the incision site. For the study, 53 patients were randomly assigned to local infiltration with ropivacaine, administered after anesthesia induction. Another 53 patients were infiltrated with normal saline. Morphine was used for rescue analgesia, with consumption in the first 24 hours post-surgery serving as the primary outcome. Morphine demand during that window was considerably lower in the ropivacaine cohort than in the saline cohort, and more time also passed before ropivacaine patients required rescue analgesia compared with the control group. The findings indicate that scalp infiltration with 0.5% ropivacaine prior to skin incision has a positive analgesic effect on craniotomy patients, who subsequently require less morphine and can manage longer after the procedure before needing rescue analgesia.
From "Effect of Skin Infiltration With Ropivacaine on Postoperative Pain in Patients Undergoing Craniotomy"
7th Space (07/26/16)
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'Gestational Sleep Apnea': Wake Up to a New Diagnosis
Obstructive sleep apnea (OSA) is widely underdiagnosed in expecting mothers—about 25 percent of whom experience repeat interruptions in normal breathing—because the resulting daytime fatigue often is dismissed as a symptom of pregnancy. In response, experts are pushing for "gestational sleep apnea" to be established as a new diagnosis. "Currently there is a lack of uniform criteria to diagnose, treat and classify OSA in the pregnant population, which in turn complicates efforts to determine the risk factors for, and complications of, gestational sleep apnea," explains anesthesiology professor Yehuda Ginosar, who also directs the Mother and Child Anesthesia Unit at the Hebrew University Medical Center and the Division of Obstetric Anesthesiology at Washington University School of Medicine. Writing in the International Journal of Obstetric Anesthesia, Ginosar and other sleep researchers say the new diagnosis will enable closer monitoring of maternal and fetal outcomes and development of more effective treatments. Left untreated, OSA is known to contribute to elevated blood pressure, high blood sugar, and heart disease in the non-pregnant population.
From "'Gestational Sleep Apnea': Wake Up to a New Diagnosis"
Science Daily (07/26/2016)
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Posterior Spinal Decompression Procedures: Does Liposomal Bupivacaine Make a Difference?
Researchers investigated differences between using liposomal bupivacaine as opposed to bupivacaine hydrochloride during posterior spinal decompression procedures. The study included 52 patients undergoing cervical procedures and 64 undergoing lumbar procedures, with both types of analgesia administered within each cohort. After looking at outcomes such as perioperative narcotic use and length of hospital stay, no argument could be made for standard use of liposomal bupivacaine in posterior spinal decompression procedures. However, researchers believe the approach might benefit one specific patient population: chronic opioid users. That supposition is based on the finding that, within that subgroup, there was a pattern of greater opiate requirement among the bupivacaine hydrochloride patients than among the liposomal bupivacaine patients. The study appears in the Journal of Neurosurgery: Spine.
From "Posterior Spinal Decompression Procedures: Does Liposomal Bupivacaine Make a Difference?"
Becker's Spine Review (07/26/16) Dyrda, Laura
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Claris Life Gets FDA Nod for Generic Anesthetic Injection
The Food and Drug Administration has given the green light to a generic bupivacaine injection to be used for local or regional anesthesia as well as for surgical analgesia. India-based Claris Lifesciences confirmed that the approval is for bupivacaine hydrochloride in 8.25 percent dextrose injection USP 7.5 mg/mL, single dose ampules with 2 ml fill volumes.
From "Claris Life Gets FDA Nod for Generic Anesthetic Injection"
Economic Times (India) (07/26/16)
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First ASCO Guidelines for Chronic Pain in Cancer Survivors
The American Society of Clinical Oncology (ASCO) has issued the first guidelines designed to help physicians manage symptoms in patients who beat cancer but face debilitating chronic pain. The recommendations, which debuted online July 25 in the Journal of Clinical Oncology, are based on a systematic review of the medical literature from 1996 to 2015. They address analgesic considerations as well as nonpharmocologic therapies and leading evidence-based treatments. "When analgesic drugs are used, the imperative to prescribe safely must expand beyond immediate adverse effects, such as the resulting respiratory depression or constipation associated with opioids, to incorporate awareness and mitigation of the long-term consequences of these and other analgesic agents," according to the expert panel that wrote the guidelines. The document—which is relevant for all doctors—also advises on strategies to minimize abuse, addiction, and adverse events; and, in an uncommon move, it offers direction in weaning patients off opioids that are no longer needed or that are working to the patient's detriment.
From "First ASCO Guidelines for Chronic Pain in Cancer Survivors"
Medscape (07/25/16) Jenkins, Kristin
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Soothing Into Surgery
A pair of anesthesiologists at the Lucile Packard Children's Hospital Stanford in Palo Alto, Calif., have developed technology that can help children relax before surgery. "For many families and kids, this is one of the most stressful events in their entire lives," according to Dr. Sam Rodriguez. He and Dr. Thomas Caruso's solution is BERT (Bedside Entertainment and Relaxation Theater), a video unit that can mount on any hospital bed and project an image onto a large infection-compliant screen attached to the bed right in front of the patient's eyes. Assembled from pieces of technology purchased online, BERT offers age-appropriate entertainment ranging from TV shows to music videos. It also offers an alternative to anti-anxiety medicine, which can calm children before an operation but carries risks of its own. "Anytime we can decrease exposure to a medication, especially in a young child who has a developing brain, it's preferential to use some of these non-medication techniques to get them off to sleep," Rodriguez explains. BERT costs about $900 to build, and Lucile Packard now has 10 units.
From "Soothing Into Surgery"
Valley News (N.H.) (07/24/16) Gold, Jenny; de Marco, Heidi
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FDA Approves Oral Formulation of Relistor for OIC in Adults
The Food and Drug Administration has approved methylnaltrexone (Relistor) in tablet form to alleviate opioid-induced constipation (OIC) in adults suffering from chronic noncancer pain. Subcutaneous injections of the drug were already approved for that same indication, as well as for OIC in adults with advanced illness under palliative care. The new thumbs-up comes on the heels of a phase III clinical trial of adults with chronic noncancer pain in which 200 received 450 mg methylnaltrexone tablets and 201 received placebo for a period of 28 days. The primary end point was achieved as the methylnaltrexone group demonstrated significant improvements in rescue-free bowel movement within four hours. There was also a higher proportion of responders in the treatment group; the safety profile was comparable to placebo; and the overall efficacy of the oral formulation was comparable to previous reports of efficacy for the subcutaneous injections in patients with chronic noncancer pain.
From "FDA Approves Oral Formulation of Relistor for OIC in Adults"
Pain Medicine News (07/22/2016)
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Post-op Surgical Infection Risk Not Associated With Number of OR Personnel
A recent retrospective case control trial disproved the supposition that more personnel in the operating room translates into higher risk for surgical site infections (SSIs). The finding held after correcting for multiple factors such as operative duration and patient factors including BMI, diabetes, and vascular disease. The researchers tapped the Mayo Clinic Division of Infection Control SSI database and patient intraoperative records to identify type 1 wounds from five surgical specialties. Orthopedic surgery had the highest number of SSI cases (49.2 percent), followed by general (18.9 percent), neurosurgery (12 percent), spine (11.8 percent) and vascular (8 percent). The researchers then divided all personnel into surgical scrubbed, non-scrubbed, and anesthesia provider categories, finding no differences among the groups. The results differed from some previous studies and guidelines, suggesting a need for further research, said lead study author and Mayo Clinic fellow Brendan Wanta, MD.
From "Post-op Surgical Infection Risk Not Associated With Number of OR Personnel"
Anesthesiology News (07/22/16) Leung, Martin
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Efficacy of Nebulized Fentanyl vs. IV Opioids Examined
A new literature review finds that nebulized fentanyl may relieve acute pain just as well as intravenous opioids, but questions linger over the ability of nebulizers to provide consistent doses of medication. Several studies have documented comparable or lower pain scores, as well as longer-lasting pain relief, with aerosol-based fentanyl compared with IV administration. However, the time required to reach maximum concentration of nebulized fentanyl differs wildly in other studies. According to one investigation, efficacy varies based on the inhalation device used to get the drug to the distal airways for fast absorption. Individual patient factors, like a sealed thoracic wall and adequate respiratory drive, also make a difference. At this point, researchers are uncertain whether ultrasonic, jet, vibrating mesh-aperture plate, or breath-enhanced jet nebulizers would be most appropriate for fentanyl administration. A nebulized version of the drug is unlikely to be made commercially available until a device is developed that can deliver a consistently prepared product reliably to the distal airways.
From "Efficacy of Nebulized Fentanyl vs. IV Opioids Examined"
Monthly Prescribing Reference (07/16) Duffy, Steve
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Opioid Use Before Hernia Repair Increases Post-op Requirement
Opioid use before abdominal wall repair cranks up need for the drugs during the subsequent hospital stay, compared with patients who had no prior opioid use. Time in hospital might be prolonged in preoperative opioid users as a result, assert University of Tennessee investigators. They reached those conclusions after reviewing data on ventral hernia patients that they had been gathering for five years as part of clinical quality improvement research. Of 102 patients, 47 were already taking opioids before they were treated; and those individuals consumed substantially more morphine equivalents during their hospital stay than opioid-naive patients. "Now," speculates lead researcher Prof. Bruce Ramshaw, MD, "we're wondering if weaning patients off preoperative opioid use would help in terms of opioid requirement in the hospital and length of stay." The team also plans to explore whether first-time opioid recipients get hooked on the narcotics used for post-surgical pain management.
From "Opioid Use Before Hernia Repair Increases Post-op Requirement"
General Surgery News (07/20/16) Smith, Monica J.
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A Retrospective Study of Success, Failure, and Time Needed to Perform Awake Intubation
Although often perceived as complicated and time-intensive, research out of New York finds that awake intubations can be performed quickly and with few adverse events or failures. In a survey of nearly 200 anesthesia providers and surgeons, members of both professions overestimated the additional time required for awake intubation compared to asleep intubation. Many of their responses suggested it would take 10 to 20 minutes more to get the job done, but the team from the Icahn School of Medicine at Mount Sinai Hospital found that awake intubation only took 8 minutes longer. The retrospective review matched two controls intubated after anesthesia induction to each of 1,085 awake intubations performed at Sinai. The median time from the patient entering the operating room to intubation was recorded at 24 minutes for awake subjects and 16 minutes for asleep subjects. The complication rate for awake intubations was just 1.6 percent, meanwhile, and the failure rate was only 1 percent.
From "A Retrospective Study of Success, Failure, and Time Needed to Perform Awake Intubation"
Anesthesiology (07/16) Vol. 125, P. 105 Joseph, Thomas T.; Gal, Jonathan S.; DeMaria, Jr., Samuel; et al.
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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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July 29, 2016

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