Anesthesia E-ssential

AANA Anesthesia E-ssential, March 12, 2020
AANA Member Advantage Program

Vital Signs

AANA Monitoring COVID-19: Task Force Assembled

The AANA continues to monitor developments related to the evolution of the Coronavirus Disease 2019 (COVID-19). The association has assembled a task force to monitor and interpret guidance provided by the World Health Organization and the U.S. Centers for Disease Control and Prevention, along with compiling clinical practice resources at

At this time, the 2020 Mid-Year Assembly is proceeding as scheduled on April 18-22. The association is monitoring health and safety updates from state and local health organizations. Event planners are working closely with the Renaissance Washington, DC Downtown Hotel to ensure well-established hygiene and cleaning procedures. To date, the Washington, D.C., Health Department has cited that risk to the virus is low.

The health and safety of our membership is our foremost concern, and we will continue to keep you informed.  
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Open Comments: Patient Safety: CRNAs and Health-Related Impaired Practice

The draft practice document titled, Patient Safety: CRNAs and Health-Related Impaired Practice, Position Statement, Practice Considerations, is available for open comment through March 26, 2020. Please review and provide feedback to Download the draft document at
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CRNAs: Want to Save Money, Better Your Health, Improve Your Breathing? Join the Kick Butts Day Campaign

Join in the national #TakeDownTobacco day of action on Wednesday, March 18! There is a nicotine epidemic with more than 34 million adult smokers and 5.4 million high school students who vape. Find more resources to stop smoking at
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Hot Topics

Submit Your Statement: Celebrate Diversity with the AANA: #IAmMe

Now in its third year, the award-winning I Am Me Campaign celebrates diversity and inclusion within the nurse anesthesia profession. Every April—aka Celebrate Diversity Month—Certified Registered Nurse Anesthetists (CRNAs) and student registered nurse anesthetists (SRNAs) are encouraged to share their "I Am Me" statement with colleagues. Submissions for 2020 are now being accepted through March 31.

There are more than 54,000 nurse anesthetists in the U.S., and while the same high quality, safe, anesthesia care is administered to patients every day, as individuals we bring a wealth of unique experiences. The AANA recognizes the differences in race, gender, ethnicity, language, cultural and religious beliefs, and socio-economic status that our CRNA and SRNA members bring to the nurse anesthesia profession.

Submit your #IAmMe statement here.
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AANA State Leadership Workshop – Denver

When: June 6-7, 2020
Location: Kimpton Hotel Monaco

Join us in Denver, Colo., for a day-and-a-half workshop that will inspire leaders to:
  • Conduct an effective crucial conversation and how to influence change for positive outcomes.
  • Describe the applied skills in emotional intelligence and how this relates to your role as a state leader.
  • Develop strategies for improving association board governance.

See more details and register! Online pre-registration closes Friday, May 22, 2020.
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Ready to Start Your Own Anesthesia Practice?

Learn the business side of anesthesia from two highly successful group practice owners, Juan Quintana and Larry Hornsby. They’re providing an online 8-week seminar with university-level curriculum covering billing and reimbursement, negotiations, contracts and proposals, and differences in practice models.

AANA Membership Exclusive - Earn 16 CE Credits; Next Session starts April 8, 2020

Seats are Filling Up! Spring 2020 Session
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Looking to Pick Up Work Outside of Your Full-time Position?

AANA Insurance Services has malpractice insurance coverage for that! Visit our Policy Options page to learn more about our short-term coverage options, including daily, weekly, monthly, and moonlighting coverages. Learn more.
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Do You Know an Outstanding CRNA? Nominate Your Colleague for an AANA Recognition Award!

Nomination Deadline: March 15, 2020.
Do you work with an outstanding program director, didactic instructor, or clinical instructor? Do you know someone who has spent a lifetime advancing the practice of nurse anesthesia as a practitioner, educator, clinician, or advocate? Consider nominating your colleague for one of the national AANA recognition awards.

Visit Recognition Awards for details on the:
  • Agatha Hodgins Award for Outstanding Accomplishment,
  • Helen Lamb Outstanding Educator Award,
  • Alice Magaw Outstanding Clinical Anesthesia Practitioner Award,
  • Ira P. Gunn Award for Outstanding Professional Advocacy,
  • Clinical Instructor of the Year Award,
  • Didactic Instructor of the Year Award, and
  • Program Director of the Year Award.
Nomination deadline is March 15, 2020.
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AANA Meetings: Refresh Your Knowledge and Make New Connections

Come Meet Your Future

Earn Class A CE credits, build your support network, and meet AANA leaders. To view all upcoming live events, visit
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Ultrasound-Guided Peripheral Nerve Block Workshop

When: March 28-29, 2020
Location: AANA National Headquarters, Park Ridge, Ill.

Earn 12 Class A CE credits and refresh your knowledge of ultrasound-guided peripheral nerve block techniques. This weekend workshop features expert lectures, hands-on instruction, and group discussions of representative clinical cases. Register now for advance registration rates.
Get Details or Register
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Mid-Year Assembly 2020: Early Bird Registration Ends on March 17

When: April 18-22, 2020
Location: Renaissance Washington D.C. Downtown, Washington, D.C.
Earn up to 12.0 Class A CE Credits

Don’t miss the chance to represent your profession and let your voice be heard on Capitol Hill! CRNAs are making a positive and significant impact on U.S. healthcare, and this year will be a pivotal moment for Nurse Anesthetists as reforms to the Medicare program are being examined. Register by 3/17 to save!

Register Today!
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Register Now for the Spinal-Epidural with Obstetric Essentials Workshop

When: April 30-May 2, 2020
AANA National Headquarters, Park Ridge, Ill.

Earn 23.50 Class A CE credits with 4.25 Pharmacology/Therapeutics credits with expert lectures and hands-on instruction. Topics include: normal and abnormal physiology of pregnancy, pharmacology, analgesia/anesthesia techniques, clinical applications of spinal and epidural anesthesia procedures, and introduction to the application of ultrasound using live models.

Get details or Register.
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Strengthen Your Leadership Skills at AANA Leadership Summit 2020

When: November 13-15, 2020
Location: Fort Lauderdale, Fla.

Mark your calendar to join more than 400 CRNA leaders at all levels! Strengthen your leadership skills, build your professional network, and enjoy the Florida sunshine.

Add to your calendar
See Leadership Summit 2019 Highlights
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Foundation and Research

AANA Foundation: Fellowship and Grant Applications Now Available

One of the goals of the AANA Foundation is to support new and seasoned investigators in nurse anesthesia through fellowships, postdoctoral fellowships and grants. Programs are designed to develop researchers in nurse anesthesia. Applications are now available on the AANA Foundation website:
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AANA Foundation: Support Nurse Anesthesia Research and Education

You can strengthen the nurse anesthesia profession by supporting the AANA Foundation. Make your tax-deductible gift today by visiting the Foundation's secure donation page. If you would like to make a legacy gift by becoming a Friend for Life, contact Nat Carmichael at (847) 655-1175 or Thank you!
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AANA Member Benefits

Are You a Member of the "800 Club"?

800 Club Laurel RoadNo, it’s not about your travel rewards—it’s about your credit score. Like those who always chased straight A’s in school to make honor roll, these young, above-800 credit score holders believe it’s the undisputed marker of financial adulthood.

Of course, there are also certain perks for those who fastidiously manage their credit scores. And for those who believe the “800-Club” is a distinct rite of passage to lower rates and better deals: they may be right. Top-tier borrowers stand to reap some benefits unavailable to others— from student loan refinancing, to other lending services such as mortgages and personal loans. A higher credit score can yield long-term savings via lower interest rates on borrowing. Learn more.
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CRNACareers - What are your next steps?

Whether you’re graduating soon and researching employers, are a seasoned professional interested in advancing your career or looking to supplement your work with locum tenens options, is the place to help get you started:

  • Search and apply to locum tenens or permanent positions at industry-leading facilities.
  • Upload your resume anonymously and allow employers to contact you.
  • Set up job alerts to receive notifications on new openings.
  • Access free career resources to assist with resume and interview preparation.

Learn more today!

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CRNA: Baylor Scott & White Health, Texas

Baylor Scott & White Health is the most awarded healthcare system in Texas.
Our location in Temple, Texas is rated as high performing by U.S. News & World Report, and is seeking talented CRNAs to join our stellar team of professionals.

Position Highlights:
  • Improved and more competitive compensation model - $30,000 sign-on bonus.
  • Join the comradery of a large established team of Anesthesiologists, CRNAs along with nursing and admin support in a mixed anesthesia care team/solo staffing model.
  • Additional earnings opportunities are provided for working overtime and weekends, also extra pay for call coverage.
  • Scott & White Memorial Hospital is a 636 bed acute care Level I trauma center.
  • Favorable culture within a teaching environment that is the academic site for Texas A&M College of Medicine.
  • This is an employed position with a competitive salary, moving allowance, a comprehensive benefits package and no state income tax.
  • Epic EMR system.
Location/Facility - Baylor Scott & White -Temple, Texas

Shift/Schedule - Full Time Flexible Shifts

Benefits - Our competitive benefits package includes*:
  • Immediate eligibility for health and welfare benefits.
  • 401(k) savings plan with dollar-for-dollar match up to 5%.
  • Tuition Reimbursement & CME pay/ time off.
  • PTO accrual beginning Day 1.
Learn more.
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Certified Registered Nurse Anesthetist: Beaumont Health, Michigan

Currently hiring for our Trenton and Wayne locations only!

We have full time and contingent positions open at our Trenton location and full time and part time positions at our Wayne location.

GENERAL SUMMARY: To provide and manage safe, efficient, anesthesia care to the various age populations under the medical direction of the anesthesiologist. Demonstrates the delivery of excellent customer service by exhibiting the hospital’s ten customer service behaviors in every aspect of the job. Learn more.
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CRNA: WellSpan Health, Pennsylvania

WellSpan Health, an integrated health system serving central Pennsylvania and northern Maryland, has an opening for a Nurse Anesthetist to join our WellSpan Hanover Health Center. This new $49 million health center houses an outpatient surgery suite, lab and imaging services, and primary care and specialty physician offices.

About the Practice
  • Must be certified as a Nurse Anesthetist; experience preferred.
  • Procedures include breast surgery, ENT, Gastroenterology, general surgery, orthopedics and others.
  • Successful candidate must be able to provide care to all ages.
  • Enjoy a well-balanced lifestyle, excellent hours and schedule.
  • Competitive salary and outstanding benefits.

About the Hanover Community
  • Family oriented community with abundant outdoor activities nearby.
  • Nestled in York and Adams Counties, Hanover is conveniently located within minutes of York and Gettysburg, PA, and Baltimore, MD.
Learn more.
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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.

Practical Training of Anesthesia Clinicians in Electroencephalogram-Based Determination of Hypnotic Depth of General Anesthesia

Knowing that electroencephalographic (EEG) brain monitoring during general anesthesia offers clues about hypnotic depth, researchers wondered if anesthesia providers could be quickly taught to recognize typical EEG changes with volatile-based anesthesia. To answer their question, they turned to 71 anesthesia practitioners—just 13 of whom had prior anesthetic-specific EEG interpretation instruction. All of the clinicians underwent pre-educational testing, followed by a training session that lasted 35 minutes, and then followed by post-educational testing. The short class was associated with improvements in the 58 anesthesia providers who lacked previous coaching in this area. Those individuals were better able, after the training, to recognize EEG waveforms corresponding to wakefulness, non-slow-wave anesthesia, slow-wave anesthesia, and burst suppression. They also became more adept at recognizing when hypnotic depth suggested by the EEG was out of sync with the processed EEG index. Conversely, the 13 study participants who reported earlier education on EEG brain monitoring showed no major improvement following the new training.

From "Practical Training of Anesthesia Clinicians in Electroencephalogram-Based Determination of Hypnotic Depth of General Anesthesia"
Anesthesia & Analgesia (03/20) Vol. 130, No. 3, P. 777 Bombardieri, Anna Maria; Wildes, Troy S; Stevens, Tracey; et al.

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Influence of St. John's Wort on Intravenous Fentanyl Pharmacokinetics, Pharmacodynamics, and Clinical Effects

Researchers wondered if a popular herbal remedy might disrupt the pharmacokinetics, pharmacodynamics, or clinical effects of intravenous fentanyl. St. John's wort induces the hepatic CYP3A4 enzyme, which is instrumental in the metabolism of fentanyl. It also may influence the expression of P-glycoprotein, which regulates the movement of drugs across the blood-brain barrier. To determine if the herb could upregulate these processes, the team worked with a small group of healthy volunteers randomized into two arms. One cohort of eight individuals received a fentanyl fixed-dose infusion and an individually tailored target-controlled infusion on different days before and after 30-day St. John's wort. The other eight participants received similar fentanyl care but with placebo. The results indicated that St. John's wort did not have an effect on fentanyl plasma concentrations, pupil diameter, analgesia, cognitive performance, or somatic cognitive-affective effects of fentanyl. Based on the evidence, the investigators concluded that the herbal medication does not change the clinical behavior of fentanyl and that patients taking it are unlikely to respond differently to I.V. fentanyl for anesthesia or analgesia.

From "Influence of St. John's Wort on Intravenous Fentanyl Pharmacokinetics, Pharmacodynamics, and Clinical Effects"
Anesthesiology (Winter 2020) Vol. 132, No. 3, P. 491 Loughren, Michael J.; Kharasch, Evan D.; Kelton-Rehkopf, Megan; et al.

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Inhaled Methoxyflurane Versus Intravenous Morphine for Severe Trauma Pain in the Emergency Setting

Italian researchers explored low-dose methoxyflurane as a non-narcotic alternative to intravenous morphine for severe trauma pain. The team conducted a post-hoc analysis of the Phase III MEDITA clinical trial, which involved 272 adults seeking emergency care for trauma pain. Participants were randomly allocated to inhaled methoxyflurane or a routine analgesic regimen including I.V. paracetamol or ketoprofen for moderate pain and I.V. morphine for severe pain. The post-hoc study focused on the subset of 93 patients with severe pain, looking specifically at the overall change from baseline in visual analog scale (VAS) pain intensity at 3, 5, and 10 minutes after randomization. The results demonstrated that VAS pain intensity decreased more over the first 10 minutes for the 49 patients who received methoxyflurane versus the 44 who received standard care. Methoxyflurane was also associated with faster time to onset of pain relief as well as greater patient and provider satisfaction with the treatment. While 20.4 percent of the non-narcotic group experienced adverse events compared with just 4.8 percent of the group treated with morphine, those side effects were all non-serious in nature.

From "Inhaled Methoxyflurane Versus Intravenous Morphine for Severe Trauma Pain in the Emergency Setting"
Journal of Pain Research (03/20) Vol. 2020, No. 13, P. 491 Voza, Antonio; Ruggiano, Germana; Serra, Sossio; et al.

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IV Ketamine Shows Promise for Chronic Pain, But Doubts Remain

Intravenous ketamine infusion, which already has gained traction as an alternative for treatment-resistant depression, is now emerging as an option for chronic pain sufferers. For those who struggle to get relief elsewhere or who have been relegated to opioids, I.V. ketamine may provide salvation from neuropathic pain, chronic migraine, and conditions like fibromyalgia and complex regional pain syndrome. Despite the anesthetic's off-label potential, not everyone is on board with ketamine's new uses. There is little evidence to support the safety and efficacy of ketamine for these indications over the long term, and what encouraging data there is comes from clinics with a vested interest in the success of the product. "We do not know what are the long-term effects of repeated I.V. ketamine infusions for chronic pain," notes Rae Frances Bell, MD, an anesthesiology specialist at Haukeland University Hospital in Norway. "What we do know is that ketamine has a range of dose-dependent adverse effects." Both Bell and Steven Cohen, MD, professor of anesthesiology and critical care medicine at Johns Hopkins, point to signs of long-term complications including liver toxicity, ulcerative cystitis, cognitive impairment, and addiction. With its steep cost, which typically is not covered by insurance, there is also growing concern that ketamine infusions may be given to patients based on whether they can afford it rather than whether it can actually benefit them.

From "IV Ketamine Shows Promise for Chronic Pain, But Doubts Remain"
Filter Magazine (03/03/20) Medrano, Kastalia

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Acceptance of mHealth Among Health Professionals: A Case Study on Anesthesia Practitioners

Researchers sought to evaluate anesthesia providers on the use of mHealth, a growing trend that employs mobile devices in the delivery of medical care. They received 349 responses to an anonymous online survey sent to members of two anesthesia professional groups in Belgium. The prevailing sentiment among specialists, who made up about 73 percent of the study sample, was that smartphone apps and peripherals could help to enhance anesthesia care. Trainees, accounting for about 27 percent of the sample, were even more confident than specialists on the potential of mobile apps and peripherals. They were also more likely to be actively using mobile apps, at 67 percent versus 37.3 percent of specialists. Among apps, the study indicates that anesthesia providers favor dose-calculating applications, digital books, and apps for active perioperative monitoring.

From "Acceptance of mHealth Among Health Professionals: A Case Study on Anesthesia Practitioners"
BMC Anesthesiology (03/03/20) Carvalho, Hugo; Verdonck, Michael; Forget, Patrice; et al.

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Associations Between Use of ERAS and Post-Op Complications in Total Hip and Knee Arthroplasty

A Spanish study evaluated Enhanced Recovery After Surgery (ERAS) in the setting of elective knee and hip replacement, with a focus on postoperative complications. The investigation included 131 hospitals that either self-identified as ERAS centers or not, and all patients were assessed for 16 ERAS items regardless of their center's designation. Among 6,146 participants who underwent total knee or hip arthroplasty, 680 presented with postoperative complications at 30 days. While there was no between-group difference in the share of patients with overall post-surgical problems, fewer individuals in the ERAS group experienced moderate-to-severe complications. In addition, greater adherence to ERAS components translated into fewer complications—regardless of the center's ERAS status and despite the fact that only a handful of the 16 ERAS items individually correlated to improved outcomes.

From "Associations Between Use of ERAS and Post-Op Complications in Total Hip and Knee Arthroplasty"
JAMA Surgery (02/12/20) Ripollés-Melchor, Javier; Abad-Motos, Ane; Díez-Remesal, Yolanda; et al.

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News summaries © copyright 2020 SmithBucklin

Anesthesia E-ssential is an executive summary of noteworthy articles of interest to nurse anesthetists. It is distributed weekly to AANA members.

Anesthesia E-ssential is for informational purposes, and its contents should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

If you are interested in advertising in Anesthesia E-ssential contact HealthCom Media at 215-489-7000.

For more information on AANA and Anesthesia E-ssential, contact:

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Attn: Cathy Hodson
E–ssential Editor
March 12, 2020