Anesthesia E-ssential

AANA Anesthesia E-ssential, March 29, 2018
AANA Member Advantage Program

Hot Topics

Celebrating Diversity Month with "I AM ME" Campaign

April is Celebrate Diversity Month, and the American Association of Nurse Anesthetists (AANA) is observing this month with the “I AM ME” campaign. We are asking Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs) to send a photo and 1-3 sentences about what makes you, you! Our goal is to post a different personalized “I AM ME” statement on Twitter and Facebook each day during the entire month of April. The deadline for submission has been extended to April 13, 2018.

See the example from Diversity & Inclusion Committee Chair Jorge Valdes to learn more see I Am Me.
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NewsMaker: CRNA Mickie Bower Brown Named March 2018 CityMaker

Retired CRNA Mickie Bower Brown is one of the founders of Noah's Ark, an organization in Lakeland, Fla., committed to empowering individuals with developmental disabilities. The organization provides or facilitates employment and social opportunities, as well as affordable housing.

The Mayor’s Love Lakeland CityMaker Award (CMA) recognizes energetic contributors, who have taken creative, positive and sometimes risky action for the greater good of the Lakeland Community. CityMakers are citizens who look for ways to make things better through their business, or their creations, events, works of art, innovative ideas and ultimately, through championing community initiatives with their fresh, new perspectives.

Mickie and her recently retired CRNA husband, Gary, became passionate about bettering the world for those who have developmental disabilities after they adopted daughter Brittany, who has special needs. In addition to Noah's Ark, Mickie also began a program at a local college that helps people with disabilities prepare for entry into the "real world." The program provides skills to succeed, such as mastering public transportation, social security, food stamps, vocational rehab and more. It can also help secure employment before the student exits the program.

Read more about this NewsMaker and CityMaker.
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Professional Practice

FDA CE Webinar: An Introduction to Drug Safety Surveillance and Adverse Event Reporting System

On April 10, 2018, the FDA’s Division of Drug Information is presenting a continuing education (CE) webinar as an introduction to drug safety surveillance and the FDA Adverse Event Reporting System. The webinar will be held from 1-2 p.m. EDT, and is intended for nurses, physicians, physician assistants, pharmacists, pharmacy technicians, other healthcare professionals and students.

This webinar will introduce the many phases of drug safety surveillance from the earliest stages of drug development through post approval, and will focus on how FDA’s Division of Pharmacovigilance (DPV) conducts pharmacovigilance, develops safety signals, and communicates its findings.

Learning objectives include:
  • Describe postmarketing and drug safety surveillance.
  • Explain the role of MedWatch for reporting and collecting postmarketing safety information.
  • Summarize the analysis of various types of postmarket safety data.
Register for the April 10, 2018 (1-2 p.m. EDT) online meeting.
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Foundation and Research

QCDR and Registry Reporting FAQs Now Available

The AANA Research and Quality staff know that there are many terms and eligibility criteria within the MIPS program that can be confusing. Therefore, the AANA is here to help you understand the program with regards to special status, exceptions, reweighting, benchmarking, MIPS scoring and/or individual and group reporting through resources located on the AANA Quality Payment Program website. This valuable resource provides educational materials ranging from an intro-video, to high-level fact sheets, in-depth FAQs, and QCDR lists. Once you have a basic understanding of the program, check out the QCDR and Registry Reporting FAQsfor further information about these reporting options.
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AANA Member Benefits

SCG Health – Know QPP QCDR

Gimme 15 Minutes SCG Health specializes in making MIPS regulatory burdens more approachable so that you can plan how to respond with limited resources and time. Choosing the right measures to report for the Medicare quality programs is hard. A well-functioning quality reporting plan requires a combination of:
  • Clear, leadership endorsed quality metrics and goals for data capture.
  • Robust reporting functions tracking metrics and reportable instances.
  • Frequent staff training, reinforced with human resources policies and financial support.
SCG Health helps to identify the relevant quality metrics for Medicare quality reporting. We then stand beside clinicians and office staff to evaluate, implement, support and optimize workflows to capture the right data.

The SCG Health Advantage
  • SCG has a unique background and approach to quality reporting. Staff bring over 40 years of combined experience in payer relations, contracting and revenue cycle management to identify mutual opportunities for outcome and protocol metric reporting.
  • SCG Health works with Clients to develop a strategy to capitalize on current data already captured and identifies existing data captured in other workflows.
  • SCG Health also supports 27 "QCDR measures" (6 created by SCG Health).

AANA Member Advantage Program and SCG Health 
  • AANA Members that become SCG Customers will receive a 10% discount off the retail base subscription of 2018 reporting at $275 per clinician for reporting Quality and Improvement Activities, which must include three or more SCG Health QCDR measures.
  • The discounted base subscription includes submission of quality data to SCG Health, live on-shored call center and online support, data submission, data verification and communication to CMS as required. Contact for more information or visit
  • Data entry support for calendar year 2018 Quality data is available for AANA members for an additional $500 per clinician (discount does not apply).
  • 2018 MIPS reporting enrollment will open April 15, 2018 and will close February 15, 2019 at 7 p.m. EST.
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One Advisory Partners Resources on New Tax Law, Retirement Planning Available from ONE Advisory Partners

Tax coordinated portfolios make sure you own the right assets in the right accounts. The idea is to increase your investment returns without assuming any more risk! 

Read "Investing Beyond Risk vs. Return: Using Tax Coordinated Portfolios to Increase Your Wealth, Not Your Risk"
Accounts may be taxable, tax-deferred, or tax-free. Individual investments have different tax rules as well depending on the particular asset. Optimizing your portfolio requires dedicating particular investments into the appropriate accounts. Investors and advisors have tried to minimize taxes for years with that knowledge through a strategy called asset location.
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Visit to view or place job postings

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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.

A Study on the Efficacy and Safety of Combining Dental Surgery with Tonsillectomy in Pediatrics

Research partners from Nationwide Children's Hospital and The Ohio State University sought to explore perioperative outcomes in pediatric patients who undergo multiple procedures during the course of one anesthetic exposure. The study included seven young children who had elective tonsillectomy and dental surgery during a single encounter and 27 whose procedures were performed during separate appointments. Outcomes including total anesthesia time, total recovery time, and need for overnight stay were similar for both sets of patients. Additionally, no postoperative complications were observed in any of the children. Although preliminary, the findings point to the viability of combining dental procedures with tonsillectomy during the same anesthetic encounter. Doing so could potentially reduce costs, they suggest, while limiting parental work absences and increasing convenience for patient families.

From "A Study on the Efficacy and Safety of Combining Dental Surgery with Tonsillectomy in Pediatrics"
Clinical, Cosmetic and Investigational Dentistry (03/27/18) Vol. 10, P. 45 Syed, Faizaan; Uffman, Joshua C.; Tumin, Dmitri; et al.

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Retrobulbar Block Reduces Pain After Strabismus Surgery

Investigators report that retrobulbar block provides sufficient analgesia and postoperative pain relief in patients undergoing pediatric strabismus surgery. Their prospective study included 50 children between the ages of two and 12 years old who underwent the procedure at a single facility. Randomization assigned 25 of them to receive an injection of combination of lidocaine and bupivacaine in one arm, after intubation but before surgery began. The other 25 kids received intravenous fentanyl, also after being intubated but before the start of surgery. While neither group required opioids, intraoperative heart rate was much higher with the fentanyl patients; and more postoperative nausea and vomiting also occurred within that group. "Only minor complications were encountered due to the retrobulbar block in the form of conjunctival chemosis and subconjunctival hemorrhage," according to Dina Hassanein, MD. She reported the findings at the American Association for Pediatric Ophthalmology and Strabismus meeting.

From "Retrobulbar Block Reduces Pain After Strabismus Surgery"
Healio (03/26/2018) Nale, Patricia

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TAP Block Not Superior in Children Undergoing Hydrocelectomy or Hernia Repair

Although regional blocks are lauded for their impact on postoperative pain, new research finds that transverse abdominis plane (TAP) block is no better than intravenous local infiltration in the setting of pediatric hydroelectomy and/or hernia repair. The small pilot trial included about 50 patients, aged five to 13 years old. All received standard intraoperative anesthetic care, but some were randomized to preoperative TAP block while others were allocated to intraoperative local infiltration. Investigators found that outcomes were much the same for both groups of children. "This was a negative result, which I think is valuable to publish," said researcher Joshua Hozella, MD. "It's important to find out whether doing an intervention is useful or worth the risks, and in our case—with no difference in total opioid consumption, mean pain scores or parental satisfaction—we determined that it wasn't." He added that lack of superiority should be verified through larger-scale trials.

From "TAP Block Not Superior in Children Undergoing Hydrocelectomy or Hernia Repair"
Anesthesiology News (03/26/18) Doyle, Chase

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Comparison of Ramosetron and Ondansetron for the Treatment of Established Postoperative Nausea and Vomiting After Laparoscopic Surgery

Researchers in Seoul, Korea, investigated ramosetron as a potential treatment for postoperative nausea and vomiting (PONV) after laparascopic surgery. The team considered a pool of 583 patients having the procedure, enrolling those who presented with PONV no more than two hours after the operation. Of 210 participants, half were randomized to intravenous ramosetron with the other half assigned to I.V. ondansetron. The complete response rate—i.e., absence of emesis and no need for additional rescue antiemetics for 24 hours after drug administration—occurred in 52.9 percent of the ramosetron patients, compared with 44.1 percent of the ondansetron patients. The rate of adverse events between the groups was comparable, meanwhile. The evidence suggests that 0.3 mg of ramosetron is noninferior to 4 mg of ondansetron in alleviating PONV following laparascopic surgery.

From "Comparison of Ramosetron and Ondansetron for the Treatment of Established Postoperative Nausea and Vomiting After Laparoscopic Surgery"
Therapeutics and Clinical Risk Management (03/26/18) Vol. 14, P. 601 Choi, Yong Seon; Sohn, Hye-Min; Do, Sang-Hwan; et al.

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Large Opioid Decrease After Gynecologic Surgery with New Restrictive Protocol

Taking an "ultra-restrictive" approach toward opioid prescription has a huge impact on usage as well as on patient satisfaction, according to researchers in New York. The finding is based on a study done at Roswell Park Comprehensive Cancer Center, which adopted a minimalist plan from June 2017 to January 2018 for managing postoperative pain after gynecologic surgery. While New York sanctions up to a week's supply of narcotic painkillers, study patients received ibuprofen, acetaminophen, or just three days' worth of opioids, depending on the type of procedure, their level of discomfort, and history of chronic pain requiring opioids. Outcomes in 337 patients under the restrictive regimen were compared with data from 626 patients who underwent similar procedures before the new protocol was put in place. Gynecologic patients received 31.7 opioid tablets on average after discharge under the old rules but only 3.5 pills on average after the switchover, for a reduction of nearly 90 percent. The biggest decrease, 97 percent, was observed in patients who had minimally invasive procedures; and the share of patients in this category who went home with no opioid medications at all surged from 19.6 percent to 92.6 percent. With postoperative pain scores remaining stable, moreover, 96 percent of patients expressed satisfaction with the prescribing protocol—to the surprise of 57.5 percent of surgeons who expected satisfaction rates to tank.

From "Large Opioid Decrease After Gynecologic Surgery with New Restrictive Protocol"
Targeted Oncology (03/25/18)

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Chronic Opioids Linked to Increased Complications After Spinal Fusion Surgery

Research out of The Ohio State University reveals an elevated risk for complications after spinal fusion surgery in patients who used opioids for several months before the procedure. Colleagues tapped an insurance database to flag 24,610 patients undergoing spinal fusion of the lower spine, 5,500 of whom were taking narcotic pain pills for more than six months beforehand. They found that in the first 90 postoperative days, long-term opioid users experienced complications, from surgical wound problems to constipation, at a higher rate than patients who used opioids for less than six months—or not at all—prior to surgery. Additionally, patients with a history of opioid consumption were more likely to present for emergency care, be hospitalized, require repeat spinal fusion surgery within a year, incur higher costs of care, and still be on opioids 12 months after the index procedure. "All these findings highlight the vicious cycle of unrelieved pain and fusion and increased healthcare costs in long-term opioid users," the researchers report in Spine.

From "Chronic Opioids Linked to Increased Complications After Spinal Fusion Surgery"
ScienceDaily (03/21/18)

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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 29, 2018
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