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Election Ballot Information Available Online

The AANA Nominating Committee, after reviewing the nominations for elected positions for the upcoming election at its February meeting, has announced the slate of candidates for the 2017 election of the AANA Board of Directors, Nominating, and Resolutions Committee members. The order of names was determined randomly on the ballot by the Nominating Committee. Those elected will begin their fiscal year 2018 terms of office at the conclusion of the AANA 2017 Nurse Anesthesia Annual Congress in Seattle, Wash.

Fiscal Year 2017 Nominating Committee
Serving on the fiscal year 2017 Nominating Committee are: Rosann Spiegel, DNAP, JD, CRNA, ARNP (Region 7)-Chair; Susan DeCarlo-Piccirillo, DNP, CRNA (Region 1); Cheryl Schosky, DNAP, MSN, CRNA (Region 2); Phillip Robles, MS, CRNA (Region 3); Julie Roden, MS, CRNA (Region 4); Sherry Swearngin, MHS, CRNA (Region 5); Jay Thomas, MS, MPA, CRNA (Region 6).

Coming Soon: AANA Connect Candidate Community
The AANA Connect Community for Candidates for the AANA Board of Directors will become available on April 8, 2017, after candidates are introduced at the Mid-Year Assembly. All AANA members will be able to interact with Board candidates during the voting cycle. This community will be available until the voting cut-off date of May 23, 2017.
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Hot Topics


Update on CEO Search

On Feb. 28, AANA President Cheryl Nimmo, DNP, MSHSA, CRNA, announced the planned retirement of AANA CEO Wanda Wilson, PhD, MSN, CRNA. An update on the search for her replacement is posted on the AANA website.
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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.
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Need More Class A CE Credits for Recertification?

If you need to earn additional Class A credits, we can help. AANA membership not only includes 6 Class A credits, it also includes automatic submission to the NBCRNA—plus, a host of other valuable benefits. AANA is the only CE provider that offers all four CPC Core Modules, an important part of the CPC Program. Stay current AND earn up to 17 Class A credits. Plus, AANA members save 50 percent when purchasing all modules. Learn more.
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Professional Practice


New Practice Resources Released

At its recent meeting, the Board of Directors approved two new practice resources.
  • Care of Patients Receiving Analgesia by Catheter Techniques – This document focuses on the registered nurse’s role as a member of the patient care team for laboring and non-laboring patients who are receiving analgesia by catheter technique.
  • Dental Office Sedation and Anesthesia Care – This position statement affirms that safe dental sedation is best achieved when provided by a healthcare professional, whose only responsibility is the sedation and monitoring of the patient, and a proceduralist whose specific focus is on the procedure.
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New Practice Management Resources Available

Two new practice management resources are available for members.
  • AANA Vendor Directory – This resource provides a vendor list of anesthesia supplies, equipment, medications, and other resources. It is based on AANA Annual Congress exhibitors and will continue to be updated.
  • Malignant Hyperthermia Crisis Policy Template – This policy template is provided to members in an editable format to help in facility policy development and is consistent with AANA and MHAUS recommendations.
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Meetings and Workshops


Mid-Year Assembly Registration Available Onsite

Missed the online registration deadline? Not to worry. You can still make a difference in D.C. at the most important advocacy meeting for nurse anesthesia. Registration will be available onsite starting Wednesday, April 5, from 4 p.m. - 7:30 p.m. in the Grand Ballroom Foyer of the Renaissance D.C. hotel.
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Earn up to 27.25 Class A CE Credits with 13.75 Pharmacology Credits at #AANA2017

Join us Sept. 8-12, 2017, in Seattle for the biggest CE and networking event in nurse anesthesia! With more than 90 expert speakers, seven educational tracks, four pre-Congress workshops, and new opportunities to connect with peers from across the nation, you won’t want to miss this opportunity to refresh your passion for the profession. Register early for significant savings. Get details.
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Foundation and Research


Fellowship, Grant, and Poster Session Applications Available—Apply Today

Post-doctoral and doctoral fellowship, research grant, and general poster session applications are due May 1, 2017. Oral poster session applications are due April 1, 2017. Visit the AANA Foundation Applications and Program Information for more information and to access the applications.

If you have any questions, please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com.
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Call for AANA Foundation Board Members — CRNA and Student Positions Available
Application Deadline Extended to June 1

The mission of the AANA Foundation is to advance the science of anesthesia through education and research. The Foundation is currently looking for candidates interested in playing an active role in supporting these important aspects of the CRNA profession by participating on the AANA Foundation Board of Trustees.

See the Foundation's webpage to review the criteria and access the application and nominee profile form.

If you have any questions, please contact the Foundation at (847) 655-1170 or foundation@aana.com.
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Jobs


Visit www.crnacareers.com 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.

Spinal Anesthesia in Elderly Patients Undergoing Lumbar Spine Surgery

Spinal anesthesia is gaining ground as a substitute for general anesthesia during lumbar spine surgery—particularly in the elderly, who would especially benefit from fewer anesthetic risks. Given the lack of specific evidence to support using the technique in this target population, however, researchers conducted a retrospective review to examine one institution's experience with patients aged 70 years or older. The investigation considered 56 patients who received spinal anesthesia for either lumbar decompression or combination decompression/fusion between December 2013 and October 2015. The surgical approach was considered successful—with no stroke, permanent loss of function, pulmonary embolism, or deaths occurring and none of the patients requiring conversion to general anesthesia. In addition, all of the patients were up and moving the same day as their procedure or the following morning. The evidence points to spinal anesthesia as a viable option for older patients and also for longer-duration surgeries of the spine, with roughly half of the procedures lasting beyond the two hours believed optimal for this technique.

From "Spinal Anesthesia in Elderly Patients Undergoing Lumbar Spine Surgery"
Orthopedics (04/17) Vol. 40, No. 2, P. 317 Lessing, Noah L.; Edwards II, Charles C.; Brown IV, Charles H.; et al.

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Paravertebral Block in Paediatric Abdominal Surgery

Researchers at Toronto's Hospital for Sick Children undertook a systematic review in order to evaluate the safety and efficacy of paravertebral block (PVB), versus other analgesic approaches, for pediatric abdominal surgeries. The co-investigators, representing the institution's Department of Anesthesia and Pain Medicine, identified six randomized controlled trials that compared PVB with any comparator or analgesic treatment during procedures including inguinal herniorraphy, appendectomy, and cholecystectomy. After reviewing the evidence, they concluded that PVB is a viable alternative to caudal and ilioinguinal block for abdominal operations in the pediatric population. Among the 358 patients studied, the technique avoided major complications; reduced the need for rescue analgesia; slightly improved pain scores, especially at 4 to 6 hours postoperatively but for as long as 24 hours; and increased satisfaction among both parents and providers.

From "Paravertebral Block in Paediatric Abdominal Surgery"
British Journal of Anaesthesia (03/24/2017) Vol. 118, No. 2, P. 159 Taylor, Katherine L.; Page, E. A.

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Literature Review Finds Ketorolac Side Effect Profile Largely Benign for Renal Function and Bone Healing

Ketorolac has been shown to lower pain scores and curtail opioid needs in the surgical setting; however, concerns about the effect of its anti-inflammatory properties on perioperative outcomes have lingered. In particular, researchers have worried about whether the non-steroidal anti-inflammatory drug (NSAID) would trigger unwanted bleeding, hinder bone healing, or damage the kidneys. Led by Lawrence Lipana, MD, of Yale New Haven Hospital, an evidence review covering the last 10 years was launched to assess the overall efficacy of ketorolac in a surgical capacity. While some of the studies did document an unfavorable impact on bone healing, this result was observed in trials that included prolonged use or high doses of the drug. In standard doses, however, keterolac did not affect fracture union. The literature also indicated no negative impact on the kidneys in patients with normal preoperative renal function. Finally, with regard to bleeding, there generally appeared to be no elevated risk associated with the NSAID—except in the cases of patients undergoing tonsillectomies and older persons receiving high doses as part of any surgery. Lipana et al. conclude that ketorolac is a safe pain management measure when administered in normal doses to otherwise healthy patients immediately after surgery.

From "Literature Review Finds Ketorolac Side Effect Profile Largely Benign for Renal Function and Bone Healing"
Anesthesiology News (03/24/17) Vlessides, Michael

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Choose Non-Opioid for Laparoscopic Colorectal Surgery

Researchers at Baylor University Medical Center report that using liposomal bupivacaine (Exparel) during laparoscopic colorectal surgery improves patient outcomes. Based on a sample of nearly 2,400 people who underwent the procedure between Jan. 1, 2011, and Sept. 31, 2015, they found that total opioid needs for the hospital stay were markedly lower among patients who received Exparel. Additionally, opioid-related adverse events occurred in only 5.5 percent of those patients, compared with 8.4 percent of controls. Exparel use also was associated with less time in the post-anesthesia care unit as well as a shorter overall hospitalization period—at 1.7 hours versus 2 hours and 5.5 days versus 6.1 days, respectively. Moreover, just 4.3 percent of Exparel patients were readmitted to the hospital within 60 days compared with 7 percent of controls; and only 4.9 percent were readmitted within 90 days compared with 8.2 percent of patients who did not receive the opioid-sparing agent. "As we are fighting an opioid epidemic in the U.S., this could be a tool to help reduce opioid dependency and other complications," said lead researcher Deborah Keller, MS, MD, "but controlled trials are needed to investigate these outcomes." Finally, while there are additional costs associated with Exparel, total costs and resource utilization are comparable to conventional treatment and sometimes even come in a bit lower.

From "Choose Non-Opioid for Laparoscopic Colorectal Surgery"
MedPage Today (03/24/17) Bachert, Alexandria

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New Treatment for Opioid-Induced Constipation Approved

Based on a series of randomized controlled trials, the U.S. Food and Drug Administration has approved a new treatment for opioid-induced constipation (OIC). The COMPOSE I, II, and III studies confirmed the efficacy and long-term safety of naldemedine, which will be marketed under the brand name Symproic. The product, a peripherally-acting mu-opioid receptor antagonist that targets tissues in the gastrointestinal tract, is indicated for OIC in adult patients with chronic non-cancer pain and could be available as early as mid-summer.

From "New Treatment for Opioid-Induced Constipation Approved"
Monthly Prescribing Reference (03/17) Han, Da Hee

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Effect of Dexmedetomidine on Mortality and Ventilator-Free Days in Patients Requiring Mechanical Ventilation With Sepsis

Japanese researchers investigated how using dexmedetomidine for sedation during mechanical ventilation affects clinical outcomes in patients with sepsis. Specifically, they were interested in the effect on mortality and ventilator-free days. The multi-center trial included 201 participants who received various agents for sedation—including fentanyl, propofol, and midazolam. About one-half were additionally assigned dexmedetomidine, while the remainder were not. After 28 days, there was no statistically significant difference between the treatment cohorts in the primary outcomes. The dexmedetomidine patients did experience well-controlled sedation during mechanical ventilation significantly more often than the control patients; but other secondary outcomes—including length of stay and renal function—were similar among both groups, as was the rate of adverse events. Despite the finding, the researchers believe further research is warranted to account for underpowering in their study in terms of mortality.

From "Effect of Dexmedetomidine on Mortality and Ventilator-Free Days in Patients Requiring Mechanical Ventilation With Sepsis"
Journal of the American Medical Association (03/21/17) Kawazoe, Yu; Miyamoto, Kyohei; Morimoto, Takeshi; et al.

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Patient-Controlled Lollipop Anesthesia Effective for Awake Intubation

New findings indicate that patient-controlled anesthesia for the upper airway is a simple, cheap, effective, and accessible way to prepare patients for awake intubation. According to researcher Kathryn Sparrow, MD, of Newfoundland's Memorial University, anesthesia providers say nearly a quarter of patients cough or gag during awake intubation; and inadequate topicalization with coughing, gagging, or vomiting plays a role in almost half of all failed intubations. To avoid this response, the assistant professor of anesthesia recommends saturating a disposable foam oral swab with 2 percent lidocaine. The anesthetic "lollipop" helps patients cooperate, such as when there is a known history of difficult airway or if there is limited cervical spine movement or instability. "We recognize this technique doesn't ensure directed local anesthetic application and requires additional topicalization techniques," concedes Sparrow, who wants to perform additional studies with more participants. Still, she says, "attempts to facilitate cooperation with patients are warranted."

From "Patient-Controlled Lollipop Anesthesia Effective for Awake Intubation"
Anesthesiology News (03/20/17) Crist, Carolyn

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Study Finds That I.V. Steroids Decrease Amount of Pain Medication Needed for Nerve Blocks

In order to prolong pain relief as much as possible during single-injection nerve block, anesthesia providers often combine the numbing agent with a steroid or other additive. Investigators from Wake Forest Baptist Medical Center who evaluated the effect of mixing dexamethasone and anesthetic for this purpose discovered that a high dose of the steroid, delivered intravenously, reduced the amount of pain medication required by the patient—although it did not prolong the numbing shot. It also increased the amount of time that passed before an initial request for relief was made. Previous studies finding that IV dexamethasone extended the duration of nerve block were based on subjective outcomes, but the North Carolina team conducted a pin-prick evaluation every two hours—an objective measurement.

From "Study Finds That I.V. Steroids Decrease Amount of Pain Medication Needed for Nerve Blocks"
News-Medical.net (03/15/2017)

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Perioperative Pain Control Reduces Need for Postoperative Narcotics After Hysterectomy for Uterine Cancer

New findings suggest that women who receive intravenous acetaminophen prior to hysterectomy and surgical staging for uterine malignancy, as well as local infiltration of liposomal bupivacaine during the process, may have a lower opioid requirement afterwards. The retrospective review included data from 243 women who underwent one of the two procedures between 2012 and 2016. Although reported pain levels were similar for all the patients, those who received acetaminophen and liposomal bupivacaine needed far less narcotic medication postoperatively than did those who did not receive the extra perioperative care. Length of stay also was shorter in the intervention group, as was the number of postoperative opioid prescriptions. The study was presented at the 48th Annual Meeting of the Society of Gynecologic Oncology.

From "Perioperative Pain Control Reduces Need for Postoperative Narcotics After Hysterectomy for Uterine Cancer"
Oncology Nurse Advisor (03/15/17) Blevins, Andrea S.

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Study Questions Anticoagulation Guidelines for Performing Regional Anesthesia Procedures

Researchers believe an update may be needed on guidelines dictating how long health care providers should wait to perform epidurals and other invasive procedures on patients who take blood thinners. In the case of the anticoagulant enoxaparin, for example, the American Society of Regional Anesthesia and Pain Medicine recommends that clinicians let at least 24 hours pass after the last treatment dose. In a study conducted at Wake Forest Baptist Hospital, however, residual anticoagulant activity was still observed in many patients even after one full day—possibly elevating their bleeding risk during spinal anesthesia or epidural. The finding casts doubt on existing guidelines and warrants further investigation to pinpoint the optimal wait time and assess the value of routine laboratory testing for patients on enoxaparin.

From "Study Questions Anticoagulation Guidelines for Performing Regional Anesthesia Procedures"
Newswise (03/14/17)

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Nociception Level Index Detects Patients' Pain During Surgery

A study performed at Rambam Medical Center in Haifa, Israel, supports the use of a new, multivariable gauge of perioperative pain. Used in conjunction with a nociception monitor, the approach considers six physiological factors: heart rate, heart rate variability, skin conductance, fluctuations in skin conductance, plethysmographic pulse wave amplitude, and the time derivatives of these metrics. Researchers, including the Cleveland Clinic's Daniel Sessler, tested the Nociception Level (NoL) Index on 58 patients undergoing a range of procedures. Compared with established nociception measures, NoL proved to be more effective. "We were able to identify—in anesthetized, noncommunicating surgical patients—a patient's response to noxious stimuli and the effect of analgesic administration, as well as grade the patient's response to noxious stimuli of varied levels and distinguish different doses of analgesia during a similar noxious stimulus," reports study lead Ruth Edry, MD. The significance, Sessler adds, is that, "titrating to NoL may thus guide clinicians and help them give patient-specific amounts of intraoperative opioid." The study findings are published in Anesthesiology.

From "Nociception Level Index Detects Patients' Pain During Surgery"
Pain Medicine News (03/14/2017) Dreyfuss, John Henry

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Economic Evaluation of Pharmacologic Pre- and Postconditioning With Sevoflurane Compared With Total Intravenous Anesthesia in Liver Surgery

Savvy perioperative anesthesia management is one way to curtail postoperative complications, which not only compromise patient safety but inflate hospitalization costs. Total intravenous (IV) anesthesia is typically preferred in the operating room, for example, despite mounting evidence of improved outcomes with inhaled anesthetics in many clinical circumstances—including some lung and heart procedures. Recent research also suggests that inhaled anesthetics may offer a hepatoprotective effect for surgeries of the liver. Based on those findings, Swiss investigators theorized that interrupting IV propofol and adding a brief pharmacologic pre- or postconditioning with sevoflurane would avoid complications during liver surgery and lower treatment costs compared to total IV anesthesia with no pharmacologic conditioning. The pair of randomized controlled trials that inspired them were the basis for a cost comparison of direct medical expenses associated with elective liver resection under those two scenarios. The analysis ultimately included 129 patients—78 who underwent preconditioning or postconditioning with sevoflurane for 30 minutes, and 51 controls who did not. Significantly fewer complications, much shorter length of hospital stay, and lower treatment-related costs were all associated with the intervention group, suggesting that the conditioning approach has great value.

From "Economic Evaluation of Pharmacologic Pre- and Postconditioning With Sevoflurane Compared With Total Intravenous Anesthesia in Liver Surgery"
Anesthesia & Analgesia (03/17) Vol. 124, No. 3, P. 925 Eichler, Klaus; Urner, Martin; Twerenbold, Claudia; et al.

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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.

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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Attn: Linda Lacey
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March 30, 2017
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