Anesthesia E-ssential

AANA Anesthesia E-ssential

Vital Signs

President Brydges to Speak at PAINWeek, CRNAs to Earn CEs

PAINWeek, held September 3-7 at The Cosmopolitan of Las Vegas, is the largest pain management conference in the U.S. The Acute Pain Management track will feature AANA President Garry Brydges, PhD, DNP, MBA, ACNP-BC, CRNA, FAAN, who will speaking about "Enhancing Recovery After Surgery: How Certified Registered Nurse Anesthetists Are Improving Outcomes."

"The field of pain management is constantly growing, and to stay abreast of the trends, CRNAs seek continuing education in this area," commented Brydges. As such, PAINWeek will provide AANA CE credits, in addition to its 39.0 - AMA PRA Category 1 credits. Learn more.
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Thank You From CRNA-PAC! Now, Our Work Continues

Thank you to the more than 1,700 AANA members who participated in CRNA-PAC’s one-week challenge earlier this month. Because of you, we raised an incredible $210,000! These funds will be used to protect and advance the nurse anesthesia profession on Capitol Hill, and to elect and re-elect CRNA champions to the U.S. House and Senate.

But we still have a long road ahead of us. The American Society of Anesthesiologists (ASA) has the largest healthcare professionals association PAC in all of Washington, D.C. And, this week it holds its annual Day of Giving, which last year brought in $600,000 for the ASA PAC in just one day. If you haven’t contributed to CRNA-PAC yet this year, please consider doing so online today at We need your help to amplify our voice on Capitol Hill! Learn more at:

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 U.S. Citizen.
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Hot Topics

AANA Membership Renewals Open on July 1

As we near the end of our current membership period, we’d like to thank you for your continued commitment to the AANA! Your membership helps support the organization's mission to advance the CRNA profession, and we are proud to serve you, our members, as we work together to protect your practice rights, ensure patient access to high-quality nurse anesthesia care, and provide you with the benefits and services you deserve.

This upcoming 2019-2020 membership period, we have big plans in store for our advocacy and public relations efforts! So please be sure to join our organization for another exciting year and renew your membership on July 1, 2019.
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AANA Foundation: Call for Early Career CRNA for Board of Trustees Application Deadline: July 1, 2019

The AANA Foundation is seeking a recently graduated CRNA (five years or less) to join the AANA Foundation Board of Trustees. The mission of the AANA Foundation is to advance the science of anesthesia through education and research. The Foundation is currently looking for a candidate interested in playing an active role in supporting the CRNA profession. The ideal candidate enjoys fundraising and possesses expertise in research.

Criteria for Board Members:
  • Five years or less from graduation
  • Current CRNA and AANA member in good standing
  • Must be a supporter of the AANA Foundation of time, talent and treasure
  • Must be willing to advocate for the AANA Foundation
  • Must have a Foundation giving history
  • Must have a history of volunteerism
  • Term is for two years (September – August)
To apply, complete an application and nominee form and submit along with your CV and a cover letter describing why you wish to be an AANA Foundation Board member.

If you have any questions, please contact the Foundation at (847) 655-1170 or
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Council on Accreditation (COA) Seeks Nomination for Director Opening

The COA is seeking nominations for a University Administrator Director. Candidates must be available to attend three-day COA meetings, typically held in January, May and October. The term of office is three years, beginning fall 2019 through fall 2022. The elected candidate then would be eligible to be considered for reelection to a second three-year term. The deadline to apply is July 15, 2019. For position criteria and application requirements, please visit
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NewsMaker: SRNA Grete Lenz Awarded Pat Tillman Foundation Scholarship

Grete Lenz, BSN, RN, University of South Florida (USF) student registered nurse anesthetist and U.S. Air Force veteran, has been selected as a 2019 Tillman Scholar. She is the only student from a Florida university in this year's Tillman class of 60 U.S. service members, veterans and military spouses.

"I couldn't be more proud to accept the honor of becoming a Tillman Scholar and join such a distinguished group of recipients," Lenz said. "I really want to continue to make a difference in the lives of other veterans, and this award will help me achieve my goals."

Lenz is currently pursuing a master's degree in nurse anesthesia from USF after serving in the Air Force for seven years as a commissioned officer and a nurse, including one deployment to Niger. She expects to graduate from USF in December and plans to pursue a career working at a Veterans Affairs hospital to help ensure military veterans receive quality care.  Learn more.
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Meetings and Workshops

Annual Congress Product Theater Preview
Clinical Considerations in Neuromuscular Blockade Management

On Sunday, August 11, at 12 p.m., speaker J. Dru Riddle, PhD, DNP, CRNA, FAAN, will address the clinical considerations in neuromuscular blockage management during one of AANA's Product Theaters at the AANA 2019 Annual Congress. Learning objectives include:
  • Understanding the importance of monitoring neuromuscular blockade and recovery.
  • Reviewing clinical data for neuromuscular blockade management.

Stay tuned with updates via and the AANA Meetings app for room assignments.

Presented by: Merck

Merck is pleased to sponsor this program to provide information consistent with FDA guidelines. This program is not an accredited CME program and is not designed to meet any training and/or educational requirements. This medical education program for U.S. healthcare professionals and healthcare business professionals only. The speaker for this program is speaking on behalf of Merck.
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Assistant Director of Nurse Anesthesia DNP Program: UAMS, Little Rock, Arkansas

The Assistant Director of the Nurse Anesthesia Program, a certified registered nurse anesthetist with a doctoral degree, assists the Program Director with administrative and day-to-day operations of the DNP Nurse Anesthesia Program and engages in the education, practice, and scholarship missions of the College of Nursing. This individual reports directly to the Nurse Anesthesia Program Director and Associate Dean for Practice. This is a 12-month, full-time faculty appointment with the option for tenure or non-tenure track. Academic rank will be commensurate with qualifications and experience relative to the position. Learn more.
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CRNA: University of Iowa Hospital, Iowa City, Iowa

If you want to deliver the very best anesthesia care for a full spectrum of diverse and challenging cases, you want to join us at Iowa. University of Iowa Hospitals & Clinics seeks highly qualified, dedicated CRNAs to deliver safe and effective anesthesia care to patients of all ages.

We offer a team-oriented, progressive CRNA practice that includes intraoperative placement of spinals and epidurals; CRNA placement of invasive monitoring modalities; educational involvement with the UI Nurse Anesthesia DNP program; a core group of pediatric CRNAs; and dynamic clinical cases in neurosurgery, orthopedics, otolaryngology, gynecology, transplant, pediatrics, burns, oral surgery, urology, trauma, and ambulatory surgery. Learn more.
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CRNA: Three Rivers Health, Edwardsburg, Michigan

Three Rivers Health is looking for another CRNA to join our fully Independent CRNA Practice and administer anesthesia in our OR. Must be proficient in spinal and epidural anesthesia and willing to learn regional blocks. Call will be 1:3 and can be taken from home if within 30 miles response time. This is an employed opportunity with good compensation and extra compensation stipends for call and overtime.

We have two operating rooms, one procedure room
, General Surgeons, Orthopedic Surgeons, ENT, OBGYN, Peds, Int Med, Family Practice, Pain Clinic and Wound Clinic on campus. 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.

Incivility in Operating Rooms Associated with Diminished Clinical Performance

BMJ Quality & Safety recently published research showing how testy interactions between operating room (OR) staff can hurt clinical performance. The study was based on videotaped encounters between an impatient surgeon-actor and anesthesia providers during a simulated hemorrhage scenario. Anesthesia providers, stratified according to whether they were subjected to incivil behavior or not, were rated on vigilance, diagnosis, communication, and patient management. Only 63.6 percent of those treated nastily by the surgeon-actor received a passing grade on overall performance versus about 91 percent of the controls. Asked if the OR environment negatively affected team performance, 65 percent of anesthesia providers in the experimental group agreed compared with only 25 percent of the controls. "When we are confronted with rude, dismissive or abusive behaviors, we are more or less hardwired to avoid their perpetrator," notes study co-author Samuel DeMaria Jr., MD, from the Icahn School of Medicine at Mount Sinai in New York. "In the OR, where inter-disciplinary communication is crucial to patient outcomes, a negative social interplay is not simply a relational stressor but also a direct risk to the patient." While the issue should also be addressed at the institutional level, he says anesthesia providers can escalate a problem to supervisors later but rise above the pettiness at that moment, for the patient's sake. "If you suddenly find yourself loathe to communicate with the surgeon, even if you know you should, this is natural but potentially dangerous," DeMaria Jr. says. "If an important piece of clinical information should be communicated, you need to find that assertive part of you, and use it!"

From "Incivility in Operating Rooms Associated with Diminished Clinical Performance"
HealthLeaders Media (MA) (06/10/19) Cheney, Christopher

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Chewing Gum to Treat Postoperative Nausea and Emesis in Female Patients

Researchers in Australia have designed the prospective CHEWY trial, which could potentially benefit tens of millions of patients who suffer from postoperative nausea and vomiting (PONV) after being exposed to general anesthesia. Study enrollment is being limited to women and is expected to include about 272 females aged 12 years and older who are undergoing volatile anesthetic-based general anesthesia for breast or laparoscopic surgery. Participants will be randomly assigned to either four minutes of intravenous ondansetron or to 15 minutes of chewing a peppermint-flavored gum while recovering in the postanesthesia care unit (PACU). The prespecified primary outcome is cessation of PONV within two hours of administration, with no recurrence and no rescue medication needed. The investigators theorize that chewing gum is noninferior to ondansetron for the main endpoint and superior to it for a number of secondary outcomes, including cost, length of stay in the PACU, and quality of recovery. The study, the first large randomized trial designed to assess the impact of chewing gum on PONV, will evaluate the safety as well as the efficacy of chewing gum after volatile-based anesthesia exposure. Recruitment began last summer in hospitals across Australia, New Zealand, and Hong Kong and is expected to close early next year.

From "Chewing Gum to Treat Postoperative Nausea and Emesis in Female Patients"
BMJ Open (06/12/2019) Darvall, Jai; von Ungern-Sternberg, Britta Sylvia; Braat, Sabine; et al.

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Premedication with Oral Paracetamol for Reduction of Propofol Injection Pain

Researchers in Thailand studied the use of oral paracetamol to avoid pain at propofol intravenous injection, an uncomfortable but common experience. The study included 324 participants who were randomized to take 500 mg of oral paracetamol, 100 mg, or a placebo one hour before general anesthesia induction with IV propofol. The syringe pump was paused once a quarter of the full dose had been delivered, at which time patients judged their pain at the injection site based on a verbal numerical rating score ranging from 0 to 10. Premedication with oral paracetamol both reduced the incidence and severity of pain compared with placebo, but the effect was more pronounced with the higher dose. Tolerance levels, meanwhile, were similar across the board. Oral paracetamol thus appears to be a viable, available, affordable, and well-tolerated solution for IV propofol injection pain, the investigators conclude.

From "Premedication with Oral Paracetamol for Reduction of Propofol Injection Pain"
BMC Anesthesiology (06/11/19) Vol. 19, No. 100 Nimmaanrat, Sasikaan; Jongjidpranitarn, Manasanun; Prathep, Sumidtra; et al.

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Needle Tip-Tracking May Reduce Time During US-Guided Peripheral Nerve Blocks

Innovative needle tip tracking (NTT) technology is a time-saver during certain nerve blocks, according to new evidence. Researchers analyzed data from 40 anesthesia providers who performed ultrasound-guided in-plane and out-of-plane simulated nerve blocks with and without NTT guidance. Procedure time using NTT was cut to 43.8 seconds from 66.7 seconds for out-of-plane procedures, and the number of hand movements was reduced to 13.9 from 22.8. Similar effects were not observed, however, when NTT was used during in-plane procedures. With both types of blocks, meanwhile, use of NTT was correlated to higher clinician confidence in a presumed block success. "Easier block performance and reduced procedure time in out-of-plane procedures support the use of NTT in clinical practice," according to the study authors, who reported their findings in Anaesthesiologica Scandinavica.

From "Needle Tip-Tracking May Reduce Time During US-Guided Peripheral Nerve Blocks"
Clinical Pain Advisor (06/13/19) Dellabella, Hannah

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Accidental Spinal Administration of Tranexamic Acid During Anesthesia Catastrophic But Avoidable

Accidental administration of tranexamic acid during spinal or epidural anesthesia and analgesia can have tragic results, according to a review, but researchers say this mistake is avoidable. The incidence rate is already low, with just 21 cases found in a MEDLINE search from 1960 to 2018. Of that number, more than half occurred during obstetric or orthopedic procedures. Accidental administration of tranexamic acid, which is used to prevent or treat excessive blood loss due to hemorrhage, resulted in the deaths of 10 of the 21 patients. An additional 10 had to be admitted to the intensive care unit for management of refractory convulsions and/or tachyarrhythmias, two common signs and symptoms that after spinal administration of tranexamic acid. The substance can be mistaken for hyperbaric preparation of bupivacaine in some countries, which may explain why none of the accidental administrations were not reported. Even so, the researchers believe all of the cases could have been avoided if their four key recommendations were followed: label all syringes; check labels with a second person or a device such as a barcode reader; carefully read the drug ampule and syringe levels before injection; and use non-luer lock connectors or epidural, spinal, and combination devices. "Spinal tranexamic acid errors are exceedingly high risk. To our knowledge, no other drug has caused such a level of iatrogenic harm in regional anesthesia practice," the study authors report. "Skill-based errors involving wrong drug administration during regional anesthesia require the robust implementation of targeted prevention strategies."

From "Accidental Spinal Administration of Tranexamic Acid During Anesthesia Catastrophic But Avoidable"
Specialty Medical Dialogues (06/13/19) Baranwal, Medha

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Brachial Plexus Block with Liposome Bupivacaine for Shoulder Surgery Linked with Decreased Opioid Use

Research suggests that ultrasound-guided brachial plexus block with bupivacaine liposome injectable suspension has a beneficial effect over placebo following shoulder surgery. Investigators studied outcomes in 155 patients having rotator cuff repair or total shoulder arthroplasty. In addition to usual analgesia, 69 were randomized to single-injection brachial plexus block with liposome bupivacaine, 15 were assigned to liposome bupivacaine, and 71 were allocated to placebo. The main outcome was the area under the curve of the VAS pain intensity score through 48 hours post-surgery, which was significantly lower in the brachial plexus block recipients compared with the control patients. Liposomal bupivacaine also was favored for several secondary outcomes, including total opioid consumption, median time to opioid rescue, and share of patients opioid-free through the first 48 hours postoperatively. The study results appear in Pain Medicine.

From "Brachial Plexus Block with Liposome Bupivacaine for Shoulder Surgery Linked with Decreased Opioid Use"
Healio (06/13/2019) Jaramillo, Monica

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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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Attn: Cathy Hodson
E–ssential Editor
June 20, 2019