Anesthesia E-ssential

AANA Anesthesia E-ssential, March 14, 2019

Vital Signs

Webinar: National Academy of Medicine Launches The Future of Nursing 2020-2030 Consensus Study

The National Academy of Medicine is formally launching a new consensus study, The Future of Nursing 2020-2030. Supported by the Robert Wood Johnson Foundation, the study's aim is to chart a path for the nursing profession to help our nation build a Culture of Health, reduce health disparities, and improve the health and well-being of the U.S. population in the 21st Century.

Learn about this important new initiative and tune in for the first public meeting of The Committee on the Future of Nursing 2020-2030, which will be livestreamed on Wednesday, March 20, 2019, from 1:30-4 p.m. ET. Register to attend via webinar and sign up for email updates on the work of the committee. There will also be town hall meetings that will come to a city near you.
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Join in Celebrating Patient Safety Awareness Week

Patient Safety Awareness Week, March 10-16, 2019, is an annual recognition event intended to encourage everyone to learn more about healthcare safety. During this week, the Institute for Healthcare Improvement (IHI) seeks to advance important discussions locally and globally, and inspire action to improve the safety of the health care system – for patients and the workforce. Join IHI, the AANA, and many other clinical specialties in advancing patient safety. Get involved though complimentary webinars, engagement on social media #PSAW19, and taking the pledge to help reduce harm in healthcare.
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The Joint Commission Updates Sentinel Event Alert 45, “Preventing Violence in the Health Care Setting”

This sentinel event alert, originally published in June 2010 and revised in February 2019, focuses on rising crime rates for assault, rape, or homicide in the care setting and considerations for safety actions to reduce risk and prevent situations from escalating. The alert updates references and resources, includes information about contributing causes taken from The Joint Commission’s Sentinel Event Database, and recommends seeking local law enforcement input on organization-specific and community-specific risks and potential solutions. The updates and revisions are in red.
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Hot Topics

Admitted vs. Non-Admitted Malpractice Insurance Companies: Do You Know the Difference?

There are significant differences between admitted and non-admitted malpractice insurance companies – and choosing the wrong company can put you, your reputation, and your personal assets at risk. Learn which questions to ask your insurance agent to ensure you have protection when you need it most. Learn more.
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CRNAdvocacy Alert: Join our Grassroots Efforts on HHS Pain Management Task Force

On Tuesday, Jan. 14, AANA President Garry Brydges, DNP, MBA, CRNA, ACNP-BC, FAAN, sent an email to members asking for your help with our grassroots efforts.

The Health and Human Services (HHS) Pain Management Best Practices Inter-Agency Task Force recently released a draft version of its report "Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations.”

The AANA supports the draft report’s recommendation to expand the availability of non-physician pain specialists. However, we are gravely concerned that another recommendation in the report for credentialing and training requirements limits the pathways available for non-physician practitioners, such as CRNAs, to provide interventional pain procedures.

The draft report, which is available online, is available for open comment until April 1, 2019. We urge you, your friends, and even patients to submit a comment asking HHS not to adopt these recommendations as drafted and request that the credentialing and training requirements be amended to be inclusive of all types of practitioners and their educational pathways.

Please follow these instructions to contact HHS today:
  1. Login to with your AANA username and password.
  2. You will be directed to a sample letter that you can personalize and send.
  3. Click “send letter” to have your letter posted to the comment site. Please note that all comments are public.

Non-AANA members can submit comments through the website. If you have any questions, please don’t hesitate to contact AANA Federal Government Affairs at or 202-484-8400.
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SRNAs: Apply for Student Representative to the Education Committee

The AANA Education Committee members include a student representative. The student representative facilitates the AANA Connect SRNA Community, contributes content to the AANA for SRNAs Facebook page, and writes the Student News column for the AANA NewsBulletin.

In addition, the student representative will participate in the efforts and mission of the Education Committee. The committee supports the professional development of nurse anesthesia didactic and clinical educators. Primary activities of the committee include planning the Assembly of Didactic and Clinical Educators (ADCE) meetings and the Student Session at Annual Congress. The committee also hosts the Student Luncheon and Anesthesia College Bowl at Annual Congress.

Students interested in education who wish to run for the position of Student Representative to the Education Committee can obtain an application from the AANA website under CE & Education > Education> Opportunities for Students. The application must be submitted by May 6, 2019 to The election will be held at Annual Congress.

Questions? Contact the Education department by e-mail or at 847-655-1161.
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Make a Difference by Serving Your Profession, Collaborating with Colleagues on an AANA Committee

Positions are available on AANA committees for CRNAs and student registered nurse anesthetists. Check out the committee page on the AANA website to read about the various opportunities. Deadline for committee request submissions has been extended to April 15, 2019. Please note: If you currently serve on a fiscal year 2019 committee, you must reapply for fiscal year 2020.
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Consider Nominating a Colleague for an AANA Award!

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 15th.
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NewsMakers: Nurse Anesthetists Raise More Than $10,000 for Employee Hardship Fund

For National CRNA Week, the more than 160 CRNAs at Vanderbilt University Medical Center (VUMC)'s Department of Anesthesiology raised $10,470 for the VUMC Employee Hardship Fund. The fund will be able to use those resources to provide financial assistance to colleagues across the medical center who are facing a hardship, such as sudden hospitalizations, acute illnesses, house fires, funerals and moves due to situations involving domestic violence. Read more.
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Meetings and Workshops

Now Open: Abstract Submission Process for 2020 Assembly of Didactic and Clinical Educators

You are invited to submit an abstract for consideration to present at the 2020 Assembly of Didactic and Clinical Educators (ADCE) on February 19-22, 2020, at the Chateau Elan Winery & Resort, Atlanta, Ga. The ADCE is the only forum that brings together all nurse anesthesia programs nationwide. Please visit the Call for Abstracts page on the AANA website for the Submission Guidelines and Content Questions.

The ADCE provides a variety of educational topics that will develop the maximum effectiveness of CRNAs in their roles as program administrators, didactic and clinical educators in diverse settings across the nation. Attended by hundreds of CRNAs, it is an excellent opportunity to present your best practices and research pertinent to education to your peers and nurse anesthesia students interested in becoming educators.

Build your reputation as an expert speaker while elevating your thought leadership. Get exposure to hundreds of top nurse anesthesia program decision-makers. All speakers are promoted in marketing materials that reach thousands of CRNAs and SRNAs leading up to the conference, and on the AANA website and AANA Meetings mobile app.

The ADCE goals are as follows:
  1. Provide an organized learning experience that augments the knowledge and skills of the CRNA in all educational settings.
  2. Serve as a forum to present best practices and research pertinent to nurse anesthesia didactic and clinical education.
  3. Facilitate interaction and networking between participants on a professional and social level.

Submission Deadlines and Notifications
  • Submission Deadline: April 16, 2019, at 11:59 p.m. CST.
  • Grading Deadline: May 20, 2019.
  • Notification Deadline: All presenters will be notified of their acceptance status no later than July 8, 2019.
Still have questions about the submission process after reviewing the website? Contact
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Foundation and Research

ADCE Thank You!

Thank you to all CRNAs and SRNAs who attended the Assembly of Didactic and Clinical Educators (ADCE) and supported the AANA Foundation by presenting an educational session, participating in the State of the Science poster session, attending the Concrete Cowboy event, donating or bidding on a silent auction, and/or by donating to the Foundation.

Check out this short video for a quick recap of Foundation events.
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Fellowship Applications and State of the Science General and Oral Poster Session Applications Due April 1, 2019

Apply today! Doctoral and Postdoctoral Fellowship applications are currently available on the AANA Foundation website at

The AANA Foundation’s ‘State of the Science’ General and Oral Poster Sessions will take place at the AANA 2019 Annual Congress on August 9 – 13, 2019 in Chicago, Ill. The poster application can be found on the Foundation website at under Applications and Programs.

If you have any questions, please contact the AANA Foundation at (847) 655-1170 or
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Attention Students and Program Administrators: Now Accepting Student Trustee and Student Advocate Applications

Applications are now being accepted for the AANA Foundation Student Advocate Program and Student Trustee position. To learn more and apply for the Student Trustee position, access the application on the AANA Foundation website and apply by April 1, 2019.

AANA Foundation Student Advocates serve as a liaison between the Foundation and each Advocate's nurse anesthesia program. Benefits include mentoring, networking, and professional development opportunities. Consider applying to be a Student Advocate for the AANA Foundation. View the list of current student advocates and apply by March 31, 2019, if there is not a current advocate in your program.

Questions, contact the Foundation at (847) 655-1170 or
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Call for Board of Trustees: Application Deadline - April 1, 2019

The mission of the AANA Foundation is to advance the science of anesthesia through education and research. The Foundation is currently looking for a candidate interested in playing an active role in supporting the CRNA profession by participating on the AANA Foundation Board of Trustees. The ideal candidate enjoys fundraising and possesses expertise in research.

Criteria for Board Members:
  • Must be a current CRNA and AANA member in good standing
  • Must be a supporter of the AANA Foundation of time, talent and treasure
  • Must be willing to advocate for the AANA Foundation
  • Must have a Foundation giving history
  • Must have a history of volunteerism
  • Term is for two years (September – August)
To apply, complete an application and nominee form and submit along with your CV and a cover letter describing why you wish to be an AANA Foundation Board member.

If you have any questions, please contact the Foundation at (847) 655-1170 or
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AANA Member Benefits

Guidelines for First-Time Homebuyers

Few experiences are more exciting or rewarding than purchasing a new home for the first time. However, the process can be more complex than it may seem. Anticipating and addressing key issues directly can make the buying experience easier and more enjoyable. Learn more.

March First Time Homebuyers
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CRNA: Medical Center Endoscopy, Houston, Texas

Surgery Partners/Anesthesia Company of Houston is currently seeking a CRNA to work 1099 at our GI center in Houston. We need an experienced endoscopy CRNA who can and has worked independently in a fast-paced environment Monday-Friday. Surgery Partners is an industry leader in managing, developing and acquiring single and multi-specialty ambulatory surgical centers. Through our portfolio of companies, Surgery Partners is committed to providing the healthcare industry with a wide breadth of innovative solutions that improve care, costs, outcomes and access. Learn more.
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CRNA Full Time: Cleveland Clinic Akron General, Akron, Ohio

CRNA sign-on bonus! Cleveland Clinic Akron General seeking full-time CRNAs. Administers anesthetic care for the purpose of facilitating diagnostic, therapeutic and surgical procedures. Learn more.
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Chief Learning Officer: AANA, Park Ridge, Illinois

The AANA is recruiting for a gifted Chief Learning Officer. To be successful in this role, you must be chameleon-like with the ability to lead AANA's learning platform and staff into the future of education learning methods. This person must have an entrepreneurial spirit, and he/she will be empowered to be disruptive and visionary. The new mantra for the AANA is "experiment, fail, learn, and repeat," and we'll need someone comfortable working in that kind of environment. Learn more.
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Senior Director of Practice Management: AANA, Park Ridge, Illinois

The AANA is recruiting for a gifted Senior Director of Practice Management. This person must have an energetic personality, knowledge of the changing healthcare landscape, and passion to lead and move the organization forward. The new mantra for the AANA is “experiment, fail, learn, and repeat,” and the Senior Director of Practice Management needs to be comfortable working in that kind of environment. All staff is expected to foster a workplace culture that promotes divergent thinking, openness, respect, trust and the desire to be epic. 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.

Ropivacaine, Fentanyl Combo Better Than Bupivacaine Combo for Labor Analgesia

Researchers recruited 60 laboring women to help them compare outcomes from two different approaches to epidural analgesia. Half of the participants were randomized to ropivacaine and half to bupivacaine, each with fentanyl as a bolus. Importantly, neither of the local anesthetics resulted in motor blockade, which the study authors said may explain the similar mode of delivery. However, they did find that ropivacaine plus fentanyl achieved sensory block in 5.67 minutes, one whole minute faster than the bupivacaine-fentanyl combination. As far as the other endpoints observed, ropivacaine and bupivacaine both were effective and safe for mother and baby, with comparable obstetric outcomes. The findings appear in the Indian Journal of Anaesthesiology.

From "Ropivacaine, Fentanyl Combo Better Than Bupivacaine Combo for Labor Analgesia"
Specialty Medical Dialogues (03/08/19) Singh, Vinay

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Suprascapular Nerve Block Yielded Better Early Results vs Subacromial Injection for Rotator Cuff Tears

According to new findings, better outcomes are evident in patients whose symptomatic rotator cuff tears are treated with suprascapular nerve block as compared to subacromial injection. The Australian study randomized 21 participants to the former intervention and 22 to the latter. Shoulder function and pain scores were the primary and secondary outcomes, respectively. Despite little between-group difference at early intervals, shoulder function according to the modified Constant-Murley score and VAS pain scores both were significantly better in the nerve block group at 12 weeks. "Suprascapular nerve block is superior to subacromial injection for restoring function and providing pain relief in patients with rotator cuff tears," said investigator Joseph Coory, MBBS. He and colleagues reported the study results in the Journal of Shoulder and Elbow Surgery.

From "Suprascapular Nerve Block Yielded Better Early Results vs Subacromial Injection for Rotator Cuff Tears"
Healio (03/05/2019) Tingle, Casey

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Pupillary Pain Index Changes After a Standardized Bolus of Alfentanil Under Sevoflurane Anesthesia

French and U.S. researchers conducted a prospective pilot study to evaluate the pupillary pain index (PPI), a new tool for gauging interoperative analgesia. With PPI, a low level of pupillary response to increasingly intense electric stimuli signifies a high level of analgesia, while a high level of pupillary reactivity denotes a low level of analgesia. To test this relationship, investigators examined PPI changes after a bolus of 10 µg·kg-1 of alfentanil in 20 healthy children having elective surgery under general anesthesia. After anesthesia induction with sevoflurane and propofol, an initial measurement was taken, followed by the alfentanil bolus and a second measurement two minutes after that. The results indicated that PPI declined significantly after alfentanil administration, reflecting an inverse relationship with level of analgesia. Based on heart rate, blood pressure, and bispectral index readings, meanwhile, PPI measurement had no clinical or hemodynamic nociceptive response. The study authors believe that PPI could be used to inform individualized opioid administration choices before nociceptive stimuli under general anesthesia.

From "Pupillary Pain Index Changes After a Standardized Bolus of Alfentanil Under Sevoflurane Anesthesia"
Anesthesia & Analgesia (03/19) Vol. 128, No. 3, P. 467 Sabourdin, Nada; Diarra, Coumba; Wolk, Risa; et al.

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Study: Opioid Prescribing and Minority Patients

New evidence finds that minority patients undergoing emergency department (ED) care for long-bone fractures typically receive less potent analgesia, although they receive prescription opioids at the same or a greater rate than their white counterparts. Investigators reviewed electronic health records at a single, large health care system in Northern California, from which they flagged 5,719 adults who were treated by 369 ED providers for long-bone fracture. The likelihood of receiving opioids at discharge was about the same across racial lines, although a little higher for Hispanics. Slightly more than 70% of Hispanics received opioids, compared with 64% of whites, 65% of Asians, and 66% of blacks. Among all patients receiving narcotic analgesics, however, non-whites tended to receive fewer total morphine milligram equivalent (MME) units. On average, white patients were prescribed 132.3 MME versus 122.6 for Hispanic patients, 118.6 for African-American patients, and 109.4 for Asian patients. "In order to address the opioid epidemic, it is vital that we understand current prescribing practices, and whether there exist implicit biases among providers who prescribe these drugs," says researcher Alice Pressman, PhD, who led the retrospective analysis. The results were shared at the American Academy of Pain Medicine meeting.

From "Study: Opioid Prescribing and Minority Patients"
MedPage Today (03/09/19) George, Judy

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Resistance-Sensing Needle Helps Improve Injection Accuracy

Researchers have improved on the common syringe which, absent live imaging or sensing systems, depends on anatomical landmarks and other blind insertion techniques to deliver injections to the target area. These imprecise methods can be problematic when smaller areas, such as the suprachoroidal space, are involved. In response, the team from Harvard's Brigham and Women's Hospital designed a new type of mechanical injector that recognizes loss of resistance. Once the needle reaches the targeted cavity space, the I2T2 device senses the reduced resistance, stops advancing the needle, and releases the payload. In animal testing, I2T2 demonstrated reliable injection accuracy without additional training. The developers believe the new injector could also be applied to the epidural space around the spinal cord, the peritoneal space in the abdomen, and subcutaneous tissue between the skin and muscles. Studies to demonstrate safety and efficacy in pre-clinical disease models represent the next step toward human use of I2T2.

From "Resistance-Sensing Needle Helps Improve Injection Accuracy"
MedGadget (03/11/19) O'Reilly, Mark

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Virtual Reality Hypnosis Cuts Post-Op Pain, Anxiety in Kids

While research shows that hypnosis and virtual reality can calm anxiety and chronic pain, new evidence suggests that it also may benefit patients in the setting of acute pain. Anesthesia providers at University of Texas Southwestern Medical Center and Hopitaux Universitaires de Strasbourg in France teamed up for the project, which focused on the pediatric population. Investigators examined outcomes in 21 children undergoing scoliosis surgery. All of the children received standard postoperative pain management, but 10 also received virtual reality hypnosis. At 72 hours postoperatively, morphine consumption in the intervention group was only about half that of the control group. In addition, these patients needed substantially less anti-anxiety medication, suffered less vomiting, had their urinary catheters removed sooner, and were able to get up more quickly. The study was presented at Anesthesiology 2018.

From "Virtual Reality Hypnosis Cuts Post-Op Pain, Anxiety in Kids"
Medscape (03/05/19) Yasgur, Batya Swift

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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
March 14, 2019