Anesthesia E-ssential

AANA Anesthesia E-ssential, May 14, 2020

Vital Signs

AANA Leaders Prove Now is the Time for Evidence-Based Policy in the VA, not Politics

Leaders of the American Association of Nurse Anesthetists (AANA) issued an action alert recently, encouraging members to contact lawmakers about improving access to quality care for the nation’s veterans.

AANA President Kate Jansky, MHS, CRNA, APRN, USA LTC (ret), and AANA CEO Randall D. Moore, DNP, MBA, CRNA—both veterans—addressed a series of “misleading” and “inflammatory” assertions made by the American Society of Anesthesiologists this week related to a U.S. Department of Veterans Affairs (VA) directive allowing full practice authority for Certified Registered Nurse Anesthetists (CRNAs) in the VA.

Jansky and Moore called the ASA’s action an attempt to “scare the public into believing that CRNAs will put our veterans’ health at risk.” In their alert, Jansky and Moore wrote: “Because ‘I say so’ is not an argument that carries any weight. Yet, that is precisely what the ASA consistently relies on to scare the public into believing that CRNAs are not safe. Unfortunately for them, this justification doesn’t work … and has no place in policymaking.”

Jansky and Moore addressed seven claims by providing evidence-based facts about CRNAs. “As veterans who care a great deal about our fellow brothers and sisters who have served this country, we feel a responsibility to tell the truth and to set the record straight,” they wrote, adding that ASA’s “over-the-top claims are missing something important: any credible evidence to back them up.” Learn more.
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AANA Pushes Back on Skewed VA Story

Last week, a CBS station in Atlanta ran a story about the Veterans Administration (VA) Directive 1899, which calls for full practice authority for CRNAs working in the VA. The story was notably biased and included only the physician anesthesiologist point of view, despite outreach from the AANA prior to the story's publication. The AANA objected to the tilt of the story and reached out to the station with our concerns.

Working with the CBS station, we presented a clear view and facts as to why CRNAs are safe and provided a counter argument to the original piece. The news story has since been edited to include the viewpoint of CRNAs and the AANA. The AANA will continue to push to ensure that the actual facts about CRNA care are used to inform policy making. We continue to ask our members to join us in making sure that your representatives in Congress also are aware of the facts.

Please follow the instructions below to contact your legislators with the FACTS about CRNAs.
  1. Go to AANA Federal Government Affairs and click "Get Started."
  2. Enter your name and address to be matched to your legislator(s).
  3. You will be directed to a letter that you can personalize and send to your legislator(s).
  4. Share the link with your friends and family so they can take action!
NOTE: If you've already contacted your legislators via the CRNA-PAC website, you do not need to take action again.

If you have any questions, please don't hesitate to contact AANA Federal Government Affairs at
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CRNA-led Advocacy for High-Quality Global Anesthesia: Increasing the Capacity to Train Qualified Nurse Anesthetists in Liberia

In 2019, members of the Boston-Africa Anesthesia Collaborative (BAAC), which includes Phebe Nurse Anesthesia Program in Liberia, Northeastern University Nurse Anesthesia Program (NEU), Beth Israel Deaconess Medical Center (BIDMC), and Children’s Hospital Boston (CHB) began a monthly virtual grand rounds series. A different topic is chosen every month, and research and clinical cases are presented. With the global onslaught of the COVID-19 pandemic, the collaborative purpose of the grand rounds hasn’t changed, but the focus of content is different.

“We started conducting remote grand rounds via video last fall and due to COVID-19, we’ve increased these from once per month to every week,” said Janet Dewan, PhD, MS, CRNA. “Presently, we’ve had as many as 12 nurses, nurse anesthetists, and health policy makers from Africa joining these sessions.”

Liberian nurse anesthetists are uniquely positioned to share lessons learned from the Ebola crisis with CRNAs in the United States. Members of the Boston-Africa Anesthesia Collaborative share research, clinical cases, and their experiences. Learn more.
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The Importance of Self-Care: Mental Health Awareness Month

May is Mental Health Awareness Month and taking care of your mental well-being now is more important than ever. Nearly 50% of Americans report that the coronavirus pandemic is harming their mental health. Take care of yourself! Visit for tips and resources.
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Make Your Voice Heard! AANA Election Voting Ends May 19, 2020, at Noon CT

By now you should have received your voting credentials for the AANA 2020 Election from AANA's election services coordinator, Survey and Ballot Systems (SBS). The AANA 2020 Election opened May 5, 2020, and will continue until May 19, 2020, at Noon CT. The email containing your voting credentials originated from Please make sure this email did not end up in your spam or junk email folder.

If you do not have your voting credentials, please click AANA Election Center, enter your email address on file with AANA, and your credentials will be emailed to you. SBS also can be reached by phone at 952-974-2339 (Monday through Friday, 8 a.m. to 5 p.m. CT) or by email at

To vote online and view candidates' biographical information and position statements, visit the election site and enter the voting credentials provided to you by SBS.

You also can view candidates' information on the AANA website (Member login required).
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Hot Topics

2019 MIPS Preliminary Feedback Is Available

CRNAs who submitted merit-based incentive payment system (MIPS) data for 2019 can now view their preliminary performance data through the Quality Payment Program website. Clinicians need to use their HCQIS* Authorization Roles and Profile (HARP) credentials to log in. This preliminary feedback does not reflect the final score, because results could change based on Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS data, or if clinicians applied for the Extreme and Uncontrollable Circumstances exception. The final score will be made available in July 2020.

*Health Care Quality Improvement System
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New AANA Resources on 2020 MIPS Reporting

CRNAs can now access updated information about 2020 merit-based incentive payment system (MIPS) reporting requirements through the AANA’s website. The Quality-Reimbursement page was updated with new slide presentations and FAQs about participation in the Quality, Improvement Activity, Cost and Promoting Interoperability performance measure categories. The slides contain overviews of performance category participation and scoring, while the FAQs go into greater detail about requirements for data collection and reporting.
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AAAHC COVID-19 Resources

Accreditation Association for Ambulatory Health Care (AAAHC) has a COVID-19 resource page that addresses surveys, converting ASCs for hospital cases, infection prevention and control, alignment of AAAHC standards with Ambulatory Surgery Center Association recommendations, and other updates. If you work at an AAAHC-accredited organization, check this page frequently for current news, standards, and updates.
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The Joint Commission COVID-19 Resources

The Joint Commission has issued many recommendations and resources related to COVID-19. These resources address appropriate masks and personal protective equipment (PPE) in the healthcare setting, including:
Additional resources address a variety of clinical, credentialing and privileging, and staff health and well-being topics, and include accreditation standard frequently asked questions. Review this page often for updated and new content.
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SUPPORT THE FRONT: Free Virtual COVID-19 Mental Well-being Support for Healthcare Professionals

CRNAs at the frontlines are seeing uncertainty in the changing workplace needs as well as the science of the coronavirus, fear of safety from inadequate PPE and testing, and facing deaths at unprecedented numbers. These unique COVID-19 factors lead to significant stress, anxiety, trauma, and grief.

To cope with the distress in a healthy way before this distress causes greater and longer term threats to your mental health, know these reactions are normal. Find support among your peers to share common concerns, stories, and insights. Join one of many free virtual support groups, view the available topics and full schedule at See also
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Apply to Serve on the CRNA-PAC Committee by June 30

Are you a CRNA or SRNA with a strong interest in furthering the nurse anesthesia profession through federal political advocacy? If so, apply for a position on the FY2021 CRNA-PAC Committee. Application deadline: June 30, 2020.

Responsibilities of Committee members include:
  • Setting and overseeing the CRNA-PAC expenditure and income policy;
  • Determining funding of open-seat and challenger candidates;
  • Fulfilling duties at CRNA-PAC events and AANA national meetings;
  • Participating in fundraising duties;
  • Attending in-person meetings at the Mid-Year Assembly and Joint Committee Conference, and conference calls on an as-needed basis.
Apply on the committee page. If you have any questions, please contact Catharine Harris, AANA Associate Director of Political Affairs, at

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 U.S. Citizen.

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Interested in Serving on a FY2021 AANA Committee? Application Deadline Extended

Deadline Extended: June 30, 2020
The deadline to apply for a position on a FY2021 AANA Committee has been extended! More information is available on the AANA Committee page. The application deadline is June 30, 2020.
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NewsMaker: CRNA Donya Baker Honored as Advanced Practice Nurse of the Year

Donya Baker, MNA, CRNA, has been chosen as Advanced Practice Nurse of the Year at McLeod Regional Medical Center in Florence, S.C. The medical center's annual Nurses of the Year ceremony is usually a standing-room-only event, but this year it was pared down and conducted outside on the hospital's front lawn.

"Donya is considered one of the most caring CRNAs in our department," says Rocky Cagle, nursing director for anesthesia, in honoring Donya Baker as Advanced Practice Nurse of the Year. "She can find the silver lining in every situation and treats everyone like family...she has selflessly volunteered to be on our intubation team for the hospital. Her sacrifices allowed others who are more vulnerable or have small children at home to lessen their chance of exposure." Learn more.
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NewsMaker: SRNA Ashlea Sledge Keeps Competitive Spirit Fun by Giving Back

An article in the Northside Sun (Jackson, Miss.) profiles SRNA Ashlea Sledge and her twin sister Kimberly. Ashlea and Kimberly have a natural competitive nature, but give back to their hometown of Jackson, Miss., through several events on their calendar each year, including a benefit for the American Cancer Society and the Walk to End Alzheimer's.

"It's a great thing when young professionals come together to build each other up and give back to the community at the same time," said Ashlea. "I think that's the basis of most of the things that Kimberly and I do." Learn more.
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Foundation and Research

AANA Foundation Open Submission: Dean Hayden Student Research & Evidence-Based Practice Grant

This grant is open to student registered nurse anesthetists (SRNAs) who are nurse anesthesia students in good academic standing and an associate member of the AANA. Visit the Foundation’s Applications and Program Information webpage to learn more and apply.
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AANA Foundation: Call for Board of Trustees Candidates - Deadline June 1, 2020

The AANA Foundation is seeking candidates for its Board of Trustees. If you are interested, review the criteria and apply by June 1, 2020. Thank you.
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AANA Member Benefits

Medtronic and Johnson & Johnson Show Their Support For CRNAs

The AANA would like to thank Corporate Partner Medtronic and Johnson & Johnson, who have provided financial support for the COVID-19 Webinar Series through a medical educational grant. With their support, the AANA can continue to provide members with essential tools and clinical resources during this challenging time. This complimentary webinar series is a resource for all CRNAs working to update their skills and knowledge related to managing patients with expected or confirmed COVID-19 infections. Earn up to 6.75 AANA Class A credits with this series.

  • Pediatric Anesthesia during the COVID-19 Pandemic
    Monday, May 18, 2020
    5:00 p.m. CT, Register
    1.25 Class A CE Credit
  • Resuming Elective, Non-urgent Surgical Procedures during the COVID-19 Pandemic
    Wednesday, May 20, 2020
    6:00 p.m. CT, Register
    0.5 Class A CE Credit
Replays Now Available on CRNA Knowledge Network
Catch up with the latest AANA COVID-related webinars on AANA's new video- and audio-streaming platform for CRNAs. FREE for all AANA members through 7/31/2020:
  • COVID-19 Infection Prevention Pearls
  • Acute Respiratory Distress Syndrome (ARDS): What You Need to Know Today
  • Peer Support, Self-Care, and Resilience for Health Care Providers during COVID-19
  • AANA Townhall

Previous/Other Topics

  • Pediatric Anesthesia During the COVID-19 Pandemic
  • Impact of Drug Shortages During the COVID-19 Pandemic
Get the latest schedule!
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Members, Take Advantage of Free Class A and Pharmacology Credits!

Earn up to 9.5 Class A CE and 1.75 pharmacology credits with exclusive AANA Learn® courses, including topics like enhanced recovery, respiratory compromise, and multimodal pain management. Free to AANA members and associate (student) members—just log in and add the course(s) to your cart. Get started today!
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New Tool Finalized For Assessing Respiratory Compromise Risk

A new tool has been finalized for assessing respiratory compromise risk: PRODIGY - PRediction of Opioid-induced Respiratory Depression In Patients Monitored by capnoGraphY.

Much has been learned about patient risk of opioid-induced respiratory depression (OIRD) and the new PRODIGY tool, supported by AANA Corporate Partner Medtronic, designed to help fill that gap and answer questions for optimal monitoring respiratory depression episodes in patients receiving opioids on the general care floor. The recent study available online in the journal, Anesthesia & Analgesia, “Prediction of Opioid-Induced Respiratory Depression on Inpatient Wards Using Continuous Capnography and Oximetry-An International Prospective, Observational Trial,” offers clinicians an updated perspective on the new tool.

Check out these resources available to members:  
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CRNACareers - What are your next steps?

Whether you’re graduating soon and researching employers, are a seasoned professional interested in advancing your career or looking to supplement your work with locum tenens options, is the place to help get you started:

  • Search and apply to locum tenens or permanent positions at industry-leading facilities.
  • Upload your resume anonymously and allow employers to contact you.
  • Set up job alerts to receive notifications on new openings.
  • Access free career resources to assist with resume and interview preparation.

Learn more today!

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Certified Registered Nurse Anesthetist: Dartmouth-Hitchcock Medical Center, New Hampshire

Are you a dedicated CRNA and wish to pursue a career within a collaborative Anesthesia Care Team? Are you interested in a setting where SRNA clinical rotations and Resident training make a dynamic and challenging teaching environment in which to work and grow?

If so, Dartmouth-Hitchcock's Department of Anesthesiology is growing and looking for additional CRNAs to join the team!

What Dartmouth-Hitchcock can offer:
  • Academic appointment as an Instructor of Anesthesiology from the Geisel School of Medicine at Dartmouth College.
  • Positive workplace culture with career advancement opportunities.
  • The quintessential New England experience – Four season living!
  • No income or sales tax.
  • Communities which have been ranked consistently as one of the best places in the US to live and work.
Why Work at Dartmouth-Hitchcock:
  • Competitive W2 base salary commensurate with experience.
  • Generous loan repayment program.
  • $10k relocation bonus.
  • Fully benefited positions through Dartmouth-Hitchcock Medical Center.
Our practice:
  • D-H is a Tertiary Care referral center with a Level-1 Trauma verification from the American College of Surgeons.
  • 60+ CRNAs - Working in an ACT Model with both an SRNA and Resident training program.
  • The Department of Anesthesiology at D-H provides anesthesia services for over 35,000 cases/year.
  • Services include, General Surgery, Trauma, Maxillofacial, Neurosurgery, Thoracic, Transplant, Vascular and Orthopedics.
Minimum Qualifications:
  • Master’s Degree from an accredited nurse anesthesia education program.
Required Licensure/Certification Skills:
  • Current New Hampshire RN license required.
  • Certified Registered Nurse Anesthetist (CRNA) required.
Learn more.
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Nurse Anesthetist: Ambulatory Surgical Center, Dartmouth-Hitchcock Medical Center, New Hampshire

Dartmouth-Hitchcock is currently seeking Certified Registered Nurse Anesthetists to join the highly anticipated state-of-the-art Ambulatory Surgical Center at Dartmouth-Hitchcock Manchester. The facility will be a well-rounded, multi-specialty surgical center. CRNAs will work in a collaborative team-based environment, where the focus will be centered on quality patient care.

About the Manchester ASC:
  • The ASC will be designed to provide 23-hour care, with six operating rooms and three procedure rooms.
  • Dynamic case mix of pediatrics and adults to include Urology, GI, ENT, Plastic, General Surgery, Breast, Pain, Gynecology, and Ortho.
  • Private Practice feel with the backing of Dartmouth-Hitchcock Medical Center, where CRNAs will work in a collaborative and supportive environment.
  • Developing team – there will be leadership opportunity and growth opportunities as the practice expands.
  • Ten-hour shifts with no weekends, no holidays and no call responsibility.
Why Work at Dartmouth-Hitchcock:
  • Competitive W2 base salary commensurate with experience.
  • $10k relocation bonus.
  • Fully benefited position through Dartmouth-Hitchcock Medical Center.
  • The quintessential New England experience – Four season living!
  • No income or sales tax.
With over 125+ physicians, Dartmouth Hitchcock Manchester is the largest multi-specialty group practice in southern New Hampshire. Our progressive, physician-led organization utilizes a patient-focused approach to the care, treatment and also supports collaboration across programs and specialties. Having been ranked the #1 Small City and Best Place to Live and Raise a Family (Fortune and Money Magazine), Manchester is within an hour's drive to Boston, the seacoast, the lakes and mountain regions - offering something for everyone. As the largest city in New Hampshire, Manchester offers many cultural and social activities as well as strong school systems to contribute to a balanced lifestyle. Learn more.
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CRNA: Southern Illinois Healthcare, Illinois

SIH Medical Group is seeking additional CRNAs to join the experienced Anesthesia Services team at our expanding health system.

We are proud to offer a successful, team-based culture combined with a balanced lifestyle and financial security.

Base salary:
  • $220,000 0-2 years experience
  • $240,000 3-4 years experience
  • $260,000 5+ years experience
  • $20,000 sign-on bonus
  • $25,000 retention bonus
  • Overtime compensation after 40 hours in a week
  • Student loan assistance
  • Paid CME allowance
  • Full benefits package with retirement plan
Paid Time Off:
  • 6 weeks, year 1
  • 7 weeks, year 2
  • 8 weeks, year 3+
Enjoy a great lifestyle operating within an anesthesia care team with anesthesiologists and CRNAs working in collaboration to provide quality care. Our anesthesia team of 40 performs a wide variety of cases and procedures across three hospitals and two ASTCs. Types of cases include bariatric, cardiac, endoscopy, electrophysiology, ENT, general surgery, GI, neurology, OB/GYN, oncology, ophthalmologic, orthopedics, podiatry, plastic surgery, trauma, urology, and well pediatrics.

SIH is the leading provider of healthcare services in southern Illinois. Financially strong with engaged leadership and talented employees, SIH is committed to doing what’s best for our patients every day. We invite you to visit and experience our community, culture, and opportunities for yourself. Learn more.
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CRNA: San Juan Regional Medical Center, New Mexico

San Juan Regional Medical Center Anesthesiology in Farmington, New Mexico, is seeking a CRNA. Covered procedures include General, Acute Pain Service, Pre-op screening, Outpatient surgery, Neurosurgery, Trauma Anesthesia, Critical Care Medicine, Orthopedic, Pediatric, Obstetric, Thoracic Anesthesia, Ped/Adult Dental, OMFS. Anesthesiologists supervise CRNAs. Successful Applicants must have New Mexico CRNA license upon hire and NBCRNA certification.

You can look forward to:
  • Base salary is competitive with MGMA median.
  • Outstanding benefit package.
  • Generous Paid Time Off (PTO)/six weeks; one week CME w/stipend.
  • Increased sign-on bonus of $15,000 and relocation package.
  • Quality work/life balance.
San Juan Regional Medical Center is a non-profit and community governed facility. Farmington offers a temperate four-season climate near the Rocky Mountains with world-class snow skiing, fly fishing, golf, hiking and water sports. Easy access to world renowned Santa Fe Opera, cultural sites, National Parks and monuments. Farmington is located 45 minutes away from Durango, CO, and 3 hours away from Moab, UT. Farmington’s strong sense of community and vibrant Southwest culture make it a great place to pursue a work-life balance. Learn more.
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CRNA: Charlton Memorial Hospital, North American Partners in Anesthesia, Massachusetts

NAPA is actively recruiting to enhance our practices in Massachusetts! Elective Surgeries to begin as early as May 15th. Compensation $100.00 per hour plus sign-on bonus.

Charlton Memorial Hospital is a not-for-profit, 328 bed, acute-care facility and St. Luke’s Hospital is a not-for-profit, 293 bed, acute-care facility. In conjunction with Southcoast Health, the group is one of the largest and fastest growing health systems in New England. This health system has become one of the most sought-after destinations for health professionals in the region. Charlton Memorial Hospital provides a full range of inpatient services. Out of all the hospitals in the Fall River area, Charlton Memorial Hospital is the only one to offer open heart surgery and elective coronary angioplasty. At Charlton Memorial Hospital in Fall River, MA, they have provided continuous service to our community since 1885. Only a short drive from Cape Cod, Providence, RI, and the Boston area, working with us affords the opportunity to live surrounded by pristine beaches, historic cities and cultural attractions that make it the absolute best that Massachusetts has to offer.

Case Assignments
Endoscopy, General, Orthopedics, ENT, GYN, Labor and Delivery, Ophthalmology, Radiology, Chronic Pain, UrologyCtsto, Urology, Vascular, Plastics, Neuro, Thoracic, Cardiac, Electrophysiology. Learn more.
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CRNA Opportunities: Cleveland Clinic, Ohio

The Anesthesia Institute at Cleveland Clinic is seeking CRNAs for opportunities available at our Main Campus, Regional Hospitals, Ambulatory Surgery Centers and Endoscopy Centers (CRNA-only practice).

Cleveland Clinic is firmly committed to being the best place to practice in medicine and providing a safe, stable, and financially fulfilling work environment even through uncertain times. Being a physician-led organization means doing what is best for the patients, every day.

Cleveland Clinic, an internationally renowned subspecialty medical center located in Cleveland, OH, is composed of a 1,400-bed main campus, 10 regional hospitals and 18 family health & surgery centers within the Cleveland metropolitan area.
The Anesthesiology Institute at Cleveland Clinic is one of the largest employers of CRNAs in the United States, employing over 250 CRNAs and CAAs!

The Anesthesia Institute offers Research and Teaching opportunities, as well as Internal CEU opportunities!

These dynamic opportunities offer a NEWLY UPGRADED COMPENSATION PACKAGE, including competitive supplemental pay opportunities. Our compensation package is enhanced by an attractive benefits package, including CEU package and sign-on bonus! Learn more.
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CRNA: St. Luke's Hospital, North American Partners in Anesthesia, Massachusetts

NAPA is actively recruiting to enhance our practices in Massachusetts! Elective Surgeries to begin as early as May 15th. Compensation $100.00 per hour plus sign-on bonus.

St. Luke’s Hospital is a not-for-profit, 293 bed, acute-care facility and Charlton Memorial Hospital is a not-for-profit, 328 bed, acute-care facility. In conjunction with Southcoast Health, the group is one of the largest and fastest growing health systems in New England. This health system has become one of the most sought-after destinations for health professionals in the region. Since opening in 1884, St. Luke's Hospital has been a leading healthcare provider in southeastern Massachusetts, providing the highest quality care with compassion and respect. Using teamwork and innovation, they have been continually growing in scope and efficient technologies, meeting the diverse needs of the families of Greater New Bedford. Only a short drive from Cape Cod, Providence, RI, and the Boston area, working with us affords the opportunity to live surrounded by pristine beaches, historic cities and cultural attractions that make it the absolute best that Massachusetts has to offer.

Case Assignments
Endoscopy, General, Orthopedics, ENT, GYN, Labor and Delivery, Ophthalmology, Radiology, Chronic Pain, Urology, Vascular, Plastics, Neuro,Thoracic, Cardiac, Electrophysiology. Learn more.
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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.

Repetitive Multiple Cranial Nerve Blocks Effectively Prevent Chronic Migraine

Repetitive multiple cranial nerve blocks (MCNBs) could help chronic migraine sufferers, U.K. researchers report. Between 2017 and 2019, the team from the Leeds Teaching Hospitals Trust enrolled 64 patients who had not previously tried nerve block as a treatment for their condition. Each participant received either repetitive bilateral occipital nerve blocks or bilateral occipital and trigeminal nerve blocks as prophylaxis. Investigators were primarily interested in the share of participants who registered a 30 percent reduction in headache days and the overall mean reduction in headache days, both assessed at 4 weeks post-block. They relied on patient diaries, scores on the Headache Impact Test 6 (HIT6), and patient-reported block efficacy to measure outcomes. The results indicated that about two-thirds of participants who responded to MCNB intervention achieved the primary outcome of a 30 percent reduction in number of headache days. The reduction in headache days across the entire patient sample was 5.4 days, and the mean reduction in HIT6 scores was 5.3. The treatment effect lasted a mean 5.7 weeks. Despite the absence of a control group and other limitations, the researchers believe MCNBs offer clinically meaningful benefit to patients with chronic migraine.

From "Repetitive Multiple Cranial Nerve Blocks Effectively Prevent Chronic Migraine"
Clinical Pain Advisor (05/08/20) May, Brandon

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Neuraxial Anesthesia May Reduce the Risk for Childhood Asthma

While maternal asthma, smoking, and obesity are predictors of pediatric asthma, as is cesarean section, evidence suggests that early placement of neuraxial anesthesia for labor lowers the risk. The finding comes from a retrospective cohort analysis of data from the Newborn Epigenetics Study (NEST). Scrutinizing data from 196 mother/child pairs, researchers uncovered a correlation between longer duration of epidural anesthesia and reduced risk of developing asthma in boys. The risk dropped with every additional hour of epidural exposure. Boys and girls both benefited, meanwhile, with each additional unit in the composite dose of local anesthesia and opioid analgesics administered intrathecally. Risk of asthma development fell for girls only when antiemetics were used, and boys' risk—but not girls'—went up with increasing dose of phenylephrine. "This study present early evidence for associations between neuraxial anesthesia and a lower risk of asthma—these associations may be stronger in males," the study authors wrote in Current Medical Research and Opinion. "Clinically, early placement of neuraxial anesthesia in women in labor who experience elevated levels of peripartum psychosocial stress could be a useful intervention for reducing the risk of childhood asthma. If replicated in larger studies with longer follow-up, investigating mechanisms could inform intervention strategies."

From "Neuraxial Anesthesia May Reduce the Risk for Childhood Asthma"
Pulmonology Advisor (05/08/20) Jacobs, Sheila

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Does the Revised Intubating Laryngeal Tube (ILTS-D2) Perform Better Than the Intubating Laryngeal Mask (Fastrach)?

German researchers launched a simulation project to evaluate the performance of ILTS-D2, a redesigned model of the intubating laryngeal tube. A total of 126 medical students took part in the randomized controlled study, with some using the new model to perform five consecutive ventilation attempts on a manikin. Others performed the same task using the intubating laryngeal mask (Fastrach), another device designed to facilitate extraglottic application and blind tracheal intubation. The main outcome was time to ventilation in the last attempt of using the devices as extraglottic devices. Time to tracheal intubation and success rates were secondary outcomes. While investigators observed no meaningful between-group differences in the primary endpoint, they did observe that blind tracheal intubation took two seconds fewer to complete with Fastrach than with ILTS-D2. Success rates on the last attempt were 100 percent for both devices. Given the positive results under controlled laboratory conditions, the study authors believe randomized clinical trials to evaluate ILTS-D2 in the setting of airway management are warranted.

From "Does the Revised Intubating Laryngeal Tube (ILTS-D2) Perform Better Than the Intubating Laryngeal Mask (Fastrach)?"
BMC Anesthesiology (05/11/20) Vol. 20, No. 111 Ott, Thomas; Tschöpe, Katharina; Toenges, Gerrit; et al.

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Preoperative Gabapentin for Minimally Invasive Hysterectomy

U.S. researchers conducted a randomized controlled trial to determine if preoperative gabapentin would curb narcotic consumption after minimally invasive hysterectomy (MIH). The single-site study, which accepted enrollees between June 2016 and June 2017, ultimately included 129 women undergoing MIH for benign indications. The control group consisted of 61 patients who received acetaminophen and celecoxib preoperatively, while the 68 participants in the intervention arm received the same regimen plus gabapentin. At 24 hours postoperatively, narcotic use registered at 161 oral morphine milliequivalents (MME) for the controls and 168 MMEs for the gabapentin recipients, a difference that was not considered significant. Secondary endpoints, such as pain scores at 2 weeks post-surgery and total narcotic use, also were comparable between both sets of patients.

From "Preoperative Gabapentin for Minimally Invasive Hysterectomy"
Journal of Minimally Invasive Gynecology (05/07/20) Huynh, Terri Q.; Patel, Nima R.; Goldstein, Neal D.; et al.

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Automated Pulse Oximeter Waveform Analysis to Track Changes in Blood Pressure During Anesthesia Induction

Swiss researchers investigated whether pulse oximeter waveform analysis might help flag changes in systolic arterial pressure (SAP) and mean AP (MAP) in surgical patients during anesthesia induction. Big swings in AP are important to measure in this setting, with intraoperative hypotension often leading to postoperative complications and mortality. As an alternative to conventional oscillometric brachial cuffs, which sometimes fail to capture these acute changes, the team recruited elective surgery patients to test the optical blood pressure monitoring (oBPM) algorithm. The pulse oximeter waveform analysis tool effectively tracked rapid changes in SAP and MAP during anesthesia induction, supported by strong correlation to and excellent concordance with changes detected through invasive AP monitoring. Going forward, the investigators suggest that clinicians might use oBPM to track changes in AP between intermittent oscillometric measurements and to automatically activate brachial cuff inflation whenever a significant fluctuation in AP is detected.

From "Automated Pulse Oximeter Waveform Analysis to Track Changes in Blood Pressure During Anesthesia Induction"
Anesthesia & Analgesia (05/20) Vol. 130, No. 5, P. 1222 Ghamri, Yassine; Proença, Martin; Hofmann, Gregory; et al.

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Oxycodone vs Sufentanil in Patient-Controlled Intravenous Analgesia After Gynecological Tumor Operation

Research out of China compared the safety and efficacy of oxycodone versus sufentanil in the setting of gynecological tumor surgery. Participants, all of whom underwent the procedure with general anesthesia, were randomly assigned to one of four postoperative treatments. Group S received sufentanil for both transition analgesia and patient-controlled intravenous analgesia (PCIA), while Group O received oxycodone for both. Group OS received oxycodone for the former and sufentanil for the latter, and Group SO received sufentanil and oxycodone, respectively. The investigators measured Numerical Rating Scale (NRS) at rest and with coughing, overall opioid usage in PCIA, patient satisfaction, and other safety and efficacy outcomes. Both analgesic agents delivered sufficient pain relief in transitional analgesia and in post-surgical PCIA, the findings indicated. Compared with Group S and Group OS, however, opioid demand was much lower with Group SO and Group O—both of which also reached intestinal recovery, first feeding, and first-time movement faster than the other cohorts. Group OS and Group O needed less time for return to consciousness and extubation after surgery, and Group O produced better patient satisfaction after surgery despite lower NRS.

From "Oxycodone vs Sufentanil in Patient-Controlled Intravenous Analgesia After Gynecological Tumor Operation"
Journal of Pain Research (05/20) Vol. 2020, No. 13, P. 937 Dang, Sha-Jie; Li, Rui-Li; Wang, Jun

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