Anesthesia E-ssential

AANA Anesthesia E-ssential, June 6, 2019

Vital Signs

CRNA Leslie Barrett Named President/CEO of Novant Health's Medical Park Hospital

Leslie Barrett, MBA, MHA, CRNA, has been named president and CEO of Medical Park Hospital in Winston-Salem, N.C. Barrett will remain Novant Health's vice president of surgical and anesthesia services, in which she oversees regulatory compliance, facility needs, financial health, quality and system-wide patient outcomes.

Barrett received her education in nurse anesthesia at St. Joseph Hospital School of Nurse Anesthesia in Providence, R.I. She also earned an MBA and a master's in health administration from Pfeiffer University in Charlotte, N.C. She has served in several administrative roles with Novant Health since 2008, and has been a vice president since 2015. Learn more.
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Upcoming Safety Action Series Webinar: Practicing for Patients: Obstetric Drill Program for Postpartum Hemorrhage

Register for the upcoming Safety Action Series webinar, "Practicing for Patients: Obstetric Drill Program for Postpartum Hemorrhage," presented by the Council on Patient Safety in Women's Health Care. The webinar will be held on Friday, June 14, 2019, at 2 p.m. ET. This patient safety bundle emphasizes the importance of clear communication and an interprofessional team approach in order to help providers address postpartum hemorrhage. Register for this webinar.
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In Recognition of the 75th Anniversary of D-Day

On June 6, 1944, the largest amphibious invasion the world had seen was launched. Allied forces invaded the shores of Normandy, France, and through their perseverance, against incredible odds (the Germans were perched in bunkers high atop 100 foot cliffs overlooking the beaches), turned the tide of the war effort in Europe. Seventy-five years ago today this invasion began. We are losing our WWII veterans, now in their 90s and 100s, at roughly 348 per day. The AANA recognizes these soldiers who gave their all during this operation, and the veterans who survived and fought for freedom and all the inherent rights therein. Thank you. We are grateful.
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Hot Topics

AANA Advisory Vote to Select the FY2019 President-elect/FY2020 President

The Advisory Vote to select the AANA FY2019 President-elect/FY2020 President started on June 4, 2019, and will continue until noon CDT on June 18, 2019. All active members as of May 27, 2019 should have received their election passcode and voting instructions electronically from Survey & Ballot Systems (SBS), the AANA's election coordinator. The member selected by the membership through the Advisory Vote will be appointed by the AANA Board of Directors to serve as the FY2019 President-elect/FY2020 President shortly after the conclusion of the Advisory Vote voting cycle.

Voting closes at noon CT on June 18, 2019. If you cannot locate your personalized election login information, or if you have difficulty with the voting site, please call 952-974-2339 (Monday-Friday, 8 a.m. - 5 p.m. CT) or email

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Limited Space Still Available
AANA State Leadership Workshop, June 22-23, 2019, in Nashville

Register now for the AANA State Leadership Workshop, "Taking the Show on the Road," June 22-23, 2019 in Nashville, Tenn.

These leadership workshops are designed for state leaders to effectively lead and govern state associations. Join your peer leaders for this interactive day and a half workshop and be inspired and engaged to:
  • Conduct an effective crucial conversation and learn how to influence change for positive outcomes.
  • Describe the applied skills in emotional intelligence and understand how this relates to your role as a state leader.
  • Develop strategies for improving association board governance.
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Vietnam Voices Needed

The AANA seeks to record the histories of our Certified Registered Nurse Anesthetists (CRNAs) who served in Vietnam. AANA hopes to share these experiences with our membership, legislators, and the general public as a means of enlightening, healing, and reaching back into history so that the many accomplishments and sacrifices of CRNAs, soldiers, brothers, sisters, friends and loved ones are not forgotten.

If you are interested in contributing your experience as a nurse (pre-CRNA) or nurse anesthetist in the Vietnam War, see the submission guidelines. Contact Cathy Hodson of the AANA Staff with any questions.
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NewsMaker: CRNA Eddie Dalton Awarded Advanced Practice Excellence Award

The North Mississippi Medical Center (NMMC) in Tupelo, Miss., presented its Excellence in Nursing awards recently, and conferred the Advanced Practice Excellence Award upon Eddie Dalton, MSN, CRNA.

Dalton earned associate degrees in both electronics and nursing from Itawamba Community College, and a bachelor's degree in nursing from Mississippi University for Women. He completed his master's degree and nurse anesthesia training at the University of Tennessee in Memphis. Dalton joined the NMMC staff 37 years ago as a biomedical technician and also previously worked in dialysis and the emergency department. Learn more.
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NewsMaker: CRNA Audrey Less Authors Article on Epidural Use During Labor and Delivery

"How an Epidural is Used During Labor and Delivery," was published June 3 on website. In the article, Audrey Less, MSN, CRNA, writes about how the epidural process unfolds, and answers several concerns and enumerates several things she thinks people should understand about epidurals.

Less emphasizes that each and every epidural is different. She also answers a common question from her patients: "What happens if I have a contraction during the procedure?" Learn more.
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Meetings and Workshops

Last Call: Anesthesia Business Seminar Begins June 10

Learn how to navigate the business aspects of anesthesia and earn 16 Class A CE credits! Successful CRNA leaders Larry Hornsby, BSN, CRNA, and Juan Quintana, DNP, MHS, CRNA, will lead you through an eight-week online seminar that will give you the skills and motivation to grab the brass ring. From developing Request for Proposals to improving your negotiation skills, you'll get a personalized experience that you can't get anywhere else (exclusive to members only). 
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NEW! Take Your Career to the Next Level: Explore the Career Fair 2019 at Annual Congress

CRNA Careers is hosting an all-new career fair this year at Annual Congress! Open to all Annual Congress attendees. No appointments necessary. Whether you’re new to the field or looking for a change, join us in Chicago to meet with seasoned recruiters from highly esteemed institutions, including:
  • American Anesthesiology
  • Carle
  • Envision Physician Services
  • North American Partners in Anesthesia
  • The University of Maryland Medical Center and
  • UF Health Shands.
Recruiters will be available to provide expert advice and help you determine your next career steps. Learn more.

Career Fair Schedule
Sunday, August 11: 9:00 a.m. – 6:00 p.m.
Monday, August 12: 9:00 a.m. – 2:00 p.m.
Tuesday, August 13: 8:00 a.m. – 10:00 a.m.

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AANA Member Benefits

Spring Featured Item: Save Up To $1,5001

Save 1,500 with Quicken LoansBuying or refinancing a home is a big step. Let Quicken Loans® help you with $500 cash back after closing, plus up to $1,000 in a closing cost credit.¹ And rest assured, our Home Loan Experts can guide and advise you the whole way. Through this program you’ll also receive:
  • Complimentary mortgage webinars to stay updated on market trends
  • A variety of loan product options with some allowing down payments as low as 3%
  • Tips for improving your credit so you can buy or refinance with the best possible rate

Speak with a Home Loan Expert today by calling (855) 245-5911.

View Options

1Valid on new applications received between 01/01/2019 and 06/30/2019 for loan amounts of $100,000 or greater. The client will receive a check 2 – 4 weeks after closing in the amount of $500, plus the client will receive a closing cost credit on their Closing Disclosure in the amount of $1,000. For loans of $99,999 or less, the client will receive a check 2 – 4 weeks after closing in the amount of $500, plus the client will receive a closing cost credit on their Closing Disclosure in the amount of $750. This offer is only available to clients who call the dedicated benefit phone number or go through the dedicated benefit website. Offer does not apply to new purchase or refinance loans submitted to Quicken Loans through a mortgage broker. Offer is non-transferrable. Offer cannot be retroactively applied to previously closed loans or loans already in process. Quicken Loans reserves the right to cancel this offer at any time. Not valid with any other discount or promotion aside from the Rocket Homes discount mentioned in this offer. Acceptance of this offer constitutes the acceptance of these terms and conditions, which are subject to change at the sole discretion of Quicken Loans. This is not a commitment to lend. Additional restrictions and conditions may apply.

Quicken Loans Inc.; NMLS #3030; Equal Housing Lender. Licensed in 50 states. AR, TX: 1050 Woodward Ave., Detroit, MI 48226-1906, (888) 474-0404; AZ: 1 N. Central Ave., Ste. 2000, Phoenix, AZ 85004, Mortgage Banker License #BK-0902939; CA: Licensed by Dept. of Business Oversight, under the CA Residential Mortgage Lending Act and Finance Lenders Law; CO: Regulated by the Division of Real Estate; GA: Residential Mortgage Licensee #11704; IL: Residential Mortgage Licensee #4127 – Dept. of Financial and Professional Regulation; KS: Licensed Mortgage Company MC.0025309; MA: Mortgage Lender License #ML 3030; ME: Supervised Lender License; MN: Not an offer for a rate lock agreement; MS: Licensed by the MS Dept. of Banking and Consumer Finance; NH: Licensed by the NH Banking Dept., #6743MB; NV: License #626; NJ: New Jersey – Quicken Loans Inc., 1050 Woodward Ave., Detroit, MI 48226, (888) 474-0404, Licensed by the N.J. Department of Banking and Insurance.; NY: Licensed Mortgage Banker – NYS Banking Dept.; OH: MB 850076; OR: License #ML-1387; PA: Licensed by the Dept. of Banking – License #21430; RI: Licensed Lender; WA: Consumer Loan Company License CL-3030. Conditions may apply.
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CRNA Jobs: Locum Tenens and Permanent Placement Opportunities Across the Country

United Anesthesia – Various Locations. United Anesthesia has been a leading CRNA and Anesthesiologist Locum Tenens and Permanent Placement firm in the country for 40 years. By specializing in only anesthesia placement, we can partner with you to find the ideal situation to suit your strengths, your priorities, your dreams. Your dedicated personal coordinator is looking forward to your call! Learn more.
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Cardiac CRNA: Memorial Health System, Springfield, Illinois

The CRNA embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision and values. These standards are evident in the daily work, which includes:
  • Administration of anesthesia for all cardiac and vascular procedures employing a variety of techniques to render persons insensitive to pain during a variety of surgical, dental, obstetric, and diagnostic procedures.
  • Evaluating the effectiveness of interventions and assist in identification of alternative strategies.
  • Demonstrates knowledge of the principles of growth and development for patients of adult age through geriatrics.
  • Assesses and interprets data reflective of the patient’s status and provides care relative to their age-specific needs in accordance with the department’s policies, procedures, and standards of care.
CRNA is directed by an Anesthesiologist and works in a collaborative team approach to improve quality, safety, and control costs. Serves as clinical mentor for Student Registered Nurse Anesthetists. Learn more.
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Chief CRNA: U.S. Anesthesia Partners, Inc., Glendale, Arizona

U.S. Anesthesia Partners of Arizona has an opening for an Arizona Platform Chief CRNA. The Arizona Platform CRNA will be a clinical working role. This position will provide feedback and interpret organizational policies, budgets, communication, consulting and quality metrics. This position is responsible for building and maintaining professional relationships with executive staff, platform physician leadership, human resources committee (HRC), continuous quality improvement (CQI) committee, and division leadership.

  • Promotes interests of U.S. Anesthesia Partners and the USAP Arizona platform.
  • Consults with workforce management and recruiting.
  • Helps design appropriate CRNA staffing models.
  • Trains and mentors other CRNAs at the division and/or facility level.
  • Works closely with division managers on the appropriate management and scheduling of CRNAs.
  • Facilitates development and implementation of an Anesthesia Care Team model at the facility level.
  • Develops training guides and programs as appropriate.
  • Works with Talent Acquisition to serve as point of contact for division managers and as requested interviewing, selecting, and hiring of qualified personnel, including interviewing, selecting, and hiring qualified personnel as requested at the division level.
  • Present recommendations to Arizona Leadership on CRNA engagement.
  • Counsel and evaluate CRNA personnel as requested.
  • Recommend operational policies and procedures.
Learn more.

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CRNA: Ochsner Health System, Baton Rouge, Louisiana

At Ochsner Health System, we connect passion to purpose. As a Certified Registered Nurse Anesthetist here at Ochsner, you will join a team of passionate caregivers committed to teamwork, innovation and excellent quality care. From the start, you will play a crucial role in proving top-notch care to patients.

Ochsner Medical Complex-The Grove, Ochsner’s newest location off I-10 in Baton Rouge, is seeking CRNAs to join our growing practice in our BRAND NEW state-of-the-art surgical suite. No weekend work and no call!

What you’ll do
  • Documents patient procedures and incidents
  • Assesses patient before, during, and after administering anesthesia
  • Ensures patient safety and administers anesthesia following accepted practice techniques
  • Acts as a liaison to surgeons, anesthesiologists, co-workers, patients, and families
  • Participates in department quality assurance initiatives and activities of professional development
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.

IV Tramadol Effective in Second Phase III Postoperative Pain Trial

A Phase III study of intravenous tramadol following abdominoplasty found that the agent safely and effectively controlled postoperative pain. The trial population included 370 participants who were randomly assigned to IV tramadol, IV morphine, or placebo after their surgery. The main outcome was analgesic efficacy as measured by Sum of Pain Intensity Difference over 24 hours, which showed that IV tramadol delivered superior pain relief compared to placebo. At the same time, the results indicated that IV tramadol provided safety and efficacy benefits similar to IV morphine. Based on the favorable results of the study, a New Drug Application for IV tramadol could be submitted to the Food and Drug Administration by the end of this year.

From "IV Tramadol Effective in Second Phase III Postoperative Pain Trial"
Monthly Prescribing Reference (06/03/19) Ernst, Diana

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New Guideline Calls for Two People in Room During Sedation of Pediatric Dental Patients

New guidance from the American Academy of Pediatrics offers recommendations for when children undergo deep sedation or anesthesia for a dental procedure. The report clarifies that a qualified anesthesia provider should administer the sedation—which might involve nitrous oxide, also known as laughing gas; general anesthesia; or mild, moderate, or deep sedation. Meanwhile, a second skilled individual—who must be certified in Pediatric Advanced Life Support—should also be present in the room. That person's role is to track the patient's vital signs and to help in the event of a medical emergency. Overall, however, the report notes that anesthesia is safe for young children and adolescents.

From "New Guideline Calls for Two People in Room During Sedation of Pediatric Dental Patients"
KFOX TV (TX) (06/03/19) Gonzalez, Jessica

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Virtual Reality Improves Tolerance of Anesthesia Procedures and Reduces Need for Intravenous Sedation By at Least 50 Percent

Researchers say that letting patients get lost in virtual reality before and during locoregional anesthesia for orthopedic surgery decreases pain and curtails the need for intravenous sedation. Their single-site study randomly allocated 20 patients to undergo standard IV sedation during locoregional anesthesia. Another 20 participants were assigned to virtual reality hypnosis distraction (VRHD) during locoregional anesthesia, consisting of virtual reality goggles and a relaxing video narrated by a calming voice. Standard IV sedation was administered only if and when their pain exceeded three on a 10-point scale. The final group of 20 underwent VHRD both before and during locoregional anesthesia, receiving IV sedation if they hit that same pain threshold. While all of the participants reported similar levels of comfort and satisfaction, only 10 percent of those receiving VRHD before and during locoregional anesthesia required additional sedation. The same was true for just 25 percent of those who received VRHD during locoregional anesthesia only. The results, presented at the Euroanaesthesia congress earlier this month, suggest that VRHD could serve as a valuable drug-free alternative for curbing anxiety and procedure-related pain without the side effects and longer recovery time seen with traditional IV sedation.

From "Virtual Reality Improves Tolerance of Anesthesia Procedures and Reduces Need for Intravenous Sedation By at Least 50 Percent"
Medicalxpress (06/02/2019)

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Cesarean Anesthesia Associated with Surgical Site Infections and Thromboembolism

Investigators report that administering general anesthesia for Cesarean delivery poses greater risks than administering neuraxial anesthesia, but at least the practice is on the decline. According to the team from Columbia University in New York, the share of avoidable general anesthetics in this setting declined to 4.8 percent during 2013-2014 from 5.6 percent 10 years earlier. The retrospective study, which encompassed more than 466,000 C-section cases—including 5.7 percent that were potentially avoidable—also identified low hospital-level utilization of neuraxial analgesia techniques during labor as one of the strongest predictors of potentially avoidable general anesthesia for Cesarean births. Compared with neuraxial anesthesia, the researchers found, cases with avoidable general anesthetics presented a greater risk of thromboembolism, surgical site infection, anesthesia-related complications, and other adverse outcomes in the mother. The findings are reported in Anesthesiology.

From "Cesarean Anesthesia Associated with Surgical Site Infections and Thromboembolism"
Specialty Medical Dialogues (05/31/19) Baranwal, Medha

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Explorers and Soldiers Don't Worry — Anesthesia Works in Antarctica!

Attendees of the recent Euroanaesthesia congress heard how common anesthetic medications work even in Antarctica's extreme climate. Researchers exposed fentanyl citrate, etomidate, rocuronium bromide, and suxamethonium chloride to the bitter cold temperatures on Deception Island in Antarctica for up to 72 hours. Even so, the drugs remained within the allowed margins of security, with no loss of potency. "Sometimes a drug can be changed or improved with weather conditions, like light or cold," explained Professor Major Ricardo Navarro-Suay of Hospital Central de la Defense "Gomez Ulla" in Madrid. "The drug administration security interval is from 95 percent to 110 percent so these results show we could employ these drugs safely to patients under the extreme conditions like the polar weather found in Antarctica."

From "Explorers and Soldiers Don't Worry — Anesthesia Works in Antarctica!"
Science Codex (05/31/19)

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In-Hospital Delirium Increases Postoperative Cognitive Dysfunction Risk in Older Adults, But Only in the First Month

There is evidence that older patients who develop postoperative delirium immediately following surgery are also more likely to exhibit signs of postoperative cognitive dysfunction one month later. However, few still appear to be at risk for the condition—defined as cognitive impairment that persists more than three months after an operation—at months two and six. "The main finding of this study was that delirium significantly increased the risk of postoperative cognitive dysfunction, but primarily in the first postoperative month," said lead study author Lori Daiello, PharmD, of Brown University. "This delayed neurocognitive recovery may represent a normal response to the waning effects of surgery, anesthesia, pain, and medications." Daiello and colleagues analyzed data from the Successful Aging after Elective Surgery (SAGES) trial, which tested the memory and thinking of 560 older patients before and after surgery. Almost a quarter of patients developed in-hospital delirium, according to the study data. That share dropped to 23 percent by two months and to 16 percent by six months. At those intervals, postoperative cognitive dysfunction was more common among men and women who had not developed postoperative delirium.

From "In-Hospital Delirium Increases Postoperative Cognitive Dysfunction Risk in Older Adults, But Only in the First Month"
Newswise (05/28/19)

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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:

222 S. Prospect Avenue
Park Ridge, IL 60068
Phone: (855) 526-2262 (toll-free)/(847) 692-7050
Fax: (847) 692-6968

Attn: Cathy Hodson
E–ssential Editor
June 6, 2019