Register Now for Nurse Anesthesia Annual Congress
Join us Sept. 8-12, 2017, in Seattle, for nurse anesthesia’s premier educational, professional, and social event! Registration is now open.
At the Annual Congress, you’ll hear the finest speakers, receive the most meaningful education, and have the opportunity to network with CRNAs and SRNAs from around the country. Here are just a few highlights that attendees can look forward to this year:
- Enhanced educational tracks, including a new Business of Anesthesia and the Fundamentals of Practice Management Track
- Sessions that focus on timely topics such as the opioid crisis and enhanced recovery after surgery
- A new welcome reception to kick off the Annual Congress
- A celebration of Agatha Hodgins’ 140th birthday and long-lasting legacy
Look for the 2017 Nurse Anesthesia Annual Congress preliminary schedule with your copy of the April issue of the AANA Journal.
AANA Announces New Corporate Partner
The AANA is pleased to announce that AbbVie has joined the AANA’s Corporate Partnership Program at the Premier Level to “support continuing education and practice excellence" for AANA members.
Headquartered in North Chicago, Ill., AbbVie is a global, research-based biopharmaceutical company formed in 2013 following separation from Abbott Laboratories. The company's mission is to use its expertise, dedicated people, and unique approach to innovation to develop and market advanced therapies that address some of the world's most complex and serious diseases. Together with its wholly-owned subsidiary, Pharmacyclics, AbbVie employs approximately 29,000 people worldwide and markets medicines in more than 170 countries.
Among the drugs AbbVie manufactures, markets, and/or distributes in the United States are the anesthesia drugs ULTANE® (sevoflurane), NIMBEX® (cisatracurium besylate), and MIVACRON® (mivacurium chloride).
- ULTANE® is a fast-acting inhalation for the induction and maintenance of general anesthesia.
- NIMBEX® is an intermediate-onset/intermediate-duration neuromuscular blocking agent indicated for inpatients and outpatients as an adjunct to general anesthesia, to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation in the ICU.
- MIVACRON® injection is a short-acting neuromuscular blocking agent indicated for inpatients and outpatients, as an adjunct to general anesthesia, to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
See www.abbvie.com for more information.
Other AANA Corporate Partners include: Edwards Lifesciences, Medtronic, PharMEDium, and Merck.
AANA Seeks to Record CRNA Service in Vietnam
For most veterans of the Vietnam War who returned home alive to the United States, life would never be the same. They had seen the atrocities of war, had lost comrades and friends, and, in some cases, had been on the receiving end of jeers, spitting, and violence as they returned home. For some, there was great psychological turmoil to reconcile. For others, physical wounds required care and healing. And still others were fortunate to escape the ravages of war's mental, emotional, or physical aftermath.
The American Association of Nurse Anesthetists (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. See submission guidelines see: Vietnam Voices.
Anesthesia Workforce Summit Connects Anesthesia Professionals, Management Company Leaders
The AANA Board of Directors convened a Future of Anesthesia Workforce Summit with representatives from eight large anesthesia employers on February 21, 2017. The summit brought together CRNAs, anesthesiologists, and talent acquisition professionals to discuss areas of shared interest such as optimizing CRNA practice, quality, reimbursement, engagement, and leadership contributions. Participants identified topics for further collaboration and set goals for consideration at a second summit to be scheduled in the near future. Look for a full report on the Anesthesia Workforce Summit in the May issue of the AANA NewsBulletin.
Duke University Offers Postdoctoral Fellowship Program in Health Services Research
Join Duke's experienced investigators for a unique one- to two-year postdoctoral training program focused on health services research relevant to Certified Registered Nurse Anesthetists (CRNAs). Postdoctoral appointment is for one year beginning in fall of 2017 with potential for a second year. Stipends are provided for the fellowship. Application deadline is April 15, 2017. For more information about this opportunity, read the announcement, and visit the Duke University School of Nursing Postdoc Website to access the application form and possible research topics. Visit the AANA Research website for information about additional opportunities.
Want to Serve 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 submission of a committee request is May 15, 2017. Please note: If you currently serve on a fiscal year 2017 committee, you must reapply for fiscal year 2018.
Foundation and Research
AANA Foundation Research Grant Applications Due May 1
One of the goals of the AANA Foundation is to support new and seasoned investigators in nurse anesthesia through grants and fellowships. Spring Research Grant applications are currently available on the AANA Foundation website at AANA Foundation. The AANA Foundation sets a broad research agenda that includes the following areas:
- Healthcare policy
- Science of anesthesia
General research grants are awarded to AANA member CRNAs in good standing. Research funding priorities change annually.
If you have any questions, please contact the AANA Foundation at (847) 655-1170 or firstname.lastname@example.org.
“State of the Science” Oral and General Poster Presentation
“State of the Science” offers an opportunity for CRNAs and SRNAs to present their research findings and innovative educational approaches at the AANA Nurse Anesthesia Annual Congress in Seattle, Sept. 8-12.
Research, literature reviews, and innovative, creative techniques in anesthesia are appropriate topics.
- Oral Poster Presentation – April 1 Deadline – An award of up to $1,000 accompanies oral presentation
- General Poster Presentation – May 1 Deadline
If you have any questions, please contact the AANA Foundation at (847) 655-1170 or email@example.com.
Support the AANA Foundation: Shop AmazonSmile
You can easily support the AANA Foundation every time you make a purchase on Amazon. When you shop at AmazonSmile, Amazon donates 0.5 percent of the purchase price to the AANA Foundation. Support the Foundation while you shop!
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Featured Career Opportunity
CRNA Opportunity – Anesthesia Associates of Southern Illinois
Anesthesia Associates of Southern Illinois is expanding to new locations and we are seeking additional CRNAs for our growing group. Our locations are eligible for Federal Student Loan Repayment!
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.
Novel Anesthetic Combination Shows Promise for Medialization Thyroplasty
For operations to repair unilateral vocal cord paralysis, Mayo Clinic researchers report on a technique that achieves a delicate balance between providing adequate sedation and enabling the awake patient to communicate verbally. In a retrospective case series describing 40 medialization thyroplasty cases, all patients underwent dexmedetomidine and remifentanil infusions; and all but one also received continuous propofol infusion. At times during the surgery when patient interaction was required, dexmedetomidine and propofol delivery was suspended and patients were temporarily maintained on low-dose remifentanil alone. "The authors describe a novel cocktail of three common intravenous sedation agents, each with advantages and potential risks," summarized Denise Wedel, MD, an anesthesiology professor at the Mayo Clinic. "The combination of these agents provided the required state of sedation without apparent additional perioperative risk. This novel approach could potentially improve patient comfort and safety during anesthetic management of thyroplasty techniques using commonly available sedation infusions." The findings were presented at the 70th PostGraduate Assembly in Anesthesia.
From "Novel Anesthetic Combination Shows Promise for Medialization Thyroplasty"
Anesthesiology News (03/10/17) Covey, Ethan
Pregnant ALS Woman Delivers Baby After Total IV Anesthesia Without Muscle Relaxant
"The choice of anesthesia type [in pregnant women with amyotrophic lateral sclerosis (ALS)] undergoing cesarean section is controversial," acknowledge Chinese researchers, in announcing what they say is a medical breakthrough in this area. Their case report, published in the Journal of Clinical Anesthesia, describes a 27-year-old patient in the 35th week of gestation who had been diagnosed with the condition 20 months prior. Upon admission to Xuan Wu Hospital in Beijing, she presented with slurred speech, motor atrophy and weakness, muscle stiffness and hyperreflexia in the arms and legs, and limited vital and total lung capacity. Despite these challenges, the woman successfully delivered her baby after receiving total intravenous anesthesia (TIVA) without muscle relaxant. According to the researchers, this approach helped prevent prolonged ventilation and respiratory complications in the mother—who was discharged five days after delivery. "This case report introduced a successful TIVA without muscle relaxant for a [pregnant woman] with ALS to prevent maternal complications during cesarean section," they wrote, adding that additional studies are needed to confirm the efficacy of this approach. ALS is rare, however, and even more so during the childbearing years.
From "Pregnant ALS Woman Delivers Baby After Total IV Anesthesia Without Muscle Relaxant"
ALS News Today (03/09/17) Fernandes, Joana
Updated Surgical Site Infection Guidelines Include Patient Warming and Supplemental Oxygen
Anesthesia providers play an important role in helping to prevent surgical site infection (SSI), according to revised guidelines. Diligence on their part can avoid conditions that are conducive to SSI—including insufficient warming of patients, which can lead to intraoperative hyperthermia; and improper timing of antibiotic administration before surgery, which can cause unfavorable outcomes. Getting more oxygen to the tissues in order to maintain cellular function and help wounds fight off infection is also critical; therefore, the anesthesia team is also tasked with providing supplemental oxygen postoperatively. The SSI document, published in the Journal of the American College of Surgeons, recommends administering oxygen at 80 percent for four hours in the PACU [post-anesthesia care unit]. "The problem," according to co-author Therese Duane, MD, "is that many patients do not stay in the PACU for a full four hours." Anesthesia providers additionally can help lower SSI rates by refraining from repeatedly going in and out of the operating room. "The less traffic the better," remarks Duane. "Every time you open that door, contaminants can come in."
From "Updated Surgical Site Infection Guidelines Include Patient Warming and Supplemental Oxygen"
Anesthesiology News (03/08/17) Kronemyer, Bob
Dose of Bupivacaine in Spinal-Epidural Analgesia for External Cephalic Version Does Not Affect Success
Contrary to previous thought, a new study concludes that success of spinal-epidural analgesia for external cephalic version is not impacted by how much local anesthetic is used. Earlier nonrandomized trials and meta-analyses have suggested that higher doses improve success rates for the procedure, which is used to shift a breech baby into proper position for vaginal birth. In the first randomized controlled trial of its kind, however, a team led by anesthesiology instructor Laurie Chalifoux, MD, of Northwestern University recruited 229 pregnant women. In addition to receiving 15 mcg of fentanyl, participants were randomly assigned to receive one of four different doses of intrathecal bupivacaine. Based on the prior evidence, the investigators believed the higher doses would produce better outcomes. Not only did that prove untrue, but escalating amounts of anesthetic had some negative associations. "Escalating neuroaxial local anesthetic dose, with resultant greater block density, does not alter external cephalic version rate or reduce the cesarean delivery rate," Chalifoux reports. "However, it does marginally improve pain scores and result in hypotension and vasopressor administration, as well as significantly increased length of stay."
From "Dose of Bupivacaine in Spinal-Epidural Analgesia for External Cephalic Version Does Not Affect Success"
Pharmacy Practice News (03/07/17) Vlessides, Michael
Non-Opioid Analgesics in Adults After Major Surgery
Morphine is a powerful pain-control medium following surgery; however, its side effects and other limitations have driven a trend toward balanced analgesia, which uses weaker opioids or non-opioid alternatives to offset the morphine requirement. A number of analgesics other than morphine (AOM) can be used to help manage postoperative pain, but it has yet to be determined which of these options is safest and most effective. To investigate, researchers performed a systematic review and network meta-analysis of randomized trials that compared 14 AOMs alone or in combination against another AOM or placebo. The 135 studies included for review involved more than 13,000 adults who underwent major surgery and received patient-controlled analgesia with morphine. The evidence suggested that acetaminophen combined with a nonsteroidal anti-inflammatory drug (NSAID) or nefopam was superior to most single AOMs in curtailing morphine consumption. The most effective AOMs used alone were a-2 agonists, NSAIDs, and COX-2 inhibitors; and the least effective were tramadol and acetaminophen. Insufficient data on severe side effects, however, prevented investigators from assessing efficacy-safety balance.
From "Non-Opioid Analgesics in Adults After Major Surgery"
British Journal of Anaesthesia (03/01/2017) Vol. 118, No. 1, P. 22 Martinez, V.; Beloeil, H.; Marret, E.; et al.
Nurse 'Champions' Linked to Better Neonatal Pain Monitoring
Newborns need to be more thoroughly monitored for continuous pain, report researchers, noting that babies are more likely to receive this kind of attention in neonatal intensive care units (NICUs) manned by nursing "champions." NICUs with higher surgical admissions and with local pain management guidelines in place also are more diligent about assessing continuous pain in new arrivals, the investigators wrote in Acta Paediatrica. The team—colleagues in the EUROPAIN survey working group of the NeoOpioid Consortium—analyzed nearly 250 NICU patients in 18 countries across Europe, documenting frequency of pain assessments; mechanical ventilation use; and sedation, analgesia, or neuromuscular blockade for up to 28 days following admission to the unit. Of 6,648 neonates studied, not even a third were evaluated for prolonged, continuous pain and only slightly more than 10 percent were checked on a daily basis. "In the absence of frequent assessments, I'm concerned that many babies may be undertreated or over-treated for painful conditions," remarked lead study author Kanwaljeet Anand, MD, of Stanford University School of Medicine.
From "Nurse 'Champions' Linked to Better Neonatal Pain Monitoring"
Nursing Times (United Kingdom) (03/07/17) Ford, Steve
Innovative Treatment Offers Relief to Children With Frequent Migraine Headaches
Sphenopalatine ganglion (SPG) block, already shown to treat adult migraines, appears to also be a safe and effective option for younger migraine sufferers. The minimally invasive technique delivers local anesthetic through small nasal catheters to a bundle of nerves implicated in headache pain. Blocking of these nerves—which are collectively known as the SPG—occurs almost instantaneously, potentially fending off headache pain for months. A study at Phoenix Children's Hospital tested the approach on 200 patients aged 7 to 18 years old. Just 10 minutes after treatment, participants reported pain scores that were down from before the block was performed—by an average of more than two points on a scale of 1 to 10. "While it isn't a cure for migraines, this treatment has the potential to really improve the quality of life for many children," said study co-author Robin Kaye, MD, noting that it avoids medications with serious side effects as well as intravenous therapies that may require hospitalization. SPG block is only recommended, however, for pediatric patients who have not benefited from first-line interventions.
From "Innovative Treatment Offers Relief to Children With Frequent Migraine Headaches"
Science Daily (03/06/2017)
Aspirin May Improve Perineal Pain After Episiotomy
New mothers often suffer from acute perineal pain following vaginal childbirth, but evidence suggests some may be able get relief from single-dose aspirin. A systematic review examined its efficacy in participants who experienced perineal pain after having an episiotomy; none were breastfeeding. The data, extracted from 17 randomized controlled trials including more than 1,100 women, showed that those given a single dose of aspirin were more likely to report sufficient pain relief after four to eight hours than those who received placebo. While adverse events occurred at a similar rate for both sets of women, aspirin use was also associated with reduced need for additional analgesia compared with placebo. "Current research has focused on women with post-episiotomy pain," the researchers wrote in Cochrane Database of Systematic Reviews. "Future [randomized controlled trials] could be extended to women with perineal pain associated with spontaneous tears or operative birth." They emphasized, however, that their findings are applicable only to new mothers who are not nursing their infants.
From "Aspirin May Improve Perineal Pain After Episiotomy"
Clinical Pain Advisor (03/06/17) Wong, Crystal
New Type of Opioid Targets Pain Areas, Directly Avoiding Negative Side Effects
Animal studies in Germany offer early evidence that a new type of opioid can block pain without the usual side effects associated with this class of drug. Adverse effects occur when opioids bind to parts of the body that are not targeted, such as constipation due to gastrointestinal binding or addiction caused by binding to nerve cells in the brain. Purposefully, the researchers developed NFEPP to bind only with nerve receptors that thrive in acidic environments—which typically are those that experience inflammation and are often the source of pain. Testing indicated that NFEPP was as effective as fentanyl in alleviating pain in laboratory rats but without constipation, addiction, respiratory problems, increased heart rate, or changes in blood oxygen levels. If the drug eventually is shown to work the same way in humans, it could represent a huge breakthrough in pain relief and management. The investigators, hailing from the Free University of Berlin and Zuse-Institut Berlin, report their findings in Science.
From "New Type of Opioid Targets Pain Areas, Directly Avoiding Negative Side Effects"
Medical Xpress (03/03/17) Yirka, Bob
Psychosocial Factors Predict Analgesic Response to Morphine
Psychosocial state of mind predicts analgesic response to morphine in patients with low back pain, according to new research. Investigators enrolled 89 patients in the study, which compared intensity of low back pain in participants before and after treatment with either a placebo or intravenous naloxone or morphine. The McGill Pain Questionnaire-Short Form was used to evaluate pain; while the Trait Anger Scale, Pain Catastrophizing Scale, Pain Disability Index, and other tools rated psychosocial factors like depression and anxiety. The findings present a positive correlation between morphine analgesic response and most psychosocial factors. "Results suggest that psychosocial factors predict elevated analgesic responses to opioid-based medications, and may serve as markers to identify individuals who benefit most from opioid therapy," the researchers wrote in the March issue of Pain.
From "Psychosocial Factors Predict Analgesic Response to Morphine"
Clinical Pain Advisor (03/03/17) Rodriguez, Tori
Is There an Ideal Dosage of Popular Sedation Drugs?
Deep sedation is not always necessary for invasive dental procedures, a study out of Japan's Showa University has found. The objective of the research was to determine an optimal dosage of midazolam and propofol—two common sedation agents—that satisfies both dentists and their patients while also reducing the likelihood of adverse effects. Dosage is critical because too much sedation can allow for involuntary movement in the patient, but too little might allow patient recall of the surgery. In hopes of identifying just the right amount, investigators enrolled 1,000 adult patients needing dental work done under intravenous sedation. An anesthesia provider started each procedure with 1 mg of midazolam, adding another 1 mg every minute until the patient's eyes drooped or speech slurred. Propofol was then used to maintain sedation. The dentist and patients both completed surveys afterwards—the former to rate the ease of the surgery and patient compliance, and the latter to gauge their comfort and intraoperative memory. According to the results, 3 mg of midazolam and 3 mg/kg per hour of propofol appeared to produce the greatest patient and doctor satisfaction. Although a relatively low dosage, there were no known adverse events in the large study sample. "Deep sedation may not be needed even for invasive procedures, such as third molar extractions," Rikuo Masuda, DDS, and colleagues wrote in PLOS One. For the best outcomes, they added, sedation doses should be selected on a case-by-case basis.
From "Is There an Ideal Dosage of Popular Sedation Drugs?"
Dr. Biscupid (02/23/17) Pablos, Theresa
The Zen of Laughing Gas
Nitrous oxide, commonly known as laughing gas, is often used to calm pediatric patients during dental care; but new research indicates that the approach works better with some children than others. University of Washington investigators reported in Anesthesia Progress on their observations of behavior and sedation in 48 dental patients aged three to eight years old. Among uncooperative participants, laughing gas was more effective with those who scored high in the temperament category of "effortful control," characterized by strong task-based focus and the ability to inhibit negative reactions. Pediatric patients who cannot focus, the study concluded, may be better suited for oral sedation or general anesthesia during dental procedures.
From "The Zen of Laughing Gas"
Bite Magazine (02/17)
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Anesthesia E-ssential is an executive summary of noteworthy articles of interest to nurse anesthetists. It is distributed bimonthly to AANA members.
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