Anesthesia E-ssential

AANA Anesthesia E-ssential, March 7, 2019

Vital Signs

FDA Approves Esketamine Nasal Spray to Fight Intractable Depression

According to the Washington Post, the Food and Drug Administration (FDA) has approved a nasal spray antidepressant "for people with depression that does not respond to other treatments - the first in decades to work in a completely new way in the brain."

The article goes on to say the drug works "within hours, rather than weeks or months as is typical for current antidepressants, and could offer a lifeline to about 5 million people in the United States with major depressive disorder who haven't been helped by current treatments. That accounts for about 1 in 3 people with depression."

Learn more.
Share Facebook  LinkedIn  Twitter 

Hot Topics

2019 MIPS Payment Adjustment based on the 2017 MIPS Performance Period FAQs Available

The 2019 payment adjustment for CRNAs who reported merit-based incentive payment sytsem (MIPS) data for 2017 were implemented January 1, 2019. CMS provided a Fact Sheet in the quality payment plan (QPP) Resource Library that answers frequently asked questions such as which services are subject to a 2019 MIPS payment adjustment, and how adjustments are reflect on remittance advice documents. The Fact Sheet includes links to additional payment adjustment resources, like the Physician Fee Schedule (PFS) Lookup tool, where CRNAs can find information about services covered by the Medicare Physician Fee Schedule.
Share Facebook  LinkedIn  Twitter 

2019 MIPS Data Validation Criteria Published

The Centers for Medicare & Medicaid Services (CMS) published 2019 merit-based incentive payment system (MIPS) Data Validation Criteria for auditing the four performance categories. The data validation process is performed annually to ensure that MIPS data is accurate and useful for reporting measures. Downloadable resources include a Fact Sheet and detailed information about Improvement Activities. CRNAs can download the information from the quality payment program (QPP) Resource Library.
Share Facebook  LinkedIn  Twitter 

Webinar: Greater Health Equity Through Entrepreneurship: How Nurses Are Mentoring and Innovating to Improve Well-Being for All

The Diversity in Nurse Anesthesia Mentorship Program is holding a webinar on Tuesday, March 12, 2019, from 3-4:30 p.m. ET, on "Greater Health Equity Through Entrepreneurship: How Nurses Are Mentoring and Innovating to Improve Well-Being for All." 

Hear how advanced practice registered nurses (APRNs) have improved health equity locally and nationally through mentoring and entrepreneurship to increase diversity in nursing. Be inspired by innovations that are promoting excellent, affordable healthcare in underserved communities and pick up ideas you can put into practice too. Learn more.
Share Facebook  LinkedIn  Twitter 

Have a Malpractice Insurance Question?

Whether you’re a policyholder with a policy, coverage, or billing question or a member concerned about the coverage provided by your employer, AANA Insurance Services is available to assist with any of your malpractice needs. Contact us today!
Share Facebook  LinkedIn  Twitter 

SRNAs Represent: Enter the Education Committee Student Writing Contest

Submissions are now being accepted for the annual Student Writing Contest. The submission deadline is April 22, 2019.

Students must submit an essay of no more than 1,500 words (including references) on a topic pertinent to education, professional practice and development, wellness, healthcare, or health policy. Potential essay topics include, but are not limited to:
  • Leadership
  • Case reports
  • Health policy
  • Professional development
  • Quality improvement
  • Student wellness
  • Diversity
  • Interprofessional collaboration
  • Community service
  • Work-life balance
  • Simulation
  • Innovative use of technology in education
  • Ethics, and
  • Generational issues.
Citations must follow the AMA format.

The winner will be recognized during the Student Luncheon at the 2019 AANA Annual Congress. There also is an opportunity for the winning essay to be published in the AANA NewsBulletin as a Student News column.

Essays must be submitted via e-mail to the Education Department at Questions may be directed to the Education Department by e-mail or at 847-655-1161.
Share Facebook  LinkedIn  Twitter 

SRNA Excellence: Who is Deserving of the Student Excellence Award?

The Education Committee is looking for student registered nurse anesthetists (SRNAs) to consider for the Student Excellence Award. One student will be chosen from the nominees and receive the award at the 2019 AANA  Annual Congress. The winner will be recognized at the Student Luncheon.

The student must be nominated by their program administrator or the program administrator’s faculty designee. All individuals who are a student at the time of the submission deadline are eligible.

Defining characteristics of nominees include:
  • Evidence of professional promise
  • Record of extracurricular activities or other contributions to the college or community
  • Consistent excellent performance in the clinical setting for at least two semesters
Award guidelines:
  • One submission per program.
  • Submission must be a narrative of no more than 1,000 words
  • The narrative should provide specific details on how the student demonstrates excellence in leadership, scholarship, service or a related area.
Nominations must be submitted via e-mail to the Education Department at by April 22, 2019. Please direct any questions to the Education Department by e-mail or at 847-655-1161.
Share Facebook  LinkedIn  Twitter 

SRNAs: Apply for Student Representative to the Education Committee

The AANA Education Committee members include a student representative. The student representative facilitates the AANA Connect SRNA Community, contributes content to the AANA for SRNAs Facebook page, and writes the Student News column for the AANA NewsBulletin.

In addition, the student representative will participate in the efforts and mission of the Education Committee. The committee supports the professional development of nurse anesthesia didactic and clinical educators. Primary activities of the committee include planning the Assembly of Didactic and Clinical Educators (ADCE) meetings and the Student Session at Annual Congress. The committee also hosts the Student Luncheon and Anesthesia College Bowl at Annual Congress.

Students interested in education who wish to run for the position of Student Representative to the Education Committee can obtain an application from the AANA website under CE & Education > Education> Opportunities for Students. The application must be submitted by May 6, 2019 to The election will be held at Annual Congress.

Questions? Contact the Education department by e-mail or at 847-655-1161.
Share Facebook  LinkedIn  Twitter 

Last Chance! Consider Nominating a Colleague for an AANA Award!

Do you work with an outstanding program director, didactic instructor, or clinical instructor? Do you know someone who has spent a lifetime advancing the practice of nurse anesthesia as a practitioner, educator, clinician, or advocate? Consider nominating your colleague for one of the national AANA recognition awards. Visit Recognition Awards for details on the:
  • Agatha Hodgins Award for Outstanding Accomplishment,
  • Helen Lamb Outstanding Educator Award,
  • Alice Magaw Outstanding Clinical Anesthesia Practitioner Award,
  • Ira P. Gunn Award for Outstanding Professional Advocacy,
  • Clinical Instructor of the Year Award,
  • Didactic Instructor of the Year Award, and
  • Program Director of the Year Award.
Nomination deadline is March 15th.
Share Facebook  LinkedIn  Twitter 

Make a Difference by Serving Your Profession, Collaborating with Colleagues 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 has been extended to April 15, 2019. Please note: If you currently serve on a fiscal year 2019 committee, you must reapply for fiscal year 2020.
Share Facebook  LinkedIn  Twitter 

Council on Accreditation (COA) Seeks Nominations for Two CRNA Director Openings

The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is seeking nominations for one CRNA Educator director and one CRNA Practitioner director. Candidates must be available to attend three-day COA meetings, typically held in January, May and October. The term of office is three years, beginning Fall 2019 through Fall 2022.

The elected candidates then would be eligible to be considered for reelection to a second three-year term. The deadline to apply has been extended to April 1, 2019. For position criteria and application requirements, please visit
Share Facebook  LinkedIn  Twitter 

Meetings and Workshops

Now Open: Abstract Submission Process for 2020 Assembly of Didactic and Clinical Educators

You are invited to submit an abstract for consideration to present at the 2020 Assembly of Didactic and Clinical Educators (ADCE) on February 19-22, 2020, at the Chateau Elan Winery & Resort, Atlanta, Ga. The ADCE is the only forum that brings together all nurse anesthesia programs nationwide. Please visit the Call for Abstracts page on the AANA website for the Submission Guidelines and Content Questions.

The ADCE is designed to provide a variety of educational topics that will develop the maximum effectiveness of CRNAs in their roles as program administrators, didactic and clinical educators in diverse settings across the nation. Attended by hundreds of CRNAs, it is an excellent opportunity to present your best practices and research pertinent to education to your peers and nurse anesthesia students interested in becoming educators.

Build your reputation as an expert speaker while elevating your thought leadership. Get exposure to hundreds of top nurse anesthesia program decision-makers. All speakers are promoted in marketing materials that reach thousands of CRNAs and SRNAs leading up to the conference, and on the AANA website and AANA Meetings mobile app.

The goals of the ADCE are as follows:
  1. Provide an organized learning experience that augments the knowledge and skills of the CRNA in all educational settings.
  2. Serve as a forum to present best practices and research pertinent to nurse anesthesia didactic and clinical education.
  3. Facilitate interaction and networking between participants on a professional and social level.

Submission Deadlines and Notifications
  • Submission Deadline: April 16, 2019, at 11:59 p.m. CST.
  • Grading Deadline: May 20, 2019.
  • Notification Deadline: All presenters will be notified of their acceptance status no later than July 8, 2019.
Still have questions about the submission process after reviewing the website? Contact
Share Facebook  LinkedIn  Twitter 

Students and CRNAs Needed for the Anesthesia College Bowl!

The Anesthesia College Bowl is a spirited event held every year at the AANA Annual Congress. Six teams of six students each compete to answer questions about anesthesia that have been submitted by nurse anesthesia program directors. The winning student team then plays the six-member CRNA Challenge Team to determine the ultimate winner of the College Bowl. The winners hold bragging rights until the following year!

Students wishing to play must inform their program administrator, who can submit a maximum of two students to participate. The submission form is available on the AANA website under CE & Education > Education > Opportunities for Educators.

CRNAs who wish to play must submit the Challenge Team sign-up form available on the AANA website under CE & Education > Education > Opportunities for Educators.

The submission deadline for students and CRNAs is May 6, 2019. Please direct any questions to the Education Department at or 847-655-1161.
Share Facebook  LinkedIn  Twitter 


CRNA Jobs: Locum Tenens and Permanent Placement Opportunities Across the Country

United Anesthesia – Various Locations. United Anesthesia has been a leading CRNA and Anesthesiologist Locum Tenens and Permanent Placement firm in the country for 40 years. By specializing in only anesthesia placement, we can partner with you to find the ideal situation to suit your strengths, your priorities, your dreams. Your dedicated personal coordinator is looking forward to your call! Learn more.
Share Facebook  LinkedIn  Twitter 

Certified Registered Nurse Anesthetists: Sanford Health, Fargo, North Dakota

Sanford Health Fargo Anesthesia Department is currently seeking Certified Registered Nurse Anesthetists (CRNA) to join its current group of 21 anesthesiologists and 72 CRNAs. Learn more.
Share Facebook  LinkedIn  Twitter 

Full-time Anesthesia School Faculty Position: Middle Tennessee School of Anesthesia, Madison, Tennessee

Position Description: The Middle Tennessee School of Anesthesia (MTSA) is searching for qualified candidates for a full-time faculty position with a concentration in didactic instruction of research and evidence-based practice, as well as oversight for doctoral student scholarly projects. Learn more.
Share Facebook  LinkedIn  Twitter 

Assistant Director - Certified Registered Nurse Anesthesia Program: Marian University, Indianapolis, Indiana

The Leighton School of Nursing at Marian University in Indianapolis seeks a dynamic and innovative leader to serve as the Assistant Program Director for the Certified Nurse Anesthesia Program. The Assistant Program Director assists the Program Director in the daily operations of the Doctoral of Nursing Practice in Nurse Anesthesia Program and assists in assuring compliance with the Council on Accreditation of Nurse Anesthesia Educational Program’s Standards and Guidelines. Learn more.
Share Facebook  LinkedIn  Twitter 

Nurse Anesthetist: WellSpan Health, York, Pennsylvania

WellSpan Health, an integrated health system serving central Pennsylvania and northern Maryland, has openings for six (6) full time CRNAs to join Apple Hill Surgical Center in York. The organization is comprised of a multispecialty medical group of more than 1,500 physicians and advanced practice clinicians, a regional behavioral health organization, a home care organization, eight respected hospitals, more than 19,000 employees, and 170 patient care locations. Learn more.
Share Facebook  LinkedIn  Twitter 

Certified Registered Nurse Anesthetist: Memorial Health System, Springfield, Illinois

This position embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision and values. Our CRNAs administer general, regional, and MAC anesthesia to patients of all ages and any ASA status. The CRNAs work in a collaborative team environment with 50 CRNAs, 21 Anesthesiologists and 12 Anesthesia Techs to assist with room turnover and stocking. The CRNAs serve as Clinical Instructors for SIUE and Millikin/Decatur Nurse Anesthesia programs. Learn more.
Share Facebook  LinkedIn  Twitter 


How Does Your Career Grow?

Are you looking to further your career? CRNA Careers is a valuable resource to help you both in your job search and with your career advancement. It's more than a job board. CRNA Careers is where those searching for fulfillment, opportunity, and challenges go to find helpful career tips, search for jobs, and upload anonymous resumes to be found by recruiters and employers.

Here's how to grow your career on CRNA Careers:

  • Seek and find the best jobs in your industry.
  • Set up job alerts to be notified when the jobs you're looking for are posted on the site.
  • Upload your anonymous resume and allow employers to contact you.
  • Access career resources and job searching tips and tools.

Growing your career requires regular care and cultivation. CRNA Careers has the tools to move your career toward your goals. Learn more today!


Share Facebook  LinkedIn  Twitter 

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.

Association Between Night-Time Surgery and Occurrence of Intraoperative Adverse Events and Postoperative Pulmonary Complications

A post hoc analysis of the Local Assessment of Ventilatory Management During General Anesthesia for Surgery (LAS VEGAS) clinical trial looked at the potential disadvantages of operations performed in the evening. The prospective, multinational study involved 9,861 patients who underwent surgery with general anesthesia and mechanical ventilation. Based on induction start time, most procedures were conducted during the daytime hours of 8 a.m. to 7:59 p.m. A total of 555, or 5.6 percent of the patients, meanwhile, had their surgeries during the nighttime hours of 8 p.m. to 7:59 a.m. The primary co-outcomes for the post hoc study were incidence of intraoperative adverse events (AEs) and postoperative pulmonary complications (PPCs). The investigators determined that both endpoints were more common in patients having surgery at night. Differences in patients' clinical traits, types of surgery, and intraoperative management at night partially explained the increase in PPCs but not the higher rate of AEs.

From "Association Between Night-Time Surgery and Occurrence of Intraoperative Adverse Events and Postoperative Pulmonary Complications"
British Journal of Anaesthesia (03/19) Vol. 122, No. 3, P. 361 Cortegiani, A.; Gregoretti, C.; Neto, A.S.; et al.

Share Facebook  LinkedIn  Twitter 

Intubation Through Retromolar Space an Option in Patients with Trismus

Intubation is problematic in patients with trismus, commonly known as lockjaw, but researchers in Texas have identified a solution. Restricted mouth openings are common among patients with head and neck cancers, and anesthesia providers historically have gotten around the dilemma with nasal intubation or tracheostomy. An effective and less invasive option, according to experts at the University of Texas MD Anderson Cancer Center, is to snake a flexible fiber-optic scope through the retromolar space. They demonstrated the feasibility of the technique in a racially diverse sample of 80 healthy men and women. Silicone putty molds were used to measure the left and right retromolar spaces of each volunteer. Although the outer diameter of 6-millimeter endotracheal tube is 8.4 mm, the mean space height was lower, indicating that compressible soft tissues may allow successful retromolar intubation in these individuals. However, the investigators also determined that for every unit increase in body mass index, the height and width of the retromolar space decreased. Subsequently, they noted at the 2018 annual meeting of the Canadian Anesthesiologists' Society, the method may not be viable in patients who are obese or overweight.

From "Intubation Through Retromolar Space an Option in Patients with Trismus"
Anesthesiology News (03/01/19) Vlessides, Michael

Share Facebook  LinkedIn  Twitter 

Ketamine as a Rapid Sequence Induction Agent in the Trauma Population

Danish researchers examined whether ketamine should be the go-to agent for facilitating endotracheal intubation in trauma patients during rapid sequence induction (RSI). Ketamine is widely used in this setting, despite associated adverse effects. To investigate, colleagues from the University of Copenhagen and Copenhagen University Hospital conducted a systematic review including four studies that compared outcomes in adult patients who underwent RSI with ketamine versus etomidate, propofol, thiopental, or midazolam. The main endpoint was 30-day mortality, and no meaningful differences were apparent. The researchers also found length of hospital stay and number of blood transfusions—secondary outcomes—to be comparable with the different induction agents. Still, they maintain, a clinically relevant benefit or harm associated with ketamine in RSI cannot be ruled out.

From "Ketamine as a Rapid Sequence Induction Agent in the Trauma Population"
Anesthesia & Analgesia (03/19) Vol. 128, No. 3, P. 504 Baekgaard, Josefine S.; Eskesen, Trine G.; Sillesen, Martin; et al.

Share Facebook  LinkedIn  Twitter 

Frailty May Be a New Screening Criterion for Fitness for an Operation

Frailty is strongly associated with poor postoperative outcomes, report researchers, who suggest that screening for decline in function and resistance to short-term stress could help gauge readiness for elective surgery. While frailty often is observed in older adults, evidence links the condition to more cases of serious complications, hospital release to a rehabilitation facility, hospital readmission, and/or death in patients of all ages. The findings come from a study of 14,530 surgical patients, more than half of them under age 60, at four hospitals in the same health care system in Texas. Each patient's risk was calculated based on the Modified Johns Hopkins Frailty score—which considers recent unintentional weight loss of 10 pounds or more, weak handgrip, low blood level of hemoglobin, and a higher anesthesia risk (ASA score) as predictors. One point is assigned for each item with an additional point tacked on if both weight loss and weak grip are present, for a maximum score of five. Patients satisfying three or more frailty criteria were significantly more likely in the first 30 days after surgery to experience worse results compared with patients not meeting frailty criteria. "Although not every patient needs an extensive frailty evaluation, every patient's preoperative risk should be known," the authors wrote in their paper, published on the Journal of the American College of Surgeons' website ahead of print.

From "Frailty May Be a New Screening Criterion for Fitness for an Operation"
Medical Xpress (03/01/19)

Share Facebook  LinkedIn  Twitter 

Fentanyl REMS Program Falls Short

Despite Food and Drug Administration (FDA) guidance, research indicates that transmucosal immediate-release fentanyl products (TIRFs) are still used inappropriately. The powerful, short-acting drugs are approved exclusively for the management of breakthrough cancer pain in patients who are opioid-tolerant but are associated with adverse outcomes, misuse, and overdose in those who are not. In an effort to combat these realities, the FDA in December 2011 adopted a risk evaluation and mitigation strategy (REMS) that compels physicians, pharmacists, and patients to demonstrate their understanding of the appropriate use, indications, and risks of TIRFs before prescribing, dispensing, or using them. The REMS aimed to prevent TIRFs from being prescribed to patients who are not opioid tolerant or who have noncancer pain; but five years after its adoption, researchers say as much as 55.4 percent of patients prescribed TIRFs were not opioid tolerant. Moreover, only about half of the 318 participating pharmacists recognized that TIRFs are not appropriate even for opioid-tolerant patients if they have chronic, noncancer pain. Despite the apparent failure to restrict use of these drugs, FDA did not demand substantive changes to the program; and it does not appear to have disenrolled any prescribers for inappropriate prescribing. The findings appear in the Journal of the American Medical Association.

From "Fentanyl REMS Program Falls Short"
Medscape (03/01/19) Vlessides, Michael

Share Facebook  LinkedIn  Twitter 

Adverse Side Effects of Dexamethasone in Surgical Patients

Researchers at Amsterdam University Medical Centre led a meta-analysis centered around the adverse effects associated with dexamethasone administration during surgery. An incidental load of the steroid is often given perioperatively to prevent postoperative nausea and vomiting. A search of the literature turned up 37 relevant randomized controlled trials that met the review criteria. The pooled results found no evidence of an elevated risk of postoperative wound infection with dexamethasone, while large confidence intervals rendered its effect on wound healing unclear. Meanwhile, in non-diabetic patients, dexamethasone did mildly increase glucose levels in the first 12 hours postoperatively. The quality of the evidence was considered low to moderate.

From "Adverse Side Effects of Dexamethasone in Surgical Patients"
Anaesthesia (03/01/19) Polderman, J.A.W.; Farhang-Razi, V.; van Dieren, S.; et al.

Share Facebook  LinkedIn  Twitter 

News summaries © copyright 2019 SmithBucklin

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.

If you are interested in advertising in Anesthesia E-ssential contact HealthCom Media at 215-489-7000.

For more information on AANA and Anesthesia E-ssential, contact:

222 S. Prospect Avenue
Park Ridge, IL 60068
Phone: (855) 526-2262 (toll-free)/(847) 692-7050
Fax: (847) 692-6968

Attn: Cathy Hodson
E–ssential Editor
March 7, 2019
Earn Your DNAP