AANA Anesthesia E-ssential

Vital Signs

Press Conference Puts VA Proposed Rule Front and Center

On July 28, the AANA, along with several nursing and veterans associations, held a press conference at the National Press Club in Washington, D.C., to demonstrate support and highlight the need for the proposed rule by the Veterans Administration (VA) to allow full practice authority for advanced practice registered nurses (APRNs) to the benefit of our nation’s veterans. The proposed rule is intended to reduce the well-documented, dangerously long wait times for healthcare endured by Veterans at VA facilities.

“Evidence must trump politics when it comes to the health of our veterans," announced AANA President Juan Quintana, DNP, MHS, CRNA, the leadoff speaker for a program that also featured Cindy Cooke, DNP, FNP-C, FAANP, president, American Association of Nurse Practitioners; Marla Weston, PhD, RN, FAAN, CEO, American Nurses Association; Jane Kirschling, PhD, RN, FAAN, dean and professor, University of Maryland School of Nursing (representing the American Association of Colleges of Nursing); CMSGT Robert Frank, USAF(ret), CEO, Air Force Sergeants Association; and CAPT Kathryn Beasley, PhD, FACHE, USN(ret), deputy director of government relations, Military Officers Association of America.

As of 9 a.m. the morning of the press conference, more than 44,000 people had submitted comments on the proposed rule, which was by far the highest number of comments for a VA rule since online comment submission was instituted in 2006 – more than six times the total number of comments previously submitted.

Media outlets that attended the event in person or remotely included Medscape, NBC, FierceHealthcare, MedPage Today, American Veterans, HealthLeaders, Merion Matters, and KFYI (Phoenix). Politico reported on the press conference the morning of the 28th. Less than 20 hours after the release was posted online, it had been viewed by more than 1,400 reporters and editors.

The public comment period on the proposed rule is currently underway and expires July 25

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CPC Facts

Life Support Courses Work as Class A and/or Class B Credit

Credits from life support courses will count as either Class A and/or Class B credits in the new CPC Program, depending on the situation. If the course is prior approved and has an assessment, it can be applied to the Class A CPC Program requirement. If the course is not prior approved and/or assessed, it can be applied to the Class B requirement. A nurse anesthetist may report up to a total of 20 credits per four-year cycle of initial and/or renewal life support courses. Examples of life support courses include BLS, ACLS, PALS, NALS/NRP, and ATLS.

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.

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Hot Topics

#AANA2016: Get Inspired, Connect with Colleagues, Grow Your Knowledge

Join us in our nation's capital September 9-13 for our profession's premier educational, professional, and social event! Highlights include:

  • Keynote speaker LTG Patricia Horoho, ANC, USA(ret), 43rd U.S. Army Surgeon General, detailing her experiences during the 9/11 attack on the Pentagon
  • Two additional educational tracks: Continued Professional Certification (CPC) Program Review and Enhanced Recovery After Surgery (ERAS)
  • Neuraxial Regional Anesthesia-Epidural Pre-Congress Workshop
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Stars and Stripes Op-Ed: Grant APRN Full Practice Authority

In an op-ed piece published in the June 21 issue of Stars and Stripes, AANA President Juan Quintana, DNP, MHS, CRNA, made the case that finalizing the VA proposed rule will improve access to safe, quality healthcare for veterans in the VA System.

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Open Session of July 16 AANA BOD Meeting to be Live Streamed

Pre-registration is required for the live stream of the Open Session of the AANA Board of Directors Meeting, which will be held on Saturday, July 16, 2016, at 9 am Central Time. The registration deadline is July 15. All AANA members are welcome to attend the Open Session, to be held at the AANA office, 222 S. Prospect Avenue, Park Ridge, IL.

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2015 PQRS Feedback Reports and 2017 Payment Adjustments

Sometime in the fall of 2016, the Centers for Medicare & Medicaid Services (CMS) will be sending 2017 payment adjustment notifications to all eligible professionals (EPs) including CRNAs who participated in 2015 PQRS reporting. In preparation of this event, the AANA Research and Quality Division has created a new Frequently Asked Questions (FAQ) page on PQRS Feedback Reports and Payment Adjustments. CRNAs should be aware of when and how to access the periodic PQRS feedback that is released by the CMS. The new FAQ page also provides information on how to appeal payment adjustment decisions through the CMS Informal Review process.

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AANA Communications Committee Recognizes MYA Student Mentoring Program Participants

On April 5, 2016, at the AANA Mid-Year Assembly (MYA) in Washington, D.C., 37 student registered nurse anesthetists (SRNAs) from around the country spent the day being mentored by practicing CRNAs as part of the Student Mentoring Program, coordinated by the AANA Communications Committee. Each year, SRNAs who demonstrate leadership qualities and skills are recommended by their educational program administrators to participate in this popular program. We congratulate the students and their CRNA mentors who made this year’s mentoring program a resounding success.

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Calling All Researchers: New Research Datasets Resource

Research Resources now includes a new webpage on Research Dataset Resources. This valuable resource provides aspiring and seasoned investigators with information on available datasets that can be accessed to conduct different types of healthcare analyses relating to practice and policy domains of nurse anesthesia research. The webpage also includes a downloadable table with hyperlinks to the actual research data sources. Please note that this webpage only provides a general overview of common datasets and does not represent all of the possible research datasets available.

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Meetings and Workshops

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

Don't Miss Stepping Out in DC!

Don’t miss Stepping Out in DC and Shake It for a Cause Dance Party - Sunday, September 11, 2016, from 7:00 – 11:45 pm at Washington Marriott Wardman Park. Ticket includes dinner, drinks, entertainment featuring Capitol Steps, and the Dance Party. For those who only want to attend the Dance Party during the second half of the evening, tickets are $50 for CRNAs and $25 for students.

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Donate Today for AANA Foundation Annual Report Recognition

Thank you to all AANA members who have supported the AANA Foundation in fiscal year 2016. Your support is so important in advancing nurse anesthesia education and research.

If you haven’t made your donation yet, please do so by July 1, 2016 to be included in the AANA Foundation’s FY16 Annual Report (donations of $100 or more will be included). Visit the Foundation’s secure donation page.

Again, thank you for your support!

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Federal Government Affairs

CRNAs, Veterans Make Themselves Heard on Veterans Access to Care Rule, while ASA Ramps Up Opposition; Have You Taken Action?

Thousands of AANA members and veterans have taken action to make their voices heard for increasing veterans access to quality healthcare—and reducing veterans wait times for care—through support for a proposed rule for full practice authority for CRNAs and other APRNs in Veterans Health Administration (VHA) facilities. But much more must be done, and AANA is making it easy for every CRNA voice to be heard—if only every CRNA and student registered nurse anesthetist will join in taking action.

Already, 13 states have met or exceeded their goal of 33 percent of membership submitting comments through the Veterans Access To Care campaign, four weeks before the July 25 public comment period deadline. CRNAs who are VA employees have been given the go-ahead by their employer to submit comments, provided that they comment as private citizens and professionals and do not use their VA office or title in the comment.

More than 63 media outlets have covered the issue, many driven by AANA public relations efforts, including op-eds by leading CRNAs in the Louisville Courier-Journal, the Las Vegas Sun and, more recently, Stars and Stripes.

Opposition to the proposal is being aggressively organized by the American Society of Anesthesiologists (ASA). In a Washington news conference June 1, ASA leaders inaccurately accused the VA of promoting a lower standard of care and putting veterans’ health and safety at risk. And during the American Medical Association’s national meeting June 12-13, policy statements were attacking CRNAs and other APRNs as well as the VA’s proposed rule.

To help make this proposed rule a final rule and the law of the land, every AANA member is being asked to:

  1. Submit a comment through Veterans Access To Care;
  2. Share with family, friends and colleagues, especially veterans, our Veterans Access To Care site where they can also take action;
  3. Watch for AANA CRNAdvocacy alerts to contact your members of Congress and be heard on Capitol Hill as needed; and,
  4. Spread our message for increasing veterans access to care and reducing their wait times by sharing news articles and strong stories on your Facebook and Twitter social media platforms, using the hashtags #CRNAs4Vets and #ForOurVets, and including Veterans Access To Care. You can also share content from the AANA Facebook and Twitter feeds.
  5. Consider making a contribution to your CRNA-PAC. Governed by AANA members and funded solely by members’ voluntary contributions, our CRNA-PAC helps make CRNAs heard on Capitol Hill as it supports federal candidates and campaigns that are CRNA-friendly and influential on CRNA issues.
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Update: Expand Veterans Access to Care through Full Practice Authority for VHA CRNAs, APRNs

The AANA continues to work with a broad coalition of groups in support of improving veterans access to care through full practice authority for CRNAs and other APRNs at the VHA. Here is a brief rundown of activities to keep members apprised of current actions.

  • Regulation: The Department of Veterans Affairs published its proposed rule on APRN full practice authority in the Federal Register on May 25, triggering a 60-day public comment period that will end on July 25. AANA continues urging all members to use Veterans Access to Care to submit regulatory comments as soon as possible in support of improving veterans access to quality healthcare through CRNA and APRN full practice authority. AANA members can also share the site with colleagues, friends, and family—especially veterans—to take action. As of June 27, the Federal Register reported having more than 43,000 comments submitted to the rule; more than 20,000 comments are being submitted through the AANA’s Veterans Access to Care campaign. AANA members can expect to receive weekly emails specific to the proposed rule throughout the comment period.
  • Legislation: The AANA continues to encourage members of the U.S. House of Representatives to cosponsor the “Improving Veterans Access to Quality Care Act” (H.R. 1247) and members of the Senate to cosponsor the “Veterans Health Care Staffing Improvement Act” (S. 2279), which have 56 and 11 bipartisan cosponsors respectively. Be sure to thank your U.S. Senators and Representatives who have supported expanding veterans access to care through full practice authority for CRNAs and other APRNs.
  • On June 29, the Senate Veterans Affairs Committee held a hearing on a variety of legislation, including the AANA-backed S. 2279. Further information will be provided in the next Anesthesia E-ssential. The AANA continues to work with committee members to advance this important legislation.
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Legislation Funding the Department of Veterans Affairs Clears House of Representatives with No Anti-CRNA Language, but the Senate Has Blocked It for Now

In the early hours of June 23, the House of Representatives voted in favor of the conference report to the Military Construction and Veterans Affairs Appropriations Act for Fiscal Year 2017 on a party-line vote of 239-171. But Senate disputes over the funding levels for combating the Zika virus and other legislative provisions united Democrats against the package, and they blocked it on a procedural vote June 28.

Negotiated among the House- and Senate-passed bills, the legislation included neutral language on the VHA full practice authority issue, which allows the proposed rule to continue moving forward (See page 46). It also lacked the technical errors and misrepresentations that were included in the Senate report.

The White House also issued a statement announcing that President Obama will veto the bill unless Zika funding is increased.

The AANA and its coalition partners continue to work with the Appropriations Committee and Congressional leaders to ensure that neutral language remains in the bill despite delays to passage.

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AANA Requests Equal Treatment with Physicians in Medicare Agency’s Proposed Rule on MACRA

In comment letters sent to Medicare on June 24 and 27, the AANA and APRN organizations requested that Medicare provide APRNs equal treatment with physicians in the new Medicare payment program.

The AANA letter, sent by President Juan Quintana, DNP, MHS, CRNA, and the APRN letter, sent by 27 national nursing organizations, were in response to the agency’s proposed rule on Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) implementation, also referred to as the quality payment program. The AANA-backed MACRA legislation, enacted last year, permanently repealed Medicare Sustainable Growth Rate (SGR) cuts and reforms Medicare payment.

The AANA comment letter also provided the following recommendations:

  • The Quality Payment Program should not impact any unnecessary supervision requirements.
  • Consult with the AANA before incorporating anesthesia into any of the proposed episode-based measures.
  • CMS should consider the costs attributed to meeting medical direction billing requirements and the costs of receiving anesthesia subsidies per anesthetizing location as alternative resource measures.
  • Ensure that specifications for clinical practice improvement activities undergo proper stakeholder comment.
  • Provide MIPS eligible clinicians with exact reasoning for negative payment adjustment.
  • Include APRNs and CRNAs in the definition of a Physician-Focused Payment Model (PFPM).
  • A Physician-Focused Payment Model Technical Advisory Committee (PTAC) should ensure that PFPMs use cost-effective anesthesia care when anesthesia is involved.
  • CRNAs should be represented on PTAC processes for evaluating payment model proposals that require the use of anesthesia services.

Read the AANA comment letter and Appendix A.

Read the APRN comment letter.

Read the CMS proposed rule.

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AANA Requests Clarification from the Health Care Payment Learning and Action Network (LAN) on the Role of CRNAs and Anesthesia in Cardiac Care

The AANA requested that the Health Care Payment Learning & Action Network (LAN) clarify in its white paper the role of CRNAs and of anesthesia in maternity care bundled payments in a comment letter submitted to the LAN on June 14. The letter was in response to LAN’s white paper titled “Accelerating and Aligning Clinical Episode Payment Models: Cardiac Care.” LAN is intended to examine issues and challenges associated with the development and deployment of alternative payment models across the public and private sectors.

Signed by AANA President Juan Quintana, DNP, MHS, CRNA, the letter stated:

“We ask for clarification on how the Clinical Episode Payment (CEP) Work Group envisions the role anesthesia providers, including CRNAs, will play as members of the surgical team under the CAD episode of care payment model. As CRNAs personally administer more than 40 million anesthetics to patients each year in the United States, CRNAs’ services are crucial to the PCI and CABG procedures…. We urge that the white paper emphasize the strategic consideration of the role of anesthesia delivery that is safe and cost-efficient and include the use of techniques such as Enhanced Recovery After Surgery (ERAS) programs, which help reduce costs and improve patient outcomes.”

The letter also requests that the draft white paper:

  • Include recommendations on design elements that encourage cost efficient anesthesia delivery models when anesthesia is used;
  • Discourage the use of policies that drive up healthcare costs;
  • Not use the Consumer Assessment of Healthcare Providers Surgical Care Survey (S-CAHPS) for quality measurement for patient experience of care as it does not adequately capture the patient and caregiver experience with all types of anesthesia professionals;
  • Acknowledge and eliminate policy barriers to the use of APRNs and CRNAs.

Read the AANA comment on the draft white paper.

Read the draft white paper.

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Medicare Agency Proposes Updates to Hospital and Critical Access Hospital (CAH) Conditions of Participation

On June 16, the Centers for Medicare & Medicaid Services (CMS) proposed a rule that would update the requirements that hospitals and critical access hospitals (CAHs) must meet to participate in Medicare and Medicaid.

The proposal would modernize and revise the requirements, known as the Conditions of Participation, to reflect current standards of practice and support improvements in quality of care by:

  • Reducing readmissions, barriers to care and the incidence of hospital-acquired conditions
  • Improving the use of antibiotics
  • Addressing workforce shortage issues
  • Improving patient protections

The AANA is currently reviewing this proposed rule for provisions that affect CRNA practice.

View the proposed rule.

View the CMS Fact Sheet.

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U.S. Supreme Court Ruling Reinterprets False Claims Act, with Implications Possible for CRNAs and other Healthcare Professionals who Bill Medicare

If you certify to Uncle Sam that the service you are providing and accepting payment for meets certain specifications, but do not meet those specifications after all, you may be liable for repayment and penalties under a unanimous U.S. Supreme Court opinion issued on June 16. Because most CRNAs bill federal programs such as Medicare for their anesthesia services, the ruling is important to be aware of. However, a brief from the AANA’s Washington advisors at Alston & Bird confirms that for CRNAs or for anyone else, the complexity of the ruling means that “the full impact of the Court’s decision is not immediately clear.”

In the case Universal Health Services v. United States ex rel. Escobar, the eight justices unanimously held that the implied false certification theory can be a basis for liability under the federal False Claims Act when a defendant submitting a claim makes specific representations about the goods or services provided, but fails to disclose non-compliance with material statutory, regulatory, or contractual requirements that make those representations misleading with respect to those goods or services.

Read the ruling.

Access the ruling and additional documents.

Read a brief from AANA’s Washington firm Alston & Bird.

Read 2012 AANA NewsBulletin article about the False Claims Act and CRNAs. 


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  • With Senator Marco Rubio (R-FL) formally announcing his intent to run for re-election in the U.S. Senate, there have been many recent changes in Florida’s political landscape. Congressman David Jolly (R-FL) withdrew his bid to replace Sen. Rubio and announced that he will instead run for re-election of his current Congressional seat in Florida’s 13th district, challenging former Governor Charlie Crist (D-FL). Congressman Jolly has been a consistent ally of anesthesiologists during his two years in Congress.
  • Federal antitrust regulators are skeptical that the merger of Cigna and Anthem health plans can generate enough concessions to preserve competition in the industry, according to the Wall Street Journal June 20. If the merger is approved, it would create the largest U.S. health insurer, with 54 million members and $117 billion annual revenue, says the WSJ. Read more here.
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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.

Guidelines Updated on Pediatric Sedation

The American Association of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD) have revised their guidelines for sedating children during medical and dental procedures. "The real issue is that we still have children that are dying related to sedation, and it's because people aren't following recommended guidelines and lack the skills to rescue the child when they get into trouble," remarked lead author and Harvard anesthesiology professor Charles J. Cote, MD. One of the most notable differences in the updated document, he said, centers around the use of capnography monitoring. The practice is now recommended for deeply sedated pediatric patients and encouraged for children under moderate sedation. Another major change stipulates a higher level of proficiency for assistants helping whoever is actually administering the sedation. Those individuals must now have pediatric advanced life support training, for example. The new recommendations were released online on June 27 and are also set to appear in the July issue of Pediatrics.

From "Guidelines Updated on Pediatric Sedation"
Medscape (06/27/16) Brown, Troy

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Recording Baseline Pain Scores, Opioid Use Improves Post-op Analgesia

Multimodal, non-opoiod analgesia has been demonstrated as an effective strategy for curtailing opioid consumption and increasing pain relief; but researchers say it can be optimized by recording preoperative pain scores and opioid use. "It is important to know where a patient's pain is starting from" in order to provide the right amount of analgesia following surgery, emphasizes University of Florida assistant anesthesiology professor Alberto Ardon, MD, MPH. Ardon, study author, reports that documentation of preoperative opioid use and pain levels increased significantly in 49 joint replacement patients after the approach was adopted, compared with documentation levels in 49 knee or hip arthroplasty patients before the protocol was introduced. The researchers found that mean and worst postoperative pain scores were markedly lower in the protocol group during the first two days after surgery, suggesting that active documentation of baseline pain and opioid use did impact postoperative analgesia. "In the future, my hope is that we can emphasize the use of nonopioid analgesics first and then opioid analgesics, such as fast-acting oxycodone or longer-acting MS Contin, for example, as a second or third stage in that process," Ardon concludes.

From "Recording Baseline Pain Scores, Opioid Use Improves Post-op Analgesia"
Anesthesiology News (06/27/16) Leung, Martin

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Nonrandomized Intervention Study of Naloxone Coprescription

People who were coprescribed naloxone while taking opioids for pain had significantly fewer opioid-related emergency department (ED) visits per month, according to new research. The two-year, nonrandomized intervention study involved nearly 2,000 adults receiving long-term opioid therapy for pain at primary care clinics in San Francisco—approximately 38% of whom were prescribed naloxone. Researchers from the San Francisco Department of Public Health and the University of California, San Francisco, report that in the six months after receipt of the prescription, patients who received naloxone had 47% fewer opioid-related ED visits per month and 63% fewer visits after one year, compared with those who did not receive naloxone. The researchers observed no net change over time in opioid dose among those who received naloxone and those who did not. The authors conclude that naloxone can be coprescribed to primary care patients taking opioid for pain. They note that in the primary care setting, prescribing naloxone may have additional benefits, including reducing the number of opioid-related adverse events.

From "Nonrandomized Intervention Study of Naloxone Coprescription"
Annals of Internal Medicine (06/27/16) Coffin, Phillip O.; Behar, Emily; Rowe, Christopher; et al.

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Local Anesthesia May Lower Mortality in Patients Undergoing EVAR for Ruptured AAA

Deaths tied to endovascular aneurysm repair (EVAR) are reduced in patients having the procedure under local anesthesia compared with those receiving general anesthesia, researchers from the University of Michigan report. Looking at data for more than 2,400 EVAR participants included in the Vascular Quality Initiative between 2003 and 2015, they documented mortality rates at 30 days and one year postoperatively. After accounting for independent risk factors—age and lowest systolic blood pressure prior to surgery—they determined that patients undergoing EVAR with local anesthesia benefited from fewer intraoperative transfusions and shorter length of stay in the ICU. "EVAR under local anesthesia for [ruptured abdominal aortic aneurysm] is recommended as a safe treatment option, with lower morbidity and improved 30-day and 12-month mortality in certain patients," write Rumi Faizer, MD, and colleagues. "A prospective evaluation of the role of ruptured EVAR under local anesthesia will provide important data to evaluate treatment protocols."

From "Local Anesthesia May Lower Mortality in Patients Undergoing EVAR for Ruptured AAA"
Healio (06/24/2016) Swain, Erik

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Two Simple Measures Can Help Decrease Incidence of POCD in Older Patients

Post-operative cognitive dysfunction (POCD), often presenting in older patients under general anesthesia (GA), is on the rise as Americans gray; but new research identifies strategies to rein in the trend. Brazilian investigators believe POCD in this population can be curbed by avoiding deep anesthesia during operations and by administering dexamethasone, an anti-inflammatory drug, just before a procedure. The conclusions are based on a study of 140 seniors randomly assigned to deep anesthesia, superficial anesthesia, deep anesthesia with dexamethasone, or superficial anesthesia with dexamethasone for their surgeries. "Our findings confirm recent evidence that the deeper the anesthesia-induced hypnosis, the higher the incidence of POCD," remarked lead researcher Maria Jose Carvalho Carmona, an anesthesiology professor at the University of Sao Paulo. "The literature points to a link with the systemic inflammatory response induced by surgical trauma, damaging the central nervous system. If so, the use of an anti-inflammatory drug may have a protective effect."

From "Two Simple Measures Can Help Decrease Incidence of POCD in Older Patients"
News-Medical.net (06/23/2016)

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Study: Many Patients Who Already Take Opioids Continue Their Use After Joint Replacement

A new study appearing in Pain shows that patients who take opioids prior to joint replacement surgery continue to use the analgesics six months after the operation. According to lead researcher Jenna Goesling, there was an expectation that opioid use would cease after the pain from a successful joint surgery subsided. However, no association between changes in pain and persistent opioid use was observed. The finding led Goesling to conclude that patients may be taking opioids for reasons other than postoperative joint pain. Among patients undergoing total knee arthroplasty (TKA), 53.3 percent continued to use opioids six months postoperatively. An estimated 34 percent of total hip arthroplasty (THA) patients reported similar results. Among patients who were opioid-naïve prior to joint replacement surgery, by comparison, only 8.2 percent of TKA patients and 4.3 percent of THA patients were still using opioids six months later.

From "Study: Many Patients Who Already Take Opioids Continue Their Use After Joint Replacement"
Healio (06/22/2016) Jaramillo, Monica

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New Ways to Treat Pain Meet Resistance

While the response to America's opioid crisis increasingly has included calls to scale back the drugs as a first response to pain, putting that plan into practice has been a challenge. Both doctors and patients continue to gravitate toward the faster and cheaper solution offered by writing and filling a prescription, respectively; and patients balk at investing the time and money to explore alternatives such as acupuncture, yoga, osteopathic manipulation, and cognitive behavior therapy. Many health insurers refuse to pay for these nonpharmacological treatments or strictly limit coverage for them, even though research has demonstrated the efficacy on some non-drug pain management programs. That evidence has been uneven, however, prompting the Obama administration to include a directive for much more research in this area as part of its national pain strategy.

From "New Ways to Treat Pain Meet Resistance"
New York Times (06/22/16) Meier, Barry; Goodnough, Abby

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Acupuncture for Craniotomy May Improve Analgesia, Reduce Anesthesia Dosage and PONV

Using acupuncture during craniotomy yields several positive outcomes, based on a meta-analysis of 10 studies comparing the procedure performed under general anesthesia alone or in conjunction with the ancient discipline. According to the review—which appeared online in the Journal of Neurosurgical Anesthesia—acupuncture was associated with significantly lower doses of inhaled anesthetic, reduced postoperative nausea and vomiting, faster extubation, and quicker recovery. In addition, blood levels of a certain brain tissue injury marker were notably lower at 48 hours after craniotomy, suggesting a neuroprotective effect. Reactions to the findings in the medical community were mixed, however. One expert found the results highly encouraging, for instance, and grounds for a "gold-standard" trial; while another cited numerous shortcomings of the analysis, including what he characterized as weakness of the underlying studies.

From "Acupuncture for Craniotomy May Improve Analgesia, Reduce Anesthesia Dosage and PONV"
Anesthesiology News (06/17/16) Dreyfuss, John Henry

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Optimized Preop Fasting Times Decrease Ketone Body Concentration and Stabilize Mean Arterial Blood Pressure During Induction of Anesthesia in Children

Preoperative fasting criteria often are not met in young children undergoing procedures that require anesthesia, but researchers report that optimizing fasting times has a beneficial effect. For the study, glucose concentration, ketone bodies, acid-base balance, and change in mean arterial blood pressure (MAP) were measured during anesthesia induction in 50 infants and children younger than three years old who underwent optimized preoperative fasting management. Their readings were compared against those of 50 controls matched for age, weight, and height who were assessed before optimizing preoperative fasting time. While glucose, lactate, bicarbonate, base excess, and anion gap were comparable, the results indicated that metabolic and hemodynamic conditions were improved in the patients in the optimized fasting management group. Mean fasting time, deviation from guideline, ketone bodies, and hypotension (MAP readings lower than 40 mmHg) were significantly lower, they report, than in the control group.

From "Optimized Preop Fasting Times Decrease Ketone Body Concentration and Stabilize Mean Arterial Blood Pressure During Induction of Anesthesia in Children"
Pediatric Anesthesia (06/16) Dennhardt, Nils; Beck, Christine; Huber, Dirk; et al.

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Camera-Based Monitoring Technology Measures Sp02 Levels Without Contact

The June issue of Anesthesia & Analgesia features research showing that contact-less technology can be calibrated to correctly gauge blood oxygen levels in multiple patients without making individual adjustments. In the study, camera-based pulse oximetry from Royal Philips was able to determine absolute oxygen saturation of arterial blood (Sp02) accurately by measuring light reflected off the foreheads of 41 healthy adult volunteers. The equipment works by quantifying minute physiological changes that are not apparent with the naked eye. Clinicians currently use devices that must touch the skin to get Sp02 readings and other vital signs, but investigators say the innovation could prove useful in cases where monitoring sensors present a threat to fragile skin—such as in premature babies, for example.

From "Camera-Based Monitoring Technology Measures Sp02 Levels Without Contact"
Medical Xpress (06/07/16)

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New Type of Painkiller Effective With Mice for Chronic Pain, Researchers Say

While exploring analgesics to treat skin-related pain, such as that from sunburn, researchers realized that a new class of drug may also alleviate pain stemming from the pancreas and colon. In 2009, the team from Duke University developed a small-molecule compound effective against pain linked to the molecule TRPV4 in the skin and was building on that work when it recently discovered the compound's additional potential. In Scientific Reports, they reveal that the compound known as 16-8 also blocks a molecule called TRPA1 that influences nerve-related pain as well as pain originating in internal organs. The drug—an ion channel that works in sensory nerve cells to detect painful stimuli—was effective against pancreatitis in lab mice and also successfully treated pain from inflammatory musculoskeletal conditions. "We are very pleased with what is a first chapter in a highly promising story," said Duke anesthesiology, neurology, and neurobiology professor Wolfgana Liedtke. "We hope to be able to develop these compounds for clinical use in humans or animals."

From "New Type of Painkiller Effective With Mice for Chronic Pain, Researchers Say"
United Press International (06/04/16) Feller, Stephen

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Female Patients Require a Higher Propofol Infusion Rate for Sedation

Sedation plays an important role in minor oral surgery by mitigating physiological responses to the procedure, such as spikes in blood pressure or heart rate, as well as behavioral ones, including elevated stress level. To pinpoint independent factors that influence the dose of anesthetic needed to reach moderate sedation but not exceed it—which could trigger airway distress or other complications—researchers in Japan analyzed 125 patients having dental implant work done. Specifically, they looked for differences in the average infusion rate of propofol among patients. Treatment time, amount of midazolam administered during anesthesia induction, and age were ruled out as predictors; but female gender was not. According to the investigators, women in the study population needed a higher propofol infusion rate than their male counterparts. The finding suggests that a higher dose of anesthetic per body weight is necessary in women to maintain the same level of sedation as in men. Body weight was significantly and negatively associated with higher infusion rates; however, it could not be considered an independent predictor, since lower body weight was a confounding factor in females participating in the study. Nonetheless, the results should contribute to safer and more effective sedation practices.

From "Female Patients Require a Higher Propofol Infusion Rate for Sedation"
Anesthesia Progress (Spring 2016) Vol. 63, No. 2, P. 67 Maeda, Shigeru; Tomoyasu, Yumiko; Higuchi, Hitoshi; et al.

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