Anesthesia E-ssential

AANA Anesthesia E-ssential

Vital Signs

Telling the CRNA Story
AANA has a diverse and talented membership, all of whom have great stories to tell. Read about two CRNAs who work in rural areas: Kimmerle Miller-Leonard, MAE, CRNA, Toppenish, Wash., and Andy Johnson, MS, CRNA, Olivia, Minn.  
Kimmerle Miller-Leonard was on her way to work in the wee hours of a dark night and had an encounter with a dead horse. Injured in the crash, she nevertheless persevered and got to work in time to help with a C-section delivery. 
Andy Johnson has provided anesthesia for neighbors, his children’s teachers, and even co-workers as the sole anesthesia provider in Olivia. Because of his pain management skills, someone who is not able to be airlifted to a bigger city can now receive treatment locally. Read more at CRNAs The Future of Anesthesia Care Today.

Hot Topics

Incoming President Bruce Weiner Touts Important Role CRNAs Play in Patient Care
President-elect Bruce Weiner, MS, CRNA, recently sat down with a reporter from Becker’s ASC Review and gave his thoughts about the strengths of the nurse anesthesia profession, how CRNAs are uniquely qualified to solve the opioid crisis, and how collaboration among healthcare providers is key to providing the appropriate care for each patient. Read more.
There's a New Way to Participate in the Business of the AANA!
On Saturday, September 9, 1 pm 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, September 10.
Six Facts About Post Traumatic Stress Disorder (PTSD)Awareness and understanding can help
A veteran hearing fireworks on the Fourth of July can be thrust back into the sounds of war: bombs exploding, guns firing, the whistle of a mortar landing nearby. An individual who has experienced a violent sexual or physical attack can experience a heightened startle response and horrifying nightmares for years. Healthcare professionals volunteer in a third-world country and suffer depression upon their return to the civilized world after witnessing some of life’s harsher realities.
All of these are varying examples of post-traumtic stress disorder, or PTSD. June is National PTSD Awareness Month, and the American Association of Nurse Anesthetists (AANA) is bringing awareness to this disorder with six facts you should know about PTSD:
  1. PTSD is an anxiety disorder, and a natural reaction. The degree of anxiety varies by individual and can occur immediately or far in the future following an event. 
  2. Military personnel or veterans may be particularly susceptible to experiencing PTSD due to the nature of their work and their exposure to battle, war, and violent situations.
  3. However, it does not just affect military personnel or veterans. Anyone who has suffered an event that feels traumatic or life-threatening to them may experience PTSD.
  4. PTSD can also arise within emergency responders and healthcare professionals who are coping with adverse events that occur in everyday work.
  5. Symptoms include re-experiencing or reliving the event, avoiding things that evoke the event, and hyperarousal or feeling keyed up and agitated. 
  6. If someone you love is exhibiting signs of PTSD, be supportive, but don’t push. If suicide is mentioned, or if you are fearful that they may consider taking their life, seek  help immediately. Do not wait. You can make the call if they are reluctant or unable – dial 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). The Veterans Crisis Line is 1-800-273-8255, press 1.
The AANA has culled together many resources to help those who suffer from PTSD. Learn more at
CRNAs Needed for #AANA2017 Anesthesia College Bowl Challenge Team
Bring your knowledge of anesthesia and your best game! Be warned, the SRNAs are hard to beat - but the CRNAs did it in 2016! With your participation, the CRNA Challenge Team can make it two in a row! Represent your program and have fun at this exciting annual event. The deadline to submit your application has been extended to July 17.

Professional Practice

Joint Commission Issues New, Revised Hospital Pain Assessment and Management Standards
These standards, effective January 1, 2018, include the following new requirements:
  • Identify a leader/leadership team responsible for pain management and safe opioid prescribing.
  • Involve patients in treatment plan development and setting realistic expectations/measurable goals.
  • Promote safe opioid use through high-risk patient identification
  • Monitor high-risk patients.
  • Facilitate practitioner access to prescription drug monitoring program databases.
  • Engage in performance improvement activities that focus on pain assessment and management to improve safety and quality of care.
Read the standards and learn more about the development process.  
Joint Commission Posts Quick Safety Alert: Daily safety briefings – a hallmark of high reliability
Daily safety briefings, at the department or organization level, provide many benefits to healthcare organizations, including fostering proactive approaches to risk reduction. If briefings are consistently done at the department and organization levels, information is channeled up through leadership and down to frontline staff. These briefings promote immediate identification of adverse events and safety issues occurring in the last 24 hours and anticipate safety and quality issues that may occur in the next 24 hours. The briefings also serve as a vehicle to review steps taken to resolve previously identified issues and resources assigned to resolve new issues. Read Quick Safety Issue 34: Daily safety briefings - a hallmark of high reliability
Joint Commission Publishes Free VTE Resource Compendium
This resource addresses the need for comprehensive discharge instructions for patients with venous thromboembolism (VTE), the third leading vascular diagnosis after heart attack and stroke, affecting approximately 300,000 to 600,000 Americans each year, according to the American Heart Association. This compendium is a guide for practitionersin need of reliable, current patient education materials.

Meetings and Workshops

#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. 
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.

Foundation and Research

Tickets and Sponsorships Available for AANA Foundation Annual Congress Fundraiser
CRNAs Live at the Hard Rock Cafe, to be held Sunday, September 10, offers fun for everyone, including food, drinks, dancing, and live band karaoke with Rock-Bot. Rock-Bot has hundreds of songs to choose from and CRNAs and SRNAs will get to sing with some of the best musicians around. It's just like karaoke with words scrolling by on a screen, but a live band is there to play the music, sing back-ups, and keep you company on stage. For those who would like to take in the city views and have a quieter setting throughout the evening, Hard Rock Café’s prime downtown location offers an adjacent rooftop terrace overlooking Pike Place Market.
Please support this event and help make this evening a success.  Join the fun while benefiting the AANA Foundation and its mission. See you in Seattle!
AANA Foundation Announces New Logo
Feedback is positive for the Foundation’s new logo which is featured here in both the rectangle and square color versions.
Last Call for AANA Foundation Annual Report and Annual Congress Recognition
Thank you to all AANA members who have supported the AANA Foundation in fiscal year 2017! Your generosity will be recognized in the FY17 Annual Report and Recognition booklet and at the 2017 Nurse Anesthesia Annual Congress in Seattle.
Last call… If you haven’t made your donation yet, please do so by July 1, 2017 to be included in FY17 recognition.  Donate through the Foundation’s secure donation page.  
Again, thank you for your support!


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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.
Analgesic Effects of Gabapentin Assessed in Chronic Neuropathic PainA Cochrane review of 37 studies has concluded that gabapentin offers "good levels" of relief for some people with neuropathic pain. Most of the 5,900-plus trial participants suffered from either postherpetic neuralgia or diabetic nerve pain. Among those with the former condition, 32 percent experienced substantial benefit—defined as pain relief of 50 percent or more from baseline—with daily gabapentin therapy at 1,200 mg or greater. By comparison, only 17 percent of patients taking placebo achieved this level of relief. Moderate benefit—pain relief of 30 percent or more from baseline—was observed in 46 percent of gabapentin recipients compared to 25 percent of controls. The rates for patients with diabetic neuropathy, meanwhile, were 38 percent versus 21 percent, respectively, for substantial pain relief and 52 percent versus 37 percent, respectively, for moderate pain relief. While the researchers agreed that gabapentin may significantly alleviate neuropathic pain for some, they also noted that more than half of users will not benefit and may even suffer from adverse events. Dizziness, somnolence, peripheral edema, and gait disturbance occurred more frequently in gabapentin recipients than placebo-takers, at a rate of 11 percent versus 8.2 percent.From "Analgesic Effects of Gabapentin Assessed in Chronic Neuropathic Pain" Monthly Prescribing Reference (06/17)
High Hopes Ride on Marijuana Painkillers Amid Opioid CrisisWith medical marijuana steadily gaining momentum in the United States, drug manufacturers are beginning to eye the market for analgesics derived from cannabis. Food and Drug Administration approval of such products promises to foster consistent dosing and potency, ensure nationwide access, and provide an alternative to addictive opioids like hydrocodone. The agency has yet to approve a marijuana-based analgesic and, because of marijuana's current classification as a Schedule I substance, it could take a decade or longer for that to happen. However, several candidate drugs are already in development that incorporate extracts or synthetic versions of THC and CBD, two compounds found in marijuana. From "High Hopes Ride on Marijuana Painkillers Amid Opioid Crisis" Reuters (06/23/17) Grover, Natalie
Safety Aspects of Postanesthesia Care Unit Discharge Without Motor Function Assessment After Spinal AnesthesiaReleasing spinal anesthesia patients from the post-anesthesia care unit (PACU) without observing motor function of the lower limbs could significantly shorten stays in the recovery room while promoting early rehabilitation. From a clinical perspective, however, there is not adequate evidence to support this approach. To learn more, Danish researchers launched a noninferiority study involving more than 1,350 patients who had total hip or knee replacement under spinal anesthesia at multiple institutions. Among the 670 who underwent motor function assessment (MFA) afterwards in the PACU, 92.2 percent achieved a successful fast-track course defined by a stay of four or fewer days and no 30-day readmission. The 689 participants discharged from the PACU without having motor function checked (NMFA), by comparison, achieved the primary endpoint 92 percent of the time—a difference not great enough to signify inferiority. In fact, the median PACU stay was reduced by 1.25 hours in the NMFA group compared to MFA group. The rate of complications 24 hours postoperatively was higher, however, in NMFA patients at 7.4 percent versus 5.8 percent for MFA patients. While a statistically insignificant disparity, the investigators suggest that additional safety data are warranted for NMFA patients before they are released from the PACU.From "Safety Aspects of Postanesthesia Care Unit Discharge Without Motor Function Assessment After Spinal Anesthesia" Anesthesiology (06/17) Vol. 126, No. 6, P. 1043 Aasvang, Eske Kvanner; Jørgensen, Christoffer Calov; Laursen, Mogens Berg; et al.
Study Links Sleep Patterns With Pain Persistence After Pediatric SurgeryImproving the quality of sleep that children receive following an operation could subdue their pain and accelerate recovery, a new study finds. During the four-month investigation, researchers documented daily sleep patterns and pain levels in 66 pediatric patients. "Poor sleep quality predicted greater subsequent pain intensity the next day and our findings suggest that poor sleep quality may continue to influence the experience of post-surgical pain in children even four months after surgery," said lead author Jennifer Rabbits, MB, of Seattle Children's Hospital. The research, conducted with the University of Washington, was published in the Journal of Pain. From "Study Links Sleep Patterns With Pain Persistence After Pediatric Surgery" Newswise (06/22/17)
Safety and Efficacy of 3 Pediatric Midazolam Moderate Sedation RegimensModerate sedation can improve the cooperation, comfort, and safety of children undergoing dental treatment; but it is unclear which anesthetic agents, dosages, and techniques are most effective. Researchers from the Ohio State University College of Dentistry studied three regimens using midazolam, a popular choice for such procedures. The retrospective study covered 650 cases of pediatric dental sedation performed between July 2012 and June 2014 at a single institution. Each event—executed via oral midazolam only, oral midazolam along with other sedatives, or nasal midazolam alone—was rated for success and postoperative complications. Sedation was considered successful in 80 percent of the cases, and planned treatment was successfully completed in more than 85 percent of cases under each regimen. Oral midazolam alone, however, was more effective than midazolam delivered intranasally, which in turn was more effective than combined anesthetics. Complications were few, with nausea/vomiting, dysphoria, or hiccups presenting in fewer than 10 percent of the encounters. The investigators' conclusion that all three midazolam regimens studied are both safe and effective for minor dental procedures in children dovetails with earlier research.From "Safety and Efficacy of 3 Pediatric Midazolam Moderate Sedation Regimens" Anesthesia Progress (Spring 2017) Vol. 64, No. 2 Gentz, Rachel; Casamassimo, Paul; Amini, Homa; et al.
Single-Dose Interscalene Block and General Anesthesia Relieved Pain After Rotator Cuff RepairAccording to new evidence, adding single-dose interscalene block to general anesthesia safely and effectively relieves pain associated with rotator cuff repair. The randomized study compared pain scores in 62 patients undergoing the surgery, based on whether they received a block plus general anesthesia or general anesthesia only. The combined approach resulted in significantly lower postoperative pain scores compared to standard general anesthesia. Participants in the block group also needed less additional rescue tramadol in the first 12 hours after the procedure than the control patients. Researchers additionally compared patients' insulin, dehyroepiandrosterone sulfate, and fibrinogen levels but observed no significant between-group difference in correlation values between those stress biomarkers and pain scores.From "Single-Dose Interscalene Block and General Anesthesia Relieved Pain After Rotator Cuff Repair" Healio (06/21/2017) Tingle, Casey
Abstract News © Copyright 2017 INFORMATION, INC. 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.If you are interested in advertising in Anesthesia E-ssential contact Slack Incorporated at 800-257-8290.For more information on AANA and Anesthesia E-ssential, contact: AANA222 S. Prospect AvenuePark Ridge, IL 60068Phone: (855) 526-2262 (toll-free)/(847) 692-7050Fax: (847) 692-6968 Attn: Linda Lacey E–ssential Editor
June 29, 2017

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