Anesthesia E-ssential

AANA Anesthesia E-ssential, May 16, 2019

Vital Signs

AANA Joins National Academy of Medicine's Action Collaborative on Countering the U.S. Opioid Epidemic

The AANA is proud to announce that, along with more than 100 organizations including community organizations, hospital and medical systems, academia, nonprofits, and health professional societies, we have joined the National Academy of Medicine's Action Collaborative on Countering the U.S. Opioid Epidemic. This public-private partnership will develop, curate, and disseminate multi-sector solutions to reduce opioid misuse and improve outcomes for individuals, families, and communities affected by the opioid crisis. As a Network Organization, the AANA will actively support and contribute to the work of the Action Collaborative and will provide input on Action Collaborative activities, as well as receive invitations to act as partners in new efforts, advance notice of new resources and publications, and priority invitations to public meetings. Read the AANA's Commitment Letter.

For more legislative news, see AANA's Hotline (member login required)

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Participate in AANA's 2019 Compensation and Benefits Survey: Receive a Free Copy!

Receive a free electronic copy of the 2019 Compensation and Benefits Report ($100 value) for 15 minutes of your time. Please respond by May 30, 2019.

Please take a few minutes of your time to participate in the AANA 2019 Compensation and Benefits Survey. By completing the survey, you will be eligible to receive a free electronic copy of the report when it is released later this summer. (To obtain your free report, follow the directions at the end of the survey.)

This survey collects CRNA compensation and benefits data that are used by the AANA to calculate statistics and trends for various geographic areas and practice settings. Each year, CRNAs, hospital administrators, and other employers of nurse anesthetists contact the AANA for information on compensation and benefits. This information helps them understand CRNA practice trends and employment arrangements across the country.

Simply put, the more CRNAs who complete the survey, the more accurate the data will be—and the better-informed employers and job seekers will be. Robust data also helps you and your CRNA colleagues effectively promote your value in the marketplace. Most importantly, we want CRNAs, employers, and others to rely on data collected directly from CRNAs by the AANA, rather than data collected by other entities.

Complete the 2019 Compensation and Benefits Survey.

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Hot Topics

Educational Materials for QPP APMs available

The Quality Payment Program (QPP) is focusing more attention on alternative payment models (APMs). To help CRNAs understand the complex requirements of different APMs included in the QPP, the Research and Quality (RQ) Division has created several educational items. First, there are three fact sheets that explain the differences between Merit-based Incentive Payment System Program (MIPS) APMs, Advanced APMs and All Payer Combination APMs in QPP Performance Year 2019.

Next, there is a video that provides an overview of these APMs. Lastly, there is a list of Frequently Asked Questions (FAQs). Please visit the AANA’s RQ website, as it has some of the most comprehensive and educational QPP 2019 participation-related information available for the practice of anesthesia.

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Much More Than Malpractice Protection

Did you know the malpractice insurance coverage offered by AANA Insurance Services includes additional coverages such as deposition representation and substitute coverages? Visit the new Additional Coverage Benefits page to learn more about the benefits of securing coverage through AANA Insurance Services. Learn more.  

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PR Recognition Awards Deadline: Here Before You Know It!

Each year 15-20 entries are received from state associations, CRNAs or SRNAs, educational programs, businesses and others for the PR Recognition Awards competition coordinated by the AANA Communications Committee. Awards are presented in four categories:

  1. Best overall public relations effort for the past year, to be awarded to an individual, organization, or state association.
  2. Best promotional effort for National CRNA Week, to be awarded to an individual, organization, or state association.
  3. Best public relations effort by an individual, small group, organization or company not affiliated with a state association.
  4. Best use of “CRNAs: The Future of Anesthesia Care Today” campaign to promote the nurse anesthesia profession by an individual, organization, or state association.

All entries are judged by the committee onsite the day before the opening of the Annual Congress, and the winners are recognized during Opening Ceremonies. Detailed information about the competition, along with entry guidelines, can be found on the AANA website.

Winners will receive a plaque to commemorate their achievement, and their names will be added to a PR Awards exhibit on permanent display in the AANA Executive Office in Park Ridge, Ill.

Please note:

  • The deadline for entries is earlier than usual because this year’s Congress is taking place in August rather than September. The deadline is Friday, June 7. Late entries will not be considered.

For additional information or answers to questions about the PR Awards, please contact PR Department Administrative Associate Karen Sutkus at or 847-655-1140.

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NewsMaker: CRNA Jody Szlachta Confirmed for Governor's Health Policy Board

Jodie Szlachta, PhD, MSN, CRNA, of Havertown, Pa., received unanimous confirmation by the Pennsylvania state Senate to serve at least one three-year term on Gov. Tom Wolf's Health Policy Board, an advisory panel that helps to shape health policy. The governor nominated Szlachta in January. Learn more.

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NewsMaker: CRNA Chris Hulin Educates on Reducing Risk of Opioid Addiction

Chris Hulin, DNP, MBA, MSN, CRNA, president of Middle Tennessee School of Anesthesia (MTSA), appeared on WKRN-TV in Nashville to explain how MTSA educates its students on reducing the risk of opioid addiction. Learn more.

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NewsMaker: Retired CRNA Allen Mushett Teaches Students About Bleeding

Retired CRNA Allen Mushett presents facts and gives explanations on past- to present-day medical practices, along with a basic demonstration on how to treat an accidental bleed—all for a group of students researching and learning about the history of bloodletting. The focus of the presentation centered on blood volume, the use of anesthesiology, and initial steps to stop bleeding. Learn more.

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NewsMakers: CRNAs Pettit and McFarlane Receive 2019 Nursing Excellence Awards

Tara Pettit, DNP, CRNA, of Pilesgrove, N.J., received The Barbara and Jack Tarditi Award for Excellence in Nursing Research; and Trisha McFarlane, DNP, CRNA, of Merion Station, Pa., received The Moorestown Auxiliary Award for Excellence in Advanced Practice Nursing.

Both awards are part of the Cooper University Health Care System 2019 Nursing Excellence Awards, awarded during National Nurses Week (May 6-12), and  recognize exceptional professional nurses and advanced practice nurses in the ambulatory care and inpatient setting at a Cooper University Health Care location. Learn more.

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NewsMaker: CRNA Jeremy Johnson Wins Daisy Award

Jeremy Johnson, MSN, CRNA, APRN, who works at Stewart Memorial Community Hospital in Carroll, Iowa, has won a Daisy Award. Johnson, who has been at the hospital since 2016, was nominated by a patient, one who felt he went 'above and beyond.'

The Daisy Award was established in 1999 in memory of J. Patrick Barnes, who died of complications of Idiopathic Thrombocytopenic Purpura, as a way to thank the nurses across the country for their compassionate care, not only for patients, but also their families. Learn more.

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Meetings and Workshops

Anesthesia Business Seminars: Build a Personalized Business Plan with Successful CRNA Leaders, Summer Session, June 10 – August 3

Larry Hornsby, BSN, CRNA, and Juan Quintana, DNP, MHS, CRNA, will lead you through an eight-week seminar that will give you the skills and motivation to grab the brass ring. From developing Request for Proposals to improving your negotiation skills, you’ll get a personalized experience that you can’t get anywhere else. Seats are limited so be sure to register today to reserve your spot.


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AANA Member Benefits

Small Business Owners: Win Up to $100,000 from Nationwide and BlueVine

Nationwide Pitch to Win Contest"Pitch to Win" is a national competition where small business owners can compete for cash prizes by presenting a unique and compelling business proposal. Small businesses are encouraged to enter before the June 30, 2019 deadline.

The winning proposal will receive $100,000 from Nationwide and BlueVine; second place will receive $20,000 and third place $10,000. The awards will be non-dilutive, meaning business owners would not lose any ownership of their company.

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CRNA: U.S. Anesthesia Partners, Inc., Phoenix, Arizona

U.S. Anesthesia Partners (USAP) is the largest single-specialty anesthesia practice in the country with over 4,000 clinical providers and associates. By joining our team in Arizona, you will participate in a highly collaborative and dynamic environment. With the recent opening of a Level 1 Trauma Center, U.S. Anesthesia Partners of Arizona has transformed into a distinguished medical center in multiple locations within the Phoenix metro area. As an organization, we are mission focused on delivering the highest quality in patient care and you will be directly supporting our talented clinical team. We are actively recruiting CRNAs to join our growing practice. We offer Full Time positions in a Care Team Model with 100% Anesthesiologist supervision. We also welcome new graduates into our team oriented and supportive practice. Our case load is diverse including trauma, general, orthopedics, neuro, urology, gyn, radiology, endoscopy, cardiology. Our CRNA works Friday–Monday, 7 a.m. to 5 p.m., primarily doing general OR, trauma and regional anesthesia and also OB. Learn more.

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Certified Registered Nurse Anesthetist: Merritt Hawkins, Sioux City, Iowa

Our well-established anesthesia group is seeking a certified registered nurse anesthetist. With a healthy work/life balance you’ll have the freedom to work autonomously and enjoy a low on-call schedule with just 4 to 5 weekends per year.


  • Excellent compensation with 401(k), match, and profit sharing.
  • Full family health insurance paid for by the group.
  • $250,000+ total compensation package with up to 10 weeks off per year.

With a cost of living 18% below the national average, our practice location in Iowa has been twice named an All-American City by the National Civic League. We are a regional hub for business, retail, and the medical trade as well as an outdoor enthusiast’s paradise. Learn more.

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CRNA: Banner Health, Fallon, Nevada

With 28 hospitals in six western states, Banner Health is one of the nation's most respected and awarded health systems in the country. We have an exceptional opportunity for a qualified CRNA to join our expending team at Banner Churchill Community Hospital (BCCH) in Fallon, Nevada.

Features and scope of practice include:

  • CRNA-only practice model.
  • Two years of autonomous independent experience preferred.
  • General, MAC, OB-Epidural/spinal skills required.
  • Will perform general, regional, and monitored anesthesia services including spinal, epidural and ultrasound guided blocks.
  • Schedule: 3 weeks on, 1 week off; rotating call split 4 ways.

BCCH is a 40-bed, JCAHO-accredited hospital providing comprehensive and emergency care, serving 45,000+ including an ambulance service that covers more than 5,900 square miles. Fallon offers a moderate year-round climate and is just a short drive from both Reno and Lake Tahoe. Fallon offers a wealth of lifestyle advantages including a rustic, rural small-town charm of 45,000, along with a recreational wonderland of outdoor sports, such as boating, fishing, hiking, biking, skiing, hunting, horseback riding and off-roading and NO STATE INCOME TAX! Learn more.

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CRNA: U.S. Anesthesia Partners, Inc., Garden City, Kansas

Tired of the big city? Start or continue a rewarding career by joining U.S. Anesthesia Partners' (USAP) newly expanded CRNA practice in Garden City, Kansas. With nearly 4,000 clinical providers, USAP is the nation’s largest and leading provider of anesthesia care in the United States. We offer you a wide case mix including GYN, podiatry, ENT, general surgery, Ortho, urology, thoracic, and plastics. We even offer opportunities in pediatrics. Want to know more about this position and the industry leading benefits USAP provides? Apply! Learn more.

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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!


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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.

Epidural Positioning During Labor May Affect Outcomes

A retrospective review has raised the possibility that patient positioning during labor analgesia can affect epidural pressure, potentially influencing outcomes in the mother and the fetus. Led by Shaul Cohen, MD, director of obstetric anesthesia at Rutgers-Robert Wood Johnson Medical Center, the researchers examined the medical records of 180 women who gave birth at the facility. Epidural anesthesia was administered in the sitting position to 100 of those patients and in the lateral decubitis position to 80. The study's authors reported at the Annual Postgraduate Assembly in Anesthesiology that average epidural pressure was higher in women who received the block in the sitting position. While the team agreed that healthy pregnant women can tolerate the resulting partial occlusion of the vena cava, which is associated with a reduction in uteroplacental perfusion and an elevated risk for maternal hypotension, they say these developments have serious implications for some expecting mothers.
Specifically, "women with diabetes, severe preeclampsia, and those who have early separation of the placenta—which can be silent and not immediately diagnosed—already have preexisting compromised uteroplacental perfusion, so further reducing uteroplacental perfusion places them and their fetuses at greater risk of poor outcomes," Cohen explained.

From "Epidural Positioning During Labor May Affect Outcomes"
Anesthesiology News (05/14/19) Wild, David

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Israeli Study Links Autism to General Anesthesia in C-Sections

Researchers in Israel say their study findings point to a correlation between general anesthesia during surgical childbirth and autism. The new evidence took shape after investigators compared birth records of 350 autistic children and 2,000 controls. The analysis indicated that children who were delivered via Cesarean section with the mother under general anesthesia had at an elevated risk of developing autism versus children whose mothers underwent epidural, spinal sedation, or other types of labor analgesia. However, the reason for surgical delivery—patient preference or pregnancy complications—was not a factor. The research was conducted by a team from Ben-Gurion University of the Negev and from Soroka University Medical Center in Beersheba.

From "Israeli Study Links Autism to General Anesthesia in C-Sections"
Times of Israel (05/14/19)

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Effects of Intravenous Infusion of Lidocaine and Dexmedetomidine on Inhibiting Cough During the Tracheal Extubation Period After Thyroid Surgery

A study out of China compared intravenous (I.V.) lidocaine and dexmedetomidine for their ability to suppress cough during tracheal extubation. The trial included 180 patients having thyroid surgery, randomly divided into three treatment arms. One group of 60 received lidocaine, another 60 received dexmedetomidine, and the remaining 60 received an I.V. infusion of normal saline. The incidence of cough was 28.3 percent and 31.7 percent, respectively, with lidocaine and dexmedetomidine. Both results were markedly lower than the incidence rate of 66.7 percent among the controls, and the pattern also applied in the case of moderate and severe cough. Secondary outcomes—including arterial blood pressure and heart rate, volume of drainage, and postoperative pain scores—also favored lidocaine and dexmedetomidine over placebo. While both techniques successfully attenuated cough and hemodynamic changes during the tracheal extubation period following thyroid surgery, lidocaine had an edge over dexmedetomidine, which was associated with bradycardia and a slower time to awareness.

From "Effects of Intravenous Infusion of Lidocaine and Dexmedetomidine on Inhibiting Cough During the Tracheal Extubation Period After Thyroid Surgery"
BMC Anesthesiology (05/04/19) Vol. 19, No. 66 Hu, Shenghong; Li, Yuanhai; Wang, Shengbin; et al.

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Nociception-Guided Versus Standard Care During Remifentanil–Propofol Anesthesia

Compared to blood pressure and heart rate activity, the nociception level index is a superior indicator of nociceptive events during anesthesia and surgery. Researchers at Leiden University Medical Center in the Netherlands suspected that the approach also curbs the amount of opioids administered to patients intraoperatively. To test the hypothesis, they equally randomized 80 patients scheduled for major abdominal surgery to receive either routine care or nociception level-guided analgesia. All participants, meanwhile, received remifentanil/propofol anesthesia by target-controlled infusion. As expected, intraoperative remifentanil consumption was significantly lower—by 30 percent—in the patients who received nociception level-guided analgesia. In addition, suboptimal anesthesia events such as hypotension and need for vasoactive medication occurred much less frequently in the intervention group than in the control group.

From "Nociception-Guided Versus Standard Care During Remifentanil–Propofol Anesthesia"
Anesthesiology (Spring 2019) Vol. 130, No. 5, P. 745 Meijer, Fleur S.; Martini, Chris H.; Broens, Suzanne; et al.

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Paravertebral Block Versus Intercostal Nerve Block in Non-Intubated Uniportal Video-Assisted Thoracoscopic Surgery

Researchers have shown non-intubated uniportal video-assisted thoracoscopic surgery (VATS) to be a safe and viable intervention for various thoracic conditions, including those with respiratory challenges. A team in Egypt, however, wondered if the use of paravertebral block or intercostal nerve block in this setting would have anesthetic and analgesic sparing effects in patients under general anesthesia (GA) and supported by a supraglottic airway device. For their investigation, they divided 105 non-intubated VATS patients who were using a laryngeal airway into groups of 35. Group 1 received GA only; Group 2 received a single-shot paravertebral block before GA induction; and Group 3 received thoracoscopic intercostal block infiltration after anesthesia induction, plus intrathoracic vagal block. Attenuated by significantly lower expiratory fraction of sevoflurane, patients in Groups 2 and 3 had fewer fentanyl requirements compared to the controls. Heart rate, mean arterial pressure, and oxygen saturation also were significantly lower in the block patients compared with GA-only patients. The block groups also had lower time to spontaneous arm and eye movements, purposeful movement, and laryngeal mask removal.

From "Paravertebral Block Versus Intercostal Nerve Block in Non-Intubated Uniportal Video-Assisted Thoracoscopic Surgery"
Heart, Lung and Circulation (05/04/19) Mogahed, Mona Mohamed; Elkahwagy, Mohamed Shafik

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Intraoperative Lidocaine May Reduce Breast Cancer Surgery-Associated Neuropathic Pain

Researchers turned to the results of a pilot study to justify or discount the feasibility of a larger, randomized trial on the pain benefits of intraoperative lidocaine for breast surgery patients. The sample population included 100 women scheduled for mastectomy or lumpectomy. Treatment with lidocaine, as compared to pregabalin, was linked to lower rates of persistent neuropathic pain postoperatively—although the benefit was erased when pain escalated to moderate or severe levels. Despite the small study size, absence of standardized perioperative pain protocols, and other limitations, the researchers found the findings promising enough to warrant additional study. "Persistent pain after breast cancer surgery is a common problem and there are no established interventions known to reduce its development," they wrote in the Journal of Pain. "Results of this pilot trial are encouraging and provide insights into developing a larger definitive trial."

From "Intraoperative Lidocaine May Reduce Breast Cancer Surgery-Associated Neuropathic Pain"
Clinical Pain Advisor (05/01/19) May, Brandon

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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.

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May 16, 2019