Anesthesia E-ssential

AANA Anesthesia E-ssential
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Welcome to the Weekly Anesthesia E-ssential!

Be sure to check your email inbox each Thursday afternoon for an informative digest of news about the AANA, the profession, and the healthcare industry. Miss an issue? See Anesthesia E-ssential.


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Hot Topics

#AANA2017: Get Inspired, Connect with Colleagues, Grow Your Knowledge

Join us September 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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HVO Launches a New Anesthesia Project in Ghana

Health Volunteers Overseas (HVO) has launched a new anesthesia training project in partnership with the University for Development Studies (UDS) in Tamale, Ghana. Located in northern Ghana, UDS is dedicated to meeting the needs and building the capacity of the predominantly low-income, rural communities surrounding its campus. HVO volunteers will assist the university with its Bachelor of Science in Anesthesia program, which is designed to train nursing school graduates to become nurse anesthetists. To learn more about the project and how to get involved, visit the HVO website.
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Health Secrets Men Shouldn’t Keep

Millions of prescriptions for erectile dysfunction (ED) medications such as Viagra® and Cialis® are written every year, and during Men’s Health Month the AANA wants to remind consumers of these products to be forthright with their anesthesia professionals when preparing for surgery or other procedures that require anesthesia.

Here are five things to know about ED drugs and anesthesia…
  • Avoid taking an ED drug such as Viagra and Cialis for a couple of days prior to surgery because the drug takes at least 24 hours to clear the body.
  • These drugs contain nitric oxide, which opens blood vessels and relaxes muscles. This can cause a patient’s blood pressure to become dangerously low when combined with anesthesia and other drugs used during surgery.
  • Nitric oxide should not be confused with nitrous oxide, also known as “laughing gas,” which is primarily associated with use in a dentist’s office.
  • Tell your anesthesia provider about ED drugs and any other prescription and nonprescription medications you are taking, including herbal remedies.  Patients should never feel embarrassed about using these products.  Anesthesia professionals need to know this information to prepare the anesthesia plan and keep patients safe.  As with all sensitive information, patient-provider trust will be honored.
  • Make sure that your spouse, a friend, and/or a family member is aware that you take a lifestyle drug like Viagra or Cialis.  In the event you need emergency care, he/she will need to share this information with your healthcare providers. 
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PR Recognition Awards Deadline for Submission: July 7, 2017

The AANA Communications Committee is seeking entries for the 2017 PR Recognition Awards Contest. Now in its 37th year, the awards recognize outstanding public relations efforts in five categories. Winners in each category will be chosen by the AANA Communications Committee during the AANA 2017 Nurse Anesthesia Annual Congress and will be notified on the Friday preceding the Opening Ceremonies. The awards will be presented on stage during Opening Ceremonies. Visit PR Recognition Awards for the awards criteria and a link to the online entry form. If you have any questions please contact Karen Sutkus, administrative associate, at or (847) 655-1140.
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Professional Practice

Hospira Recalls Succinylcholine, Sodium Bicarbonate, Potassium Phosphates

Hospira, Inc. is voluntarily recalling 42 lots of 8.4% Sodium Bicarbonate Injection, USP, 50 mL vials; five lots of Neut™ (Sodium Bicarbonate 4% additive solution) 5 mL vials; five lots of QUELICIN™ (Succinylcholine Chloride Injection, USP) 200 mg/10 mL vials; and seven lots of Potassium Phosphates Injection, USP, 45 mM vials due to microbial growth detected during a routine simulation of the manufacturing process, which represents the potential introduction of microorganisms into the products. Read the recall announcement for more information and affected lot numbers.
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Advanced Pharma Recalls Unexpired Nitroglycerin Injection in 5 Percent Dextrose USP

Advanced Pharma, Inc. d/b/a Avella of Houston is voluntarily recalling all unexpired lots of Nitroglycerin products that were produced at Advanced Pharma’s Houston location between March 3, 2017 and May 31, 2017. The recall is being issued based on laboratory test results indicating a lower than expected potency on certain lots of compounded NitroGlycerin Injection which would lead to a lower dose being administered. Read the recall notice for more information.
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Meetings and Workshops

12th Annual AANA Wellness Fun 5K Walk/Run

Going to #AANA2017? Join us Sept. 12 for a 5K walk/run benefiting CRNA research! Take in views of the Puget Sound, Seattle skyline, and mountains.
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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 on 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.

Virtual Reality Beats Slideshow for Kids' Anesthesia Prep

Based on the results of a Phase II experiment at The Hospital for Sick Children in Toronto, virtual reality (VR) is a fun and effective way to prepare kids for anesthesia. An immersive video, delivered via smartphones and Google Cardboard headsets, allowed the 93 patients to feel what it is like to receive and recover from an anesthetic. Questionnaire responses afterwards indicated that the approach was well-received by the children, who ranged in age from 6 to 18 years old. Almost all of them, 98 percent, found the system to be user-friendly; 95.5 percent reported that it did a good job of showing them what to expect from anesthesia; and 90 percent agreed that they would want to use VR for this purpose in the future. Among the participants who had been through anesthesia before, there was a consensus that the VR strategy was true to life. Given a choice of VR or a slideshow to prepare for anesthesia in the future, 93.3 percent preferred VR. Aside from a handful of cases involving motion sickness, dizziness, or reaction to blurriness in the video, there were no negative reactions; and there was only one complaint from one parent, who felt isolated from the child's experience. Given the overall positive reaction, the team is planning a prospective Phase III randomized controlled trial.

From "Virtual Reality Beats Slideshow for Kids' Anesthesia Prep"
Anesthesiology News (06/19/17) Raj, Ajai

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Acupuncture Relieves Pain in Emergency Patients: Study

A large Australian study has determined that acupuncture works as well as opioids to alleviate pain in the emergency department (ED) setting. Researchers from RMIT University recruited 528 patients who sought emergency care for acute low back pain, migraine, or ankle sprain at four hospitals between January 2010 and December 2011. Those reporting pain at four or higher on a scale of one to 10 were randomly assigned to receive acupuncture only, medication only, or both. More than 80 percent continued to rate their pain at four or greater after one hour; but by 48 hours, the majority were satisfied with their treatment. Nearly 83 percent of patients who received just acupuncture said they would probably or definitely do it again, as did almost 81 percent of the combined-therapy patients and more than 78 percent of the pharmacotherapy-only group. "Emergency nurses and doctors need a variety of pain-relieving options when treating patients, given concerns around opioids such as morphine, which carry the risk of addiction when used long-term," noted study lead Marc Cohen. "Our study has shown acupuncture is a viable alternative, and would be especially beneficial for patients who are unable to take standard pain-relieving drugs because of other medical conditions." The research appears in the Medical Journal of Australia.

From "Acupuncture Relieves Pain in Emergency Patients: Study"
Medical Xpress (06/19/17)

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Women 'Catastrophize' About Pain More Than Men

"Catastrophizing" by women with chronic pain makes them feel even worse and results in more opioid prescriptions compared with men, Stanford University research suggests. The single-site, retrospective study included clinical data for almost 1,800 adults with chronic pain, most of whom reported receiving at least one opioid medication. Females who were overly focused on pain were more likely to also have an opioid prescription, even when pain levels were not that high. The chances of men being prescribed an opioid, on the other hand, were more closely tied to intensity of pain. "Our findings show that even relatively low levels of negative cognitive and emotional responses to pain may have a great impact on opioid prescribing in women," remarked lead author Yasamin Sharifzadeh, a Virginia Commonwealth University medical student who helped launch the study as a Stanford undergraduate. "When treating chronic pain patients—especially women—[physicians] should analyze pain in its psychological aspect as well as its physical aspect." The findings appear in Anesthesiology.

From "Women 'Catastrophize' About Pain More Than Men"
Pain News Network (06/19/17) Anson, Pat

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Could a Shot of Local Anesthetic Block PTSD's Harmful Effects? The Army Is Trying to Find Out

Encouraged by promising anecdotal evidence, the United States Army has undertaken the first large-scale randomized controlled trial (RCT) into how anesthetic can be used to combat post-traumatic stress disorder (PTSD). Early experiences with stellate ganglion block (SGB) have shown that injecting local anesthetic into a bundle of nerves in the neck inhibits excess nerve growth that triggers chronic stress. Researchers believe the "fight or flight" instinct is rebooted as a result, possibly muting the symptoms of PTSD. When it works, patient see almost immediate relief. While military doctors believe SGB could be life-changing for the 20 percent of veterans returning from war with PTSD, as well as some civilians with the condition, the medical community as a whole needs more convincing. An RCT with favorable results would go a long way toward winning them over, but recruitment has been challenging. Investigators want to enroll at least 240 participants by the time the study closes next February; but after two years, it has lined up only 48. Another problem is that the placebo is unable to replicate the physical signs of the shot, which may undermine the blinding process and influence the findings. In hopes of ironing out these snags, the company conducting the investigation, RTI International, has applied for an extension to continue the study until February 2019.

From "Could a Shot of Local Anesthetic Block PTSD's Harmful Effects? The Army Is Trying to Find Out"
Independent Journal Review (06/19/17) Havlak, Julie

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Choice of Anesthesia for Cesarean Delivery

In an effort to identify patient and facility factors that may influence anesthetic choice for cesarean deliveries (CDs) in the United States, researchers consulted the National Anesthesiology Clinical Outcomes Registry. The colleagues from Boston's Brigham and Women's Hospital and Harvard Medical School as well as the University of California, San Diego analyzed c-sections performed from January 2010 through March 2015. The repository ultimately yielded a sample population of 218,285 CDs, which were stratified according to American Association of Anesthesiologists (ASA) physical status and classification as emergency status. The team also considered patient age; year and time of surgery; day of the week; trial of labor after CD; U. region; and facility type, setting, and volume. The investigators found that neuraxial anesthesia, which has been steadily gaining favor since the 1980s, was selected for the majority of CDs in the sample—205,671 out of 218,285, specifically. Only 5.8 percent of c-sections, or 12,614 cases, were performed using general anesthesia; but this approach was taken in 14.6 percent of the 15,282 cases that were considered emergencies. General anesthesia also was used at higher rates at university hospitals, after hours and on weekends, and with adolescent patients or those defined as ASA class III or higher.

From "Choice of Anesthesia for Cesarean Delivery"
Anesthesia & Analgesia (06/17) Vol. 124, No. 6, P. 1914 Juang, Jeremy; Gabriel, Rodney A.; Dutton, Richard P.; et al.

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Too Many Opioids After Cesarean Delivery

New research reported in Obstetrics & Gynecology suggests that women are receiving too many opioids following cesarean section. The single-site study involved 179 mothers undergoing surgical delivery, who went home with a prescription for the equivalent of 30 doses of 5 mg of oxycodone or hydrocodone. Interviews conducted 2 weeks after discharge indicated that most of the patients took the opioids for about 8 days, and about 75 percent of them had medicine left over at the end of the follow-up period. "About a quarter of the women used all their pills and still reported they had pain," noted study lead Sarah S. Osmundson, an assistant professor of obstetrics at Vanderbilt University, "so it's not as simple as 'just use less.' We need to figure out how to individualize opioids, as opposed to giving all patients the same prescription."

From "Too Many Opioids After Cesarean Delivery"
New York Times (06/14/17) Bakalar, Nicholas

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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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June 22, 2017
Quicken Loans AANA Group Disability Nurse Anesthesia Annual Congress

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