Anesthesia E-ssential

AANA Anesthesia E-ssential, May 10, 2018
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Vital Signs

The Hill Op-Ed: With Key Legislation Ready, Congress Must Act Now to Address Opioid Addiction

AANA President Bruce Weiner urges Congress to pass the Addiction Treatment Access Improvement Act of 2017, enabling CRNAs to help patients struggling with opioid addiction. "As the opioid crisis continues its devastation across the United States," writes Weiner, "an important piece of legislation that would have an immediate impact on patients battling addiction is stuck in neutral—the Addiction Treatment Access Improvement Act of 2017."

Read the full op-ed in The Hill.  
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The Joint Commission Seeks Comments on Proposed Pain Assessment and Management Standards

The Joint Commission is developing new pain assessment and management standards for critical access hospitals, ambulatory settings, and office-based surgery settings. These proposed requirements stress active participation by leadership and safe opioid prescribing protocols, as well as strengthen pain assessment, treatment, education and monitoring. Read the proposed standards and submit your comments to The Joint Commission . Comments are due May 22, 2018
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Hot Topics

AANA Calls on Healthcare Community to Use Opioid-Sparing Pain Management to Prevent Addiction and Abuse

Over 2 million people each year switch to persistent opioid use after surgery, and nearly half of all U.S. opioid overdose deaths involve a prescription opioid. The American Association of Nurse Anesthetists (AANA) is calling on the healthcare community at large to use opioid-sparing pain management techniques to better prevent opioid addiction and abuse.

“The American opioid crisis is one of the most pressing healthcare issues of our time, and more than ever the healthcare community needs to come together to modernize opioid-prescribing criteria and use more effective, evidence-based solutions to pain management practices, to help prevent opioid addiction,” said Bruce Weiner, a Certified Registered Nurse Anesthetist and president of the AANA.

One such approach is Enhanced Recovery After Surgery (ERAS) – a patient-centered, evidence-based, pain management strategy employed by CRNAs to reduce the need for opioids, improve patient outcomes and reduce cost. Rather than relying on opioids as the primary tool, ERAS uses robust patient communication and opioid-sparing techniques, such as regional anesthesia, peripheral nerve blocks, non-pharmacologic approaches and non-opioid medications to control pain. Recent research also shows:
  • ERAS provides an average savings of $880 to $5,560 per patient. ERAS reduces patient length of stay by 3-4 days on average.
  • ERAS reduces 30-day patient readmission rates and costs.
  • ERAS helps patients return to normal activities more quickly.

See a detailed infographic describing Enhanced Recovery After Surgery and its benefits. To learn more about CRNAs and their expertise in providing holistic, patient-centered, cost-effective pain management care, visit
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Deadline: May 15 to Apply for a FY2019 AANA Committee Position!

President-elect Garry Brydges is looking for volunteers to fill committee positions in fiscal year 2019. Many committees have positions available 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, 2018. Please note: If you currently serve on a fiscal year 2018 committee, you must reapply for fiscal year 2019.
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2018 Board Candidate Forum: Interact with the Candidates!

The AANA Connect 2018 Board Candidate Forum is now available for members to interact with candidates for the AANA Board of Directors. The forum will remain open until May 23, 2018. After that date, members will be able to view the forum through the end of the voting cycle (June 5, 2018) but won't be able to post additional questions.

To participate or view the discussion, visit the Candidate Forum. You also will  receive a daily digest email of the discussions in the forum. If you'd like to turn off those emails, visit your Community Notification settings page. In the drop-down menu next to "2018 Board Candidate Forum," select "No Email."

In this year's Candidate Forum Community, each office will have its own thread: a thread for President-Elect, a thread for Vice President, a thread for Treasurer, and so on. Here, members are able to ask questions of the candidates running for that particular office.

If you have questions or need assistance, please email We look forward to your participation.
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Program Administrators/Faculty: Nominate an SRNA for the Student Excellence Award

One student will receive the Education Committee Student Excellence Award at the Nurse Anesthesia Annual Congress. The winner will be recognized at the Student Luncheon with a plaque and will be given the opportunity to address the audience for no more than 5 minutes (not required).

The award will be presented to a student in good academic standing who demonstrates outstanding leadership and professionalism during their 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. The student must be nominated by the 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 May 14th. Please direct any questions to the Education Department at or 847-655-1161.
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Apply for Student Representative to the Education Committee

The AANA Education Committee supports the professional development of nurse anesthesia didactic and clinical educators. Primary activities of the committee include planning the Assembly of School Faculty (ASF), the ASF portion of the Nurse Anesthesia Annual Congress, and the Student Session at Annual Congress. The committee also hosts the Student Luncheon and Anesthesia College Bowl at Annual Congress.

The committee includes a student representative. In addition to participating in the above activities, the student representative facilitates the AANAConnect SRNA Community, contributes content to the AANA for SRNAs Facebook page, and writes the Student News column for the AANA NewsBulletin.

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 June 4th to The election will be held at Annual Congress.

Questions? Contact the Education department at or 847-655-1161.
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Consensus Statement on Ear and Hair Coverage

Recently, a task force reviewed and discussed literature related to recommendations for operating room attire, specifically ear and hair covering. The task force concluded that the requirement for ear coverage is not supported by sufficient evidence and that available scientific evidence does not demonstrate any association between the type of hat or extent of hair coverage and surgical site infection rates.

Although AANA was not represented at this meeting, we continue to work closely with the Association of peri-Operative Registered Nurses (AORN), as members of the multidisciplinary AORN Guidelines Advisory Board, to research and update the guidelines for surgical attire.

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NewsMaker: CRNA Ron Castaldo Wins AANP 2018 State Award for Excellence

Ron Castaldo, PhD, MBA, MS, CRNA, APRN, CCRNRon Castaldo, PhD, MBA, MS, CRNA, APRN, CCRN, is one of the American Association of Nurse Practitioners' (AANP) 2018 State Award for Excellence recipients.

The State Award for Nurse Practitioner Excellence, founded in 1991, recognizes a state nurse practitioner who demonstrates excellence in practice.

Castaldo will be honored at an awards ceremony and reception held during the AANP 2018 National Conference held June 26-July 1, 2018, in Denver, Colorado.
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NewsMaker: SRNA Jason Flowers Wins Business Pitch Competition

Nurse anesthesia student Jason Flowers took home first place in the Hagerman Center for Entrepreneurship and Innovation Business Pitch Competition for a minimally invasive, expandable endotracheal tube.

The competition is a University of Michigan-Flint (UM-Flint) event run by the center and the school of management. The competition is open to students from all disciplines. Flowers received $5,000 and a range of free consultations.

Read the Q&A with Jason.
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Meetings and Workshops

New: The Writers Workshop Becomes a Pre-Congress Workshop, Lengthened to 3 hours

"The Writers Workshop: Writing for Professional and Scholarly Publication" will be held on Friday, Sept. 21, from 8-11:15 a.m. at the Sheraton Boston Hotel.

The Writers Workshop will include presentations and a discussion regarding what constitutes a good idea for publication, the process of marshaling that idea to a tangible product that merits consideration for publication, and anticipating what will occur during the peer-review process.

Exemplars will be used to explore optimizing the process, and the workshop will be led by senior leaders of the AANA Journal Committee. This Writers Workshop is intended to provide both novice and experienced clinician/scholars with practical advice on writing for publication.

Those who will benefit the most from this workshop are students, faculty and clinicians who seek to contribute to, and advance our profession by writing for refereed (peer-reviewed) publication sources. The benefits of publishing in  healthcare research are many. In addition, publishing advances patient safety, the profession of nurse anesthesia, and gains you recognition among your colleagues that will greatly benefit your career.

Don’t miss this prime opportunity to get crucial advice from seasoned authors.

Learn more.
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Get in the Game at the Anesthesia College Bowl!

Why stay on the sidelines when you can get in the game? Students and CRNAs are needed for the Anesthesia College Bowl, a fun-filled event held every year at the Nurse Anesthesia Annual Congress. Six teams of six students each compete to answer questions about anesthesia that have been submitted by nurse anesthesia program administrators. 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 who wish to play must inform their program administrator, who can submit a maximum of two students to participate. The rules and submission form are available under CE & Education > Education > Opportunities for Educators.

CRNAs who wish to play must submit the Challenge Team sign-up form available under CE & Education > Education > Opportunities for Educators, where the rules also are posted.

The submission deadline for students and CRNAs is June 4th. Please direct any questions to the Education Department at or 847-655-1161.
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Foundation and Research

Friends for Life Deadline – June 15, 2018

Friends for Life support the future of the nurse anesthesia profession through meaningful, lasting gifts that fund and sustain programs in anesthesia research and education.

The minimum gift commitment to join Friends for Life is $25,000. Members may fulfill this commitment through a cash gift, but there are many other ways to meet the commitment through planned gifts. Some of the most popular planned gift options for becoming a Friend for Life include:
  • A gift (bequest) in the will for a specific amount or a percentage of the total estate.
  • Gift of personal property or real estate.
  • Including the Foundation as a beneficiary on a retirement plan or a whole life insurance policy.
Friends for Life receive a medallion at the AANA Annual Congress Opening Ceremonies, an engraved plaque in the AANA Park Ridge office and an invitation to the Annual Awards and Recognition Event.

For further information, please contact Nat Carmichael at (847) 655-1175 or The Friends for Life submission deadline for recognition at this year’s Annual Congress in Boston, Massachusetts, is June 15, 2018.

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Support Education and Research: Make Your Donation to the AANA Foundation’s Annual Fund Today!

Thanks to your donations, the AANA Foundation supports education and important research which benefits all CRNAs. Evidence provides proof, and proof is power!

Access the Foundation’s secure donation page and make your tax-deductible gift to AANA Foundation’s Proof is Power Annual Fund today.

Donations of $100 or more made by July 1, 2018 will be included in the AANA Foundation Fiscal Year 2018 Annual Report and Recognition booklet.

Thank you in advance for your contribution and support of nurse anesthesia through the AANA Foundation!
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Support the AANA Foundation: Shop AmazonSmile

You can easily support the AANA Foundation every time you make a purchase on Amazon. When you shop at AmazonSmile, Amazon donates 0.5 percent of the purchase price to the AANA Foundation. Please bookmark the link and support the Foundation while you shop!
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AANA Member Benefits

CRNA Financial Planning: A Free Book, Free Tax Evaluation, and Discounted Retirement Income Analysis

Our new Member Advantage Partner, CRNA Financial Planning, is offering a free book and tax evaluation for AANA members, as well as a discount on their retirement income analysis services.

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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.

Pre-Sedation Guidelines for Kids May Be Too Strict

Children in need of emergency care can undergo sedation even if they eat or drink something right before arriving at the emergency department (ED), Canadian researchers report in JAMA Pediatrics. The results from their multi-site cohort study challenge current American Society of Anesthesiologists (ASA) guidelines that dictate children should have no clear liquids for at least two hours, no breast milk for at least four hours, no infant formula or light meals for at least six hours, and no solids for at least eight hours before sedation. The rules are meant to avoid pulmonary aspiration; but no such event occurred in any of the nearly 6,200 kids included in the study, almost half of whom did not satisfy fasting requirement for solids and 5 percent of whom did not meet the requirement for liquids. The likelihood of any sedation-involved adverse event, meanwhile, did not increase the longer patients abstained from food and drink. Based on the findings, the investigators at Children's Hospital of Eastern Ontario determined the risk of pulmonary aspiration to be much lower than the literature suggests: 3.1 in 10,000 sedations, as opposed to 15 in 10,000. "It is important to note that, to our knowledge, there have never been any reported cases of pulmonary aspiration in children undergoing parenteral sedation in the ED setting, despite widespread nonadherence with fasting guidelines," the authors said. "Our study findings provide support to the idea that strict adherence to ASA fasting guidelines does not improve patient outcomes for children undergoing procedural sedation in the ED." What it could accomplish, they add, is a prolonged stay in the ED and impediment of patient flow. Therefore, they back the American College of Emergency Physicians' recommendation "not to delay ED procedural sedation based solely on fasting time."

From "Pre-Sedation Guidelines for Kids May Be Too Strict"
MedPage Today (05/07/18) Lou, Nicole

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Surgery While You're Wide Awake? MD Anderson Doctors Using Hypnosis Instead of General Anesthesia

Clinical researchers at MD Anderson Cancer Center are exploring the use of hypnosedation for certain types of lumpectomies performed on early-stage breast cancer patients. "Do we need to use the same anesthesia, the same approach for every patient for every cancer? Probably not," says Dalliah Black, MD, a breast surgical oncologist. "As patients we're all different, the cancers are all different, the surgeries are different." For the study, participants received analgesia and local anesthetic, plus a mind-body intervention specialist led them into a hypnotic state through a series of relaxation techniques. Hypnosedation allows patients to bypass general anesthesia—which MD Anderson doctors say can weaken immune systems—and potentially recover from their procedure more quickly. Even so, they acknowledge that the approach is not suitable for every patient or every operation. One goal of the trial, they add, is to get a better idea of when and where it works best.

From "Surgery While You're Wide Awake? MD Anderson Doctors Using Hypnosis Instead of General Anesthesia"
ABC13 (Houston) (05/06/18) Lodhia, Pooja

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Key Factors Determine Success of Epidural Patch for CSF Leaks

Mayo Clinic researchers have achieved new understanding of epidural blood patches for the treatment of spontaneous cerebrospinal fluid (CSF) leaks. The condition, which involves loss of fluid around the brain stem, is known to present as orthostatic headache and is frequently misdiagnosed or diagnosed late. While epidural patches can improve the so-called brain sag that may develop as a result of lost fluid, just one application typically is not effective. The Mayo team performed a retrospective case series of 202 patients who had received a total of 604 epidural blood patches. About half required at least two treatments, and the average period before the patch wore off was only about two weeks. However, the study revealed that patch efficacy—deemed as relief lasting three months or longer—was more likely in cases where a higher volume of blood was injected. Another predictor was use of multiple needles and multiple injections along a number of sites in the epidural space, as opposed to using single needles. Additionally, transforaminal route of administration and use of site-directed patches versus nontargeted patches were markers of efficacy. Meanwhile, MRI confirmation of brain sag, four or more MRI abnormalities, and development of rebound intracranial hypertension were predictive factors to patch failure at three months, as was blood-only injection as opposed to injections including fibrin. The study was presented at the American Academy of Pain Medicine 2018 Annual Meeting.

From "Key Factors Determine Success of Epidural Patch for CSF Leaks"
Medscape (05/02/18) Anderson, Pauline

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Effect of Atropine with Propofol vs Atropine with Atracurium and Sufentanil on Oxygen desaturation in Neonates Requiring Nonemergency Intubation

A French study compared two premedication interventions for nasotracheal intubation in newborns. Although both techniques—propofol, or a combination of muscle relaxant and synthetic opioid—are accepted in this setting, it was unknown if one performed better than the other. The researchers turned to six neonatal intensive care units for answers, recruiting 173 babies for their randomized trial. Before undergoing nonemergency intubation, the children were assigned to receive either atropine-propofol or atropine-atracurium-sufentanil. The primary outcome was prolonged desaturation, defined as a pulse oximetry value below 80% for at least 60 uninterrupted seconds. The frequency of such events was about 60% for the propofol group and roughly 66% for the atropine-atracurium-sufentanil group. Although this difference was not considered statistically significant, measurements of prolonged desaturation in an earlier investigation were more dramatic 6 minutes and 9 minutes after induction. The French study, therefore, may have been underpowered to detect a clinically meaningful difference in the primary outcome. Further research is warranted, the researchers conclude.

From "Effect of Atropine with Propofol vs Atropine with Atracurium and Sufentanil on Oxygen desaturation in Neonates Requiring Nonemergency Intubation"
Journal of the American Medical Association (05/01/18) Vol. 319, No. 17, P. 1790 Durrmeyer, Xavier; Breinig, Sophie; Claris, Olivier; et al.

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Effects of Ambient Temperature and Forced-Air Warming on Intraoperative Core Temperature

Researchers conducted a factorial trial in hopes of better understanding the effect of ambient temperature on intraoperative core temperature. The study involved 292 patients who were randomly assigned to ambient temperatures of 19, 21, or 23 degrees Celsius. Participants additionally were randomized to forced-air warming or passive insulation. The main endpoint was core temperature change between one and three hours following anesthesia induction. Using linear mixed-effects models, the investigators determined that core temperature is little affected by ambient intraoperative temperature when forced-air warming is used. There is a slightly more pronounced, but still small effect, meanwhile, when patients are kept warm through passive insulation. Based on the findings, the researchers agree that in cases where patients are actively warmed, ambient temperature can be set with the comfort of the operating room staff in mind.

From "Effects of Ambient Temperature and Forced-Air Warming on Intraoperative Core Temperature"
Anesthesiology (05/18) Vol. 128, No. 5, P. 903 Pei, Lijian; Huang, Yuguang; Xu, Yiyao; et al.

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A Comparative Study of Oral Analgesics for Postoperative Pain After Minor Oral Surgery

Research done in Japan compared the performance of three drugs commonly used to manage pain following minor dental surgery under general anesthesia. The study's 128 patients were randomized into four treatment groups: diclofenac sodium, celecoxib, acetaminophen, or placebo. All of the medications were taken by the oral route preoperatively, while intravenous patient-controlled fentanyl infusion was used postoperatively. Based on measurements taken at four, five, and six hours after administration of the test drug, visual analog scale (VAS) scores were lower at all three intervals for diclofenac sodium and celecoxib compared with placebo. In addition, more time passed before the first demand for post-surgery analgesia with recipients of those drugs, who also consumed less fentanyl than placebo-takers after the procedure. A similar trend emerged with acetaminophen versus placebo, but only at the five- and six-hour marks. There was no meaningful difference seen between the two, however, in VAS scores at four hours after administration or in time to first requirement for fentanyl. The study results indicate that 400 mg of oral celecoxib is appropriate for controlling postoperative pain and is as effective as 50 mg of diclofenac sodium. At a dose of 1,000 mg, meanwhile, acetaminophen also provides analgesic relief for postoperative pain in the dental setting—but with slower onset.

From "A Comparative Study of Oral Analgesics for Postoperative Pain After Minor Oral Surgery"
Anesthesia Progress (Spring 2018) Vol. 65, No. 1, P. 24 Hanzawa, Atsushi; Handa, Toshiyuki; Kohkita, Yoshihiko; et al.

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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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May 10, 2018
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