Anesthesia E-ssential

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Vital Signs


Coming Soon
CPC Program 2-Year Check-in Starts April 3

The next step in the CPC Program is just around the corner, as the 2-year Check-in window opens April 3. CRNAs who recertified or originally certified in 2016 can complete this simple and quick online process in about 10 minutes. 
 
The 2-year Check-in is the mid-point requirement in the 4-year CPC Program cycle, where CRNAs will:
 
  • Confirm current licensure and practice.
  • Update contact information so you can be reached with important certification information.
  • Check CPC Program compliance progress to make continuing education plans for the next two years. Class A or B credits and Core Modules are not required at the Check-in. 
  • Pay the CPC fee for your upcoming two years ($110 – the same amount and timing as in the past).
 
The first 2-year Check-in window will be open through July 31, 2018.
 
Watch for the opening email announcement on April 3 with a link to the NBCRNA portal. Find a 2-year Check-in deadline chart, FAQs, videos, and more at www.nbcrna.com/2YCI.
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Hot Topics


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 committee request submissions is May 15, 2018. Please note: If you currently serve on a fiscal year 2018 committee, you must reapply for fiscal year 2019. 
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CDC: Emergency Department Data Signal Worsening Opioid Epidemic

The Centers for Disease Control and Prevention (CDC) has released data from hospital emergency rooms that show substantial increases in the number of opioid overdose visits nationwide.  CDC’s latest Vital Signs report found that in just over a year, emergency department visits for suspected opioid overdoses increased 30 percent in all parts of the U.S. The most dramatic increase was in the Midwest, which saw a 70 percent jump in opioid overdoses.  Read the full report.
 
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Kelley R. Gardner Recognized by Professional Organization of Women of Excellence

Kelley Gardner, MS, CRNA, has been honored as a VIP Member for 2018 by the Professional Organization of Women of Excellence Recognized (POWER) for her outstanding contributions and achievements for nearly 25 years in the healthcare field.

Gardner is owner and CEO of Kelley Gardner, CRNA, Inc., and works as an anesthesia services contractor in northern California. She coordinates CRNA groups delivering high risk anesthesia in Sacramento, specializing in obstetrics, high risk obstetrical anesthesia and general anesthesia.

She also volunteers her anesthesia skills for medical missions in Haiti. She earned her BSN from the University of Utah School of Nursing in 1984. She worked as a trauma ER nurse, then earned her MS in nurse anesthesia from the Abbott Northwestern School of Nurse Anesthesia in 1991. In her spare time she enjoys snow skiing, golfing, watercolor painting and sporting clay.
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Meetings and Workshops


Register Now for Mid-Year Assembly: Early Bird Rates Expire Soon

Still haven't registered for the 2018 Mid-Year Assembly? Network with hundreds of your peers from across the nation, all while building your advocacy skills and healthcare policy understanding - and have fun doing it! Don't wait! Register by Wednesday, March 21, to save $100.
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Foundation and Research


AANA Foundation Fellowship and Grant Applications Now Available, Due May 1

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. Postdoctoral and Doctoral Fellowship Applicationsand Grant Applications are available on the AANA Foundation website and are due May 1, 2018.
 
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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.

Phrenic Nerve Infiltration vs SNB for Acute Ipsilateral Shoulder Pain

Researchers suspect the phrenic nerve may serve as a pathway for ipsilateral shoulder pain and, therefore, may have a role in calming associated pain. Because ipsilateral shoulder pain can develop after thoracic surgery, they built their study around 135 lung cancer patients scheduled for the procedure. Participants were randomized equally into three treatment arms: one receiving phrenic nerve infiltration during surgery, another receiving suprascapular nerve block (SNB) preoperatively, and a control group receiving thoracic epidural with general anesthesia. Postoperative ipsilateral shoulder pain occurred in 66.75 percent of the control patients and 64.40 percent of the SNB recipients but in only 15.60 percent of the phrenic nerve infiltration patients. Visual analog score of ipsilateral shoulder pain, rescue therapy with ketorolac for breakthrough shoulder pain, and peak expiratory flow rate—measured every six hours for the first two postoperative days—were all significantly lower with phrenic nerve infiltration than with the other approaches. The technique is "more effective than preoperative, ultrasound-guided SNB as regards the management of acute post-thoracotomy [ipsilateral shoulder pain]," according to the investigators, who report in the Journal of the Egyptian National Cancer Institute. "In spite of its depressing effect in postoperative [peak expiratory flow rate] values, [phrenic nerve infiltration] is considered clinically safe in terms of maintaining postoperative respiratory function."

From "Phrenic Nerve Infiltration vs SNB for Acute Ipsilateral Shoulder Pain"
Clinical Pain Advisor (03/12/18) Rice, Tyler

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The Effect of Pre-operative Gastric Ultrasound Examination on the Choice of General Anesthetic Induction Technique for Non-elective Pediatric Surgery

French researchers evaluated noninvasive gastric ultrasound as a tool in guiding choice of anesthesia induction technique, especially in patients undergoing nonelective surgery. Pulmonary aspiration of gastric contents is a major concern during general anesthesia, but emergency procedures may not allow enough time for a patient's stomach to empty. Knowing which patients are at risk is important, prompting investigators to evaluate the utility of gastric ultrasound for this purpose. They designed a prospective cohort study involving 143 pediatric patients. Gastric ultrasound was performed on 130 of them. In 67 cases, the results prompted providers to change the planned induction approach from routine to rapid sequence or vice versa. Ultimately, an appropriate decision was made for 85 percent of children who underwent gastric ultrasound compared with about half of the kids whose induction technique was selected based only on a preoperative clinical assessment. According to the team, the finding points to gastric ultrasound as a useful tool for choosing general anesthetic induction technique with respect to the risk of pulmonary aspiration.

From "The Effect of Pre-operative Gastric Ultrasound Examination on the Choice of General Anesthetic Induction Technique for Non-elective Pediatric Surgery"
Anaesthesia (03/01/18) Vol. 73, No. 3, P. 304 Gagey, A.-C.; de Queiroz Siqueira, M.; Monard, C.; et al.

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Awake Versus Asleep Craniotomy: A Cost Comparison and Analysis

Researchers at the Moffitt Cancer Center in Tampa compared the costs associated with awake craniotomies at their facility with the cost of all craniotomies across Florida. The awake approach—which uses an anesthetic agent to deliver an appropriate level of sedation to keep the patient alert, comfortable, and able to respond to commands—is growing in popularity, with previous work drawing a correlation between the technique and favorable outcomes. The retrospective review included 74 awake craniotomies at Moffitt from July 2013 to February 2015 and nearly 3,200 craniotomies performed across Florida from April 2015 to March 2016, as identified on floridahealthfinder.gov. Analysis showed that awake craniotomies at Moffitt significantly reduced length of stay and lowered costs compared with all craniotomies performed in the state. At Moffitt, patients stayed an average of two days and incurred a minimum cost of $35,255 and a maximum cost of $82,171. In contrast, patients who underwent standard procedures elsewhere in the state stayed in the hospital for 8.3 days on average and incurred a minimum of $78,260 and a maximum of $193,190 in costs. The findings, researchers contend, underscore the viability of the awake anesthetic technique as a safe and low-cost solution for craniotomy.

From "Awake Versus Asleep Craniotomy: A Cost Comparison and Analysis"
Anesthesiology News (03/12/18) Ackerman, Robert S.; Tufts, Christopher W.; Garcia Getting, Rosemarie E.; et al.

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Preoperative Factors Were Predictors of Chronic Pain After Hip Arthroscopy for FAI

Researchers say older age and any of a number of other preoperative factors can explain chronic pain or symptoms that linger two years after arthroscopy for femoroacetabular impingement (FAI). Led by Austin Stone, MD, PhD, the researchers compared 174 patients with persistent FAI pain against a control group of FAI patients who had similar characteristics but did not experience persistent pain. "So, what we found was independent predictors of postoperative pain included current smoking and a mental health history of anxiety and depression. Protective factors included running and high-level athletic participation," said Stone, reporting at the American Academy of Orthopaedic Surgeons annual meeting. Participants with mental health issues, for example, were nearly three times as likely to present with persistent pain following arthroscopy for FAI, according to Stone. "We know that athletes are motivated to return to sport . we know that motivation and expectations have effects on pain," he said. "These are adversely affected by mental health in the setting of FAI. It is also documented elsewhere in the literature."

From "Preoperative Factors Were Predictors of Chronic Pain After Hip Arthroscopy for FAI"
Healio (03/08/2018) Rapp, Susan M.

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Oliceridine Yielded Clinically Meaningful Pain Relief vs Placebo After Bunionectomy

Oliceridine alleviates bunionectomy-related pain significantly compared with placebo, according to new research. For the study, investigators randomized participants to one of five treatment arms: placebo, morphine, or one of three oliceridine regimens. Pain intensity levels were measured at various intervals, and adverse events were documented. Patients whose pain intensity improved at least 30 percent from baseline to 48 hours postoperatively, who received no rescue medication, and who did not reach the dosing limit within the first 12 hours after surgery were considered treatment responders. The share of responders was significantly greater in the intervention group than in the placebo group, said primary investigator Peter Whang, MD, who presented the findings at the annual meeting of the American Academy of Orthopaedic Surgeons.

From "Oliceridine Yielded Clinically Meaningful Pain Relief vs Placebo After Bunionectomy"
Healio (03/07/2018) Tingle, Casey

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Effects of Opioid vs. Nonopioid Medications on Osteoarthritis Pain-Related Function

A recent study compared the use of opioid medication and nonopioid medication for the treatment of patients with chronic back pain or osteoarthritis pain. The 12-month study randomized 240 individuals recruited from Veterans Affairs primary care clinics; eligible patients had moderate to severe chronic back pain or osteoarthritis pain in the knee or hip despite analgesic use. The researchers found, however, that the two groups did not differ significantly on pain-related function—the primary outcome—over 12 months. Pain intensity was significantly better in the nonopioid group over the course of the study. Additionally, the investigators observed that adverse medication-related symptoms were more common in the opioid group. Based on the findings, the authors conclude: "Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain."

From "Effects of Opioid vs. Nonopioid Medications on Osteoarthritis Pain-Related Function"
Journal of the American Medical Association (03/06/18) Vol. 319, No. 9 Krebs, Erin E.; Gravely, Amy; Nugent, Sean

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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.

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March 15, 2018
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