AANA Anesthesia E-ssential
AANA Anestehsia E-ssential
Anesthesia E-ssential

March 30, 2015

 

Vital Signs

 
 
Business of Anesthesia Conference: Building a Successful Practice
Get answers to your questions about practice management at the 2015 AANA Business of Anesthesia Conference, to be held June 26-27, 2015, in San Diego, Calif. This two-day weekend conference will provide expert, CRNA-specific information on important topics, including: leadership strategies, contracts and negotiation, reimbursement, practice models, implementation of ICD-10, and risk management models.
 
Expert Faculty
All CRNAs will benefit from this conference, with an expert faculty providing a look at the economic, legal, and government policies that shape CRNA reimbursement and value to healthcare. Among the featured speakers at this conference sill be AANA President-elect Juan Quintana, CRNA, DNP, MHS, who was instrumental in the development and expansion of Business of Anesthesia Conference content from previous years. See the Preliminary Program for more information.
 
Terrific Location
The US Grant Hotel, San Diego, Calif., a local icon since 1910, is situated in the city's lively and historic downtown Gaslamp Quarter, just steps from top shopping, dining, and entertainment, and a short drive from the destination's world-renowned beaches, museums and family attractions.
 
Register Now
Register by May 26 and save $50!
 

CPC Pulse

Information in this section is provided to help CRNAs keep their finger on the pulse of what’s happening with the NBCRNA’s Continued Professional Certification (CPC) program, which will launch on Aug. 1, 2016.
 
A Look at Core Modules
Core modules are important educational components of the CPC Program, which will provide a more well-rounded continuing education experience compared to a program that relies only on self-selected continuing education activities. They are being developed and offered by continuing education vendors using a common set of educational objectives. The primary focus of the core modules is on the most recent evidence-based literature. In response to feedback from nurse anesthetists, the core modules can be used toward meeting Class A requirements for assessed continuing education. The core modules are focused on the most recent findings in the professional literature and so are intended to help nurse anesthetists remain current with the evolving evidence. The core modules are linked to the content outline of the CPC Examination, sharing the same four domains of nurse anesthesia practice: airway management, anesthesia equipment and technology, applied clinical pharmacology, and physiology and pathophysiology. Core modules will be optional for the first four years of the CPC Program. More information about Core Modules can be found on the AANA and the NBCRNA websites.
 
 
CPC Sound Bite: Will I Really Have to Take an Exam to be Recertified?
This is the second in a series of video messages on the Continued Professional Certification (CPC) Program, recorded by President Sharon Pearce, CRNA, MSN, and President-elect Juan Quintana, CRNA, DNP, MHS. In these brief videos, President Pearce and President-elect Quintana answer questions about the CPC program. Click here to view the video.

 

The Pulse

 
  • New Free CE Opportunity: October 2014 AANA Journal Course Exam Now Available at AANALearn
  • Register Now for Mid-Year Assembly
  • ISMP Warns of Potential Confusion between Bloxiverz and Vazculep Injection
  • ANA Issues Call for Public Comment on Draft Nursing: Scope and Standards of Practice, Third Edition
  • Need CE Credits for Recertification?
  • AANA Student Writing Contest Deadline is April 13
  • Students and CRNAs Needed for Anesthesia College Bowl
  • Nominees Sought for Student Excellence Award
  • Award Nominations - Last Call
  • Student Rep Position on Board of Trustees Available for 2015-2017
  • Apply Today: "State of the Science" Oral and General Poster Presentations
 
  • Registration Now Open for Jack Neary Pain Management Workshop, Part 1
 
 
  • U.S. House Approves AANA-backed Permanent SGR Repeal, Medicare Reforms on Huge Bipartisan Vote; Senate Action Next
  • What Does Permanent SGR Repeal Bill Do for CRNAs?
  • House Bill Authorizing Full Practice Authority for CRNAs and other APRNs Providing Care to Our Veterans Gains Cosponsors
  • What Is the Current Status of AANA's Efforts to Ensure Veterans Access to Quality Care?
  • President Obama Nominates New Veterans Affairs Under Secretary for Health
  • HHS Launches Healthcare Payment Learning and Action Network and AANA is Serving as a Stakeholder
  • Register Now for the 2015 AANA Mid-Year Assembly, the CRNA-PAC Event, and the First-Ever Capitol Hill Rally
  • Amendments
  • FEC REQUIRED LEGAL DISCLAIMER FOR CRNA-PAC
 
 

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.
 
 

 
 
Inside the Association
New Free CE Opportunity: October 2014 AANA Journal Course Exam Now Available at AANALearn
The October 2014 AANA Journal Course examination is now available online at AANALearn for free continuing education credit. Take advantage of this opportunity by clicking here to access Journal Course 34, Article No. 4: “Update for Nurse Anesthetists—Part 4—Anesthesia and Critical Care Ventilator Modes: Past, Present, and Future.” The exams for Journal Course 34, Articles 1-3, are also available on AANALearn. For more than 30 years, the Journal Course exam has proven to be a valuable benefit of AANA membership, providing the highest quality educational content on topics that are foundational to your practice. In October of this past year, the exam was moved to AANALearn.com to join the other valuable online continuing education opportunities found there.
 
Register Now for Mid-Year Assembly
This year's AANA Mid-Year Assembly, April 18-22, in Arlington, Va., is an excellent opportunity for you to participate in the national policymaking impacting our profession, and with 10 educational sessions to choose from, you can earn CEs while you're there. Register today.
 
 
ISMP Warns of Potential Confusion between Bloxiverz and Vazculep Injection
ISMP is alerting hospitals, ambulatory surgical centers, and anesthesia professionals about the potential for dangerous mix-ups between two relatively new presentations of older medications, neostigmine injection and phenylephrine injection. Read more here.
 
 
ANA Issues Call for Public Comment on Draft Nursing: Scope and Standards of Practice, Third Edition
American Nurses Association’s Nursing Scope and Standards Revision Workgroup invites review and public comment on the draft Nursing: Scope and Standards of Practice, Third Edition. Submit comments and recommendations online by April 6.
 
 
Need CE Credits for Recertification?
Recertification Opened March 1, and AANALearn has more than 40 relevant online courses so you can get the credits you need by July 31. AANALearn offers high-quality, affordable, online education that you can access at your convenience - so you take the courses you want, when you want to. Browse our extensive catalog of course at www.aanalearn.com.
 
Students and CRNAs Needed for Anesthesia College Bowl
Deadline: May 1
The annual Anesthesia College Bowl at the AANA Nurse Anes¬thesia Annual Congress will once again be a rousing battle of the brains between the 2015 Student Champion Team and a CRNA Challenge Team. For further information, click here or contact the Education Department at education@aana.com.
 
 
Nominees Sought for Student Excellence Award
Deadline: May 15
The Education Committee will present a Student Excellence Award at the 2015 AANA Nurse Anesthesia Annual Congress to a student who demonstrates outstanding leadership and professionalism during his or her nurse anesthesia program, participates in activities that foster a positive public image of nursing, participates in activities that foster high-quality healthcare to consumers, or engages in volunteer activities of community service or support of healthcare. For rules and guidelines, click here or contact the Education Department at education@aana.com.
 
 

  
 
Award Nominations – Last Call
"Appreciation is a wonderful thing: It makes what is excellent in others belong to us as well." -Voltaire
 
Show your appreciation for someone you admire and submit an award nomination today. The deadline is April 1, 2015. Click here to access the nomination/application forms for:
  • Advocate of the Year
  • John F. Garde Researcher of the Year
  • Rita L. LeBlanc Philanthropist of the Year
  • Janice Drake CRNA Humanitarian Award
Forward the completed form to the AANA Foundation – email to foundation@aana.com or mail to 222 S. Prospect Avenue, Park Ridge, IL 60068.
 
Thank you in advance for recognizing a member of the nurse anesthesia community. If you have any questions, please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com.
 
 
Student Rep Position on Board of Trustees Available for 2015-2017
Attention Students… The AANA Foundation would like to encourage energetic and highly motivated students to apply for the student representative position on the AANA Foundation Board of Trustees. The student representative serves a two-year term as a full board member with equal voting privileges and represents an integral role as the voice for students across the country. The student representative is a valued and essential board member for accomplishing the AANA Foundation’s mission.
 
Click here to access the student application for the AANA Foundation Board of Trustees. The application deadline has been extended to May 1, 2015. For additional information, please review the application requirements and/or email
foundation@aana.com.
 
 
Apply Today: “State of the Science” Oral and General Poster Presentations
“State of the Science” offers an opportunity for CRNAs and nurse anesthesia students to present their research findings and innovative educational approaches at the AANA Nurse Anesthesia Annual Congress. Research, literature reviews, and innovative, creative techniques in anesthesia are appropriate topics. Click here to access the applications, which are currently available on the AANA Foundation website at www.aanafoundation.com.
  • Oral Poster Presentation – April 1 Deadline – 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 foundation@aana.com.
 
 

 
 
 
Business of Anesthesia Conference: Building a Successful Practice
Get answers to your questions about practice management at the 2015 AANA Business of Anesthesia Conference, to be held June 26-27, 2015, in San Diego, Calif. This two-day weekend conference will provide expert, CRNA-specific information on important topics, including: leadership strategies, contracts and negotiation, reimbursement, practice models, implementation of ICD-10, and risk management models. Register by May 26 and save $50!
 
 
Registration Now Open for Jack Neary Pain Management Workshop, Part 1
May 30-June 1, Park Ridge, Ill.
Expand your knowledge of interventional pain management through scientific and theoretical bases of pain, pharmacology, and pain management considerations. Workshop registration includes access to four online learning modules. Registrants are encouraged to complete the modules to be best prepared for the workshop. Learn more and register here.
 
 
 

 
 
 
U.S. House Approves AANA-backed Permanent SGR Repeal, Medicare Reforms on Huge Bipartisan Vote; Senate Action Next
On a bipartisan 392-37 vote, the U.S. House of Representatives on March 26 passed the Medicare Access and CHIP Reauthorization Act (H.R. 2), a major AANA-backed bill permanently repealing the “sustainable growth rate” (SGR) cuts to Medicare Part B CRNA and physician payments scheduled to hit April 1.
 
Attention now turns to the U.S. Senate to pass HR 2 before Medicare begins paying Part B payments with 21% SGR cuts in mid-April. CRNAs should stand ready for possible additional CRNAdvocacy action alerts (requires AANA member login and password), and for possible Medicare payment disruptions if the Senate does not act in time to pass HR 2 and send it to the President for signature into law.
 
The AANA has long been involved with efforts to permanently repeal the harmful cycle of SGR cuts, first created in 1997 and temporarily averted 17 times by subsequent acts of Congress. If the SGR cuts are allowed to take effect, they would cost the average CRNA some $15,000 a year. With the involvement of AANA and CRNAs over the past three years, the permanent SGR repeal and Medicare reform legislation treats CRNAs the same as physicians in making and participating in alternative payment models. It also excludes provisions sought by the American Society of Anesthesiologists that would have extended the Medicare Part A rural reasonable cost pass-through program for CRNA services to also include anesthesiologists, which would have increased rural healthcare costs without improving access to care and risked proliferation of wasteful “tele-supervision” of safe CRNA care.
 
In recent days, AANA members sent more than 7,500 CRNAdvocacy messages to U.S. Representatives and Senators in support of HR 2 and in opposition to harmful anti-CRNA provisions. With the AANA Mid-Year Assembly approaching April 18-22 in Washington, AANA members will have opportunity to thank their federal lawmakers in person – if the Senate completes the job.
 
Supported by the Obama administration and by the AANA coordinating a coalition of nursing organizations representing more than 340,000 APRNs, H.R. 2 now goes to the Senate for consideration. With Senate Finance Committee minority Democrats expressing concern that H.R. 2 extends the CHIP program two years not four, timely Senate action is hoped-for but not guaranteed. The Senate may act upon it before departing Friday, March 27 for Easter and Passover recess. Or, it may delay action to the week of Monday, April 13 when lawmakers return to Washington from recess.
 
On a practical level for CRNAs, Congress has not made an allowance for a short-term relief patch from the 21% Medicare Part B CRNA and physician payment cuts that take effect April 1. Advocates for HR 2 hope that the big House vote presses the Senate to act promptly to pass the bill and send it to the President to be signed into law. Therefore, if the Senate postpones action on HR 2 to mid-April, the Medicare agency is expected to hold payment for claims for services beginning April 1 through mid-April to give the Senate time to act before the agency has to make reduced payments. AANA is monitoring the situation closely and will keep members apprised of developments.
 
 
What Does Permanent SGR Repeal Bill Do for CRNAs?
The House-passed, AANA-backed “Medicare Access and CHIP Reauthorization Act” (H.R. 2) bill has more effects on CRNAs than simply the end of the annual cycle of disruptive cuts to Medicare Part B CRNA and physician payments. It also provides a 0.5 percent increase to Part B payments each year through 2019 and extends the Children’s Health Insurance Program for two years. Equally important, it excludes harmful anti-CRNA provisions.
 
Of greater long-term interest, at AANA’s request and involvement the legislation treats CRNAs and physicians the same as it transitions Medicare payments from the fee-for-service model to one more closely related to patient outcomes, quality, and efficient healthcare delivery. The involvement of AANA and CRNAs in developing and carrying out such reforms, and of monitoring their impacts, will be important, affecting the future of the profession and the ultimate goals of improving the quality and efficiency of healthcare delivery and of health overall, as well as reducing healthcare costs.
 
Transitioning from Medicare fee-for-service payment, the legislation consolidates three Medicare quality reporting mechanisms – the Physician Quality Reporting System (PQRS), the Value-based Modifier (VBM), and the Meaningful Use of Electronic Health Records (EHR MU) models – into one Merit-based Incentive Payment System (MIPS) starting in 2019 for physicians, CRNAs and other APRNs. Alternatively, providers participating in Alternative Payment Models (APMs) developed in the healthcare provider community and evaluated by an agency Technical Advisory Committee may be exempt from MIPS reporting and payment incentives or penalties, as would providers treating small numbers of Medicare patients. Entities that receive Medicare data for public reporting purposes, which the bill calls “qualified entities” (QEs), would be permitted to provide or sell non-public claims data to provider organizations for the purpose of developing or supporting quality improvement activities or APMs. 
 
 
House Bill Authorizing Full Practice Authority for CRNAs and other APRNs Providing Care to Our Veterans Gains Cosponsors
House Bill Authorizing Full Practice Authority for CRNAs and other APRNs Providing Care to Our Veterans Gains Cosponsors
AANA-backed legislation introduced March 4 in the House of Representatives (H.R. 1247) authorizing all advanced practice registered nurses (APRNs) in the Veterans Health Administration (VHA), including CRNAs, to practice as full practice providers has gained five additional bipartisan cosponsors. Now’s the time for AANA members to ask their U.S. Representatives to cosponsor this important legislation intended to help improve veterans access to quality healthcare.
 
The bill, sponsored by Reps. Sam Graves (R-MO) and Jan Schakowsky (D-IL), is now also cosponsored by Reps. Jared Polis (D-CO), James Langevin (D-RI), James McGovern (D-MA), Raul Grijalva (D-AZ), and Elise Stefanik (R-NY).
 
Please take action today and request that your U.S. Representative support and cosponsor HR 1247 because it includes CRNAs: https://www.crna-pac.com/actionalerts.aspx (AANA member login required). See the APRN Workgroup letter here: http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150304%20APRN%20Letter%20for%20Graves-Schakowsky%20IVAQCA%20Final.pdf (AANA member login required). Text for HR 1247 is available at https://www.congress.gov/bill/114th-congress/house-bill/1247/text?q=%7B%22search%22%3A%5B%221247%22%5D%7D
 
 
What Is the Current Status of AANA’s Efforts to Ensure Veterans Access to Quality Care?
With new legislation in Congress and a regulatory proposal in the Veterans Health Administration (VHA) affecting recognition of CRNAs and other APRNs all under consideration at the same time in Washington, keeping the issues straight can be challenging. But keeping them straight is critical to knowing what to say to your lawmakers in support of veterans access to care delivered by CRNAs. In short:
  • The AANA is supporting new legislation in the House, H.R. 1247, the “Improving Veterans Access to Quality Care Act,” sponsored by Reps. Sam Graves (R-MO) and Jan Schakowsky (D-IL). AANA is requesting that AANA members contact their U.S. Representatives to cosponsor this bill. Please do so here.
  • The AANA has expressed strong concerns about legislation in the Senate, S. 297, the “Frontlines to Lifelines Act,” sponsored by Sen. Mark Kirk (R-IL). Unlike the House bill, H.R. 1247, S. 297 recognizes only three of the four APRN specialties for full practice authority in the VHA, omitting CRNAs. The AANA encourages CRNAs to contact their U.S. Senators with similar concerns about S 297, and to request that the bill be amended to include CRNAs. Please do so here.
  • The AANA continues to strongly support the VHA’s efforts to update its Nursing Handbook to recognize CRNAs and other APRNs to their full practice authority, consistent with the recommendations of the Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health. According to the VHA, the agency intends to publish regulatory rulemaking later this year recognizing CRNAs and other APRNs to their full practice authority in the VHA.

Since mid-February, AANA members have sent over 12,000 messages to their federal legislators expressing support for H.R. 1247 and concern for S. 297 as written. Your voice matters today!

If you have not already done so, please contact your Representative and request that they cosponsor H.R. 1247: https://www.crna-pac.com/actionalerts.aspx. See the AANA and APRN Workgroup letter of support at http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150304%20APRN%20Letter%20for%20Graves-Schakowsky%20IVAQCA%20Final.pdf (requires AANA member login and password). See the Nursing Community letter of support at http://admin.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150304%20Nursing%20Organizations'%20Letter%20to%20Reps.%20Graves%20and%20Schakowsky.pdf (requires AANA member login and password). Text for H.R. 1247 is available at https://www.congress.gov/bill/114th-congress/house-bill/1247/text?q=%7B%22search%22%3A%5B%221247%22%5D%7D.
If you have not yet contacted your Senators, take action today and request that they refrain from cosponsoring or supporting S 297 until it is amended to include CRNAs: https://www.crna-pac.com/actionalerts.aspx (requires AANA member login and password). See the AANA’s letter at http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150209%20FINAL%20AANA%20ltr%20to%20SVAC%20re%20S%20297%20Sec%204.pdf. Text for S. 297 is available at https://www.congress.gov/bill/114th-congress/senate-bill/297/text?q=%7B%22search%22%3A%5B%22s+297%22%5D%7D.
 
 ​
President Obama Nominates New Veterans Affairs Under Secretary for Health
President Obama on March 18 nominated David J. Shulkin, MD, as Veterans Affairs Under Secretary for Health. Subject to confirmation by the Senate, Dr. Shulkin would succeed Carolyn Clancy, MD, who has been serving in the post on an acting basis.
 
Currently the president of Morristown (NJ) Medical Center, Dr. Shulkin has held senior leadership posts with major accountable care organizations (ACOs), hospitals and health systems including Beth Israel Medical Center in New York, plus several institutions specifically focused on healthcare quality improvement. Dr. Shulkin’s confirmation hearings have not yet been scheduled, and would be expected to take place in the Senate Veterans Affairs Committee chaired by Sen. Johnny Isakson (R-GA) and ranking member Sen. Jon Tester (D-MT). Learn more about Dr. Shulkin here.
 
 
HHS Launches Healthcare Payment Learning and Action Network and AANA is Serving as a Stakeholder
When the U.S. Department of Health and Human Services (HHS) launched its Health Care Payment Learning and Action Network (HCPLAN) in Washington on March 25, the AANA was participating in person as a stakeholder as the Medicare agency works to transition provider payments to alternative payment models relating to healthcare quality or value.
 
While more about the HCPLAN and its work will be reported to AANA membership in the weeks and months to come, CRNAs should also consider working with their facility to determine whether to join the network, or if their facility has already joined, how they can play a role in this initiative.
 
Register Now for the 2015 AANA Mid-Year Assembly, the CRNA-PAC Event, and the First-Ever Capitol Hill Rally
To make your voice and the voices of CRNAs strong in Washington, the time is now to register
for the AANA Mid-Year Assembly, April 18-22, 2015, in Arlington, VA. For the first time ever, our Capitol Hill advocacy days starting Tuesday, April 21, will kick off with a CRNA rally with members of Congress at the foot of Capitol Hill.
 
Begin your Mid-Year Assembly advance preparations with information available here (requires AANA member login and password). Kick start Congressional visits with a bang! This energetic event will take place with the U.S. Capitol as our backdrop and will feature the presentation of the 2015 National Health Leadership Award.
 
Tickets are going fast for the CRNA-PAC event, “Great Moments in Time,” and student tickets have already sold out while others are going fast. Make sure to get your tickets in advance by purchasing them online at https://aptify.aana.com/aptify/meetings/newmeetingregistration.aspx?id=173280 (AANA member login required). You can also purchase tickets and register for the 2015 Mid-Year Assembly at http://www.aana.com/meetings/aanaassemblies/Pages/Mid-Year-Assembly-Registration.aspx
 
 
Amendments
  • Both the House and Senate are on recess through April 13, when the Senate will return to complete work on HR 2 repealing the Medicare SGR payment cuts and the House will start work on FY 2016 appropriations bills.  If you see your legislators or their staff at home, let us know how your visits went by logging your visit on the CRNA-PAC website at https://www.crna-pac.com/legisreport.aspx (AANA login required) and sending us pictures to info@aanadc.com. To see when Congress is in Washington or at home, go to House schedule, Senate schedule.
ryan pearce.jpgklobuchar pearce.jpg 
 As part of AANA leadership visits in Washington, President Sharon Pearce CRNA, MSN, visited with several members of Congress, including Medicare-writing House Ways and Means Committee Chair Rep. Paul Ryan (R-WI) and Sen. Amy Klobuchar (D-MN).
 
The following is an FEC required legal notification for CRNA-PAC: Gifts to political action committees are not tax deductible. Contributions to CRNA-PAC are for political purposes. All contributions to CRNA-PAC are voluntary. You may refuse to contribute without reprisal. The guidelines are merely suggestions. You are free to contribute more or less than the guidelines suggest and the association will not favor or disadvantage you by reason of the amount contributed or the decision not to contribute. Federal law requires CRNA-PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. Each contributor must be a US Citizen.
 
 

 
 
Visit the CRNA Career Center

 

Graduate faculty position with specialization in Nurse Anesthesia- National University
Fresno, CA

National University (NU) is the second-largest, private, nonprofit institution of higher learning in California. Full-Time Faculty Openings: Nurse Anesthesia Faculty. Read more about this position.
 

 
 
 
Where Anesthesia Takes Effect
A discovery by researchers at Johns Hopkins may represent a breakthrough in the quest for less-concentrated anesthetics with fewer adverse outcomes. The study identified postsynaptic density protein (PSD95) as a key player in how well inhalational anesthetic works. Reporting in Anesthesiology, the team revealed that molecules found in inhaled anesthetics bind on PSD95 to stop excitatory neurons from sending signals. When blocked, the protein prevents some forms of chronic pain and curtails the amount of anesthesia needed to be effective. "The current findings could help to design new or more specific anesthetics or allow us to lower the anesthetic concentration needed for anesthesia," said senior author Johns Hopkins anesthesiology professor Roger Johns. Because PSD95 also plays a role in connecting neurons in the brain during early development, the research could have implications for pediatric anesthesia.
 
From "Where Anesthesia Takes Effect"
Outpatient Surgery (03/23/15) Cook, Daniel
 
 

Postop Cognition in Elderly Improved With Dexamethasone
Older surgical patients are vulnerable to postoperative cognitive dysfunction (POCD), but Brazilian researchers say this elevated risk can be mitigated with the use of dexamethasone in conjunction with general anesthesia. Of 170 patients aged 60 to 87 years old, half were randomized to receive IV dexamethasone along with light or deep general anesthesia; the other half received just general anesthesia. Neurological tests indicated that, among the anesthesia-only group, 68.2 percent of deep-anesthesia and 27.2 percent of light-anesthesia patients presented with POCD on the third day following surgery. Those numbers dropped to 25.2 percent and 15.3 percent, respectively, for patients in the dexamethasone cohort. "We conclude that dexamethasone can reduce the incidence of postoperative cognitive dysfunction in noncardiac surgical patients undergoing general anesthesia, especially if the depth of anesthesia is light and the patients are elderly," said Livia Valentin, PhD, from the University of Sao Paulo. "It remains to be seen why this association exits, and further research is certainly warranted."
 
From "Postop Cognition in Elderly Improved With Dexamethasone"
General Surgery News (03/01/15) Vol. 42, No. 3 Vlessides, Michael
 
 
A Faster, Better, Cheaper Path to Filling the Doctor Shortage
By one estimate, the United States is facing a shortage of 62,900 physicians this year—a figure that could more than double to 130,600 in another decade. How to narrow the void has become a very real issue, as training new doctors would be highly time- and cost-intensive, particularly in the specialty fields. Expanding the scope of practice for advanced practice nurses (APRNs), including nurse anesthetists, is one alternative that would cost less, take less time, and be more effective. To accomplish this, North Carolina and many other states must eliminate legislative hurdles that keep them from practicing to the full extent of their capability. A study on that state's restrictive regulations governing APRNs concluded that loosening these rules would eliminate no less than 85 percent of the anticipated shortage of anesthesiologists there, in addition to putting a 41 percent dent in the overall shortage of nonfederal physicians. What is more, the research found that APRN practice outcomes are of at least the same quality as those of the physicians against whom they are measured. And for some metrics, like patient satisfaction, APRNs actually rate higher.
 
From "A Faster, Better, Cheaper Path to Filling the Doctor Shortage"
Forbes (03/16/15) Conover, Chris
 
 
Risk for Anesthesia Complications Still High in Children With Pulmonary Hypertension
Disease-modifying drugs have slashed the mortality rate for untreated pediatric cases of pulmonary hypertension in recent years, but researchers say children with the condition still face an elevated risk for complications while anesthetized. The team from Toronto's Hospital for Sick Children looked at data from 284 noncardiopulmonary bypass procedures performed over a period of about two years on 122 patients, with 121 of the procedures involving disease-modifying treatment. The results showed that complication rates declined in patients who received the drugs compared to those who did not. While airway type and the kind of anesthetic used seemed to have no impact, the researchers discovered that age was a significant factor. Children younger than five months old, as well as those aged six months to 24 months, both were more likely to experience adverse outcomes during surgery; and those five months and under also were more likely to experience severe complications.
 
From "Risk for Anesthesia Complications Still High in Children With Pulmonary Hypertension"
Anesthesiology News (03/01/15) Vol. 41, No. 3
 
 
 
WebTIPS Helps Make Surgery Less Scary for Children—And Their Parents
The Web-based Tailored Intervention Preparation for Surgery (WebTIPS) project, featured in the April issue of Anesthesia & Analgesia, aims to prepare both children and their parents ahead of a pediatric surgery. The user-friendly interactive site dispenses personalized information and advice, based on parental feedback on a child's coping style, anxiety level, and apprehension about an upcoming procedure. In addition, there is a section that uses games and animation to introduce children to elements—such as an anesthesia mask—that they likely will encounter as part of their surgery. A preliminary assessment of the new resource indicates that WebTIPS alleviates anxiety for parents as well as pediatric patients before the procedure and possibly even curbs "emergence delirium," the agitated state that some children experience during anesthesia recovery. "WebTIPS has the potential to transform the delivery of behavioral interventions for children and families undergoing surgery, will likely reduce hospital costs, and can reach a broad health care provider and patient base," according to University of California, Irvine researchers who evaluated the program.
 
From "WebTIPS Helps Make Surgery Less Scary for Children—And Their Parents"
Newswise (03/23/15)
 
 
Propofol for Colonoscopy: Are Some Patients Being Oversedated?
Researchers in Pennsylvania enrolled 87 patients in a study designed to gauge and compare depth of sedation in colonoscopy patients who were put under with and without propofol. Forty-four subjects received endoscopist-guided sedation with no propofol, and an anesthesia provider administered propofol to the other 43. Using an electroencephalogram-based monitor, investigators confirmed that the propofol patients spent much more time in the deepest stages of sedation. "Most [propofol] patients were in the range of general anesthesia, whereas those with IV conscious sedation were mostly in the moderately sedated range," explained researcher and Drexel medical student Augustus Carlin. Patients who received propofol also were under sedation longer. Although none of the study participants experienced aspiration, researcher Basavana Goudra, MD, of the University of Pennsylvania emphasized that deeper sedation under propofol inherently means higher risk of aspiration. However, he suggested that "with appropriate titration, all the benefits of propofol sedation can be realized, with a possible reduction in risk."
 
From "Propofol for Colonoscopy: Are Some Patients Being Oversedated?"
Gastroenterology & Endoscopy News (03/15) Vol. 66, No. 3 Helwick, Caroline
 
 
 
Multimodal Antiemesis Protocol Loses Efficacy Post-Discharge
Le Fort I osteotomy patients, whose jaws are held together by elastics, suffer disproportionately from postoperative nausea and vomiting (PONV); but recent research suggests a multimodal antiemetic regimen can alleviate the side effects. Prolonged surgical times, swallowed blood, altered diets, and other factors increase the probability of PONV in this patient population. Hoping to address the problem, which can lead to more serious complications and lower patient satisfaction, UNC-Chapel Hill investigators tested a protocol that eliminated aspects of anesthesia proven to promote nausea and vomiting. Half of the 230 study enrollees received the regimen, which was heavily based on total IV anesthesia and opioid-sparing analgesia; while the other half was treated mainly with volatile anesthetics and standard narcotics. Based on patients' journal records, the protocol reduced PONV by a statistically significant margin immediately after surgery. The efficacy of the multimodal antiemetic protocol was not repeated during the post-discharge period, however, to the researchers' disappointment.
 
From "Multimodal Antiemesis Protocol Loses Efficacy Post-Discharge"
Anesthesiology News (03/01/15) Vol. 41, No. 3 Leung, Martin
 
 
Study Investigates Effects of Antidepressant Treatment in Pain Catastrophizing Patients
Early administration of an antidepressant treatment could help reduce pain after surgery in patients with pain catastrophizing disorder, a new study has found. With pain catastrophizing, an irrational thought process can make patients think that their pain is worse than it really is. While antidepressant medications could help limit this thought process, the study found that it may not help for acute pain. The researchers write in the April edition of Anesthesiology that antidepressant treatment did not reduce pain 24 hours after total-knee replacement surgery, but it did reduce overall pain scores on days two through six after surgery. In the study, 120 patients were given either placebo or escitalopram, a type of selective serotonin reuptake inhibitor, every day from the day of surgery to the sixth day after surgery, in addition to pain medication. The study findings suggest that initiating the antidepressant treatment even earlier may help reduce pain within 24 hours after surgery.
 
From "Study Investigates Effects of Antidepressant Treatment in Pain Catastrophizing Patients"
News-Medical.Net (03/18/15)
 
 
 
Holy Grail: Pain Pills Without the High
Researchers are trying to determine whether pharmaceutical companies can develop new analgesics that do not cause euphoria or lead to abuse—an urgent need amid a growing crisis of the drugs' misuse. Abuse of such medication has increased dramatically in recent years, prompting stricter Drug Enforcement Agency regulations that make some analgesics tough to prescribe and refill. Biotech startups and pharmaceutical firms including Pfizer and Biogen Idec are developing new classes of analgesics, often based on different mechanisms than traditional opioids like morphine. Industry experts believe a safer analgesic could achieve annual sales totaling many billions of dollars. The most widely abused analgesics currently are opioids, such as morphine, oxycodone, or hydrocodone. They work by activating mu-opioid receptors on the surface of cells in the brain, spinal cord and other organs, which are responsible for modulating pain perception. Some companies are attempting to trigger different opioid receptors, known as kappa- and delta-opioid receptors, that they hope will have similar properties without the euphoric effects.
 
From "Holy Grail: Pain Pills Without the High"
Wall Street Journal (03/18/15) Whalen, Jeanne
 
 
 
DEA Issues Nationwide Alert on Fentanyl as Threat to Health and Public Safety
The U.S. Drug Enforcement Agency (DEA) has issued a nationwide alert about the risks of fentanyl and fentanyl analogues/compounds. "Drug incidents and overdoses related to fentanyl are occurring at an alarming rate throughout the United States and represent a significant threat to public health and safety," said DEA Administrator Michele M. Leonhart. "Often laced in heroin, fentanyl and fentanyl analogues produced in illicit clandestine labs are up to 100 times more powerful than morphine and 30–50 times more powerful than heroin." The drug, a Schedule II narcotic, is used as an analgesic and anesthetic. DEA also warned law enforcement officials about the risks of absorbing the drug through the skin and accidentally inhaling airborne powder. Data from the National Forensic Laboratory Information System show that state and local labs reported more than 3,300 fentanyl submissions in 2014, an increase from 942 in the previous year. DEA has also identified 15 other fentanyl-related compounds.
 
From "DEA Issues Nationwide Alert on Fentanyl as Threat to Health and Public Safety"
DEA Press Release (03/18/15)
 
 
 
DEA Contributes to Shortages of Drugs With Controlled Substances: Report
A new report from the U.S. Government Accountability Office (GAO) finds that the Drug Enforcement Agency (DEA) has contributed to a noticeable shortage of prescription drugs containing controlled substances, such as narcotics and stimulants, causing difficulties for both patients and physicians. Controlled substances are regulated by DEA, and to prevent diversion, the agency sets quotas that limit the amount that can be produced. DEA, however, has not effectively managed the quota process and this has contributed to product shortages, according to the GAO report. "Each year, manufacturers apply to DEA for quotas needed to make their drugs," the report states. "DEA, however, has not responded to [the drug makers] within the timeframes required by its regulations for any year from 2001 through 2014. ... Manufacturers who reported quota-related shortages cited late quota decisions as causing or exacerbating shortages of their drugs." DEA disputes some of the findings and argues that some of the problems stem from disagreements with the Food and Drug Administration—notably, that the two agencies have differing views on how to define prescription drug shortages.
 
From "DEA Contributes to Shortages of Drugs With Controlled Substances: Report"
Wall Street Journal (03/11/15) Silverman, Ed
 
 
 
Label Design Affects Medication Safety in an Operating Room Crisis: A Controlled Simulation Study
The redesign of medication labels can help prevent some types of medication errors. In one study, 96 anesthesia trainee participants were randomly assigned to either a current or a redesigned label condition. Each participant was the sole anesthesia provider in a simulated operating room scenario and was asked by the surgeon to administer hetastarch to the simulated patient. The anesthesia cart's fluid drawer contained three 500 ml I.V. bags of hetastarch and one 500 ml I.V. bag of lidocaine. The redesigned labels were intended to help participants correctly select hetastarch or to detect incorrectly selected lidocaine before it was administered. Among the participants who correctly selected hetastarch, 63 percent had been given the redesigned labels and 40 percent had been given the current labels. Of the participants who incorrectly selected lidocaine, the percentage who noticed it before administration did not differ by label condition.
 
From "Label Design Affects Medication Safety in an Operating Room Crisis: A Controlled Simulation Study"
Journal of Patient Safety (03/07/2015) Estock, Jamie L.; Murray, Andrew W.; Mizah, Margaret T.; et al.
 
 
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