Anesthesia E-ssential

AANA Anesthesia E-ssential, May 2, 2019

Vital Signs

CPC Program Next Step is Two-Year Check-in: Are You Due?

Since the window to complete the CPC two-year check-in for almost half of all CRNAs opened April 2, nearly one-third who were scheduled to check in have already completed the process.

The check-in is simple and quick and can be completed from a computer, cell phone, or other mobile device in about five minutes. This mid-point requirement in the four-year CPC Program cycle serves an important purpose in confirming current licensure and practice, as required by NBCRNA’s accreditors, ensuring updated contact information, and checking your progress in the CPC Program. No Class A or B credits or Core Modules are required at the check-in; those are due at the end of each four-year cycle.

At check-in, CRNAs will:

  • Confirm licensure and practice.
  • Update contact information – nearly a quarter of all CRNAs who have already checked in have needed to update their information.
  • Review progress in the CPC Program.
  • Pay the $110 credentialing fee for the upcoming two years—the same fee amount and timing as in the past, which supports year-long NBCRNA activities that seek to keep the credential strong.

Unsure if you need to check in this year? Find a two-year check-in deadline chart, FAQs, videos, and more at You can also check by logging in on the NBCRNA website—see the green Login button at the top of the NBCRNA home page. Only CRNAs who recertified or initially certified in 2017 will need to complete the two-year check-in this year. Individual check-in deadlines will vary depending on recertification or initial certification dates.

When you're ready to check in, use the following link to connect to the portal and select “2-year Check-in” on the menu:

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Be Sure to Vote in the AANA 2019 Election!
Voting Ends May 21, 2019 at noon CT

The AANA 2019 election started on April 23, 2019, and will continue until May 21, 2019, 12:00 noon CDT. By now, active AANA members should have received their ballot materials, including their election passcode and voting instructions, electronically or in the mail from Survey & Ballot Systems (SBS), the AANA's election coordinator. The email with the voting credentials originates from Please make sure this email did not end up in your spam or junk mail folder.

To vote online and view candidates’ biographical information and position statements, visit the election site and enter your member number and the election passcode provided to you by SBS.

If you do not have your election login information, click on the “Email me my login information?” link on the login page and enter the email address on file with AANA, and your election login information will be emailed to you. SBS can be reached by phone at (952) 974-2339 (Monday through Friday, 8 a.m. to 5 p.m. CDT) or by email at

To view Board Candidates’ Video Speeches
Board candidates’ speeches presented at the April Mid-Year Assembly are available on the AANA website through the Video Speeches page (member login required).

AANA Connect Community for Candidates for the AANA Board of Directors
The AANA Connect Community for Candidates for the AANA Board of Directors (member login required) became available on April 8, 2019, after candidates were introduced at the Mid-Year Assembly. All AANA members will be able to interact with Board candidates during the voting cycle. This community will be available until May 8, 2019.

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Hot Topics

Upcoming Webinar: Moving from Surviving to Thriving

Join the Council on Patient Safety in Women’s Health Care for a complimentary webinar on Wednesday, May 8 at 2 p.m. ET to review the current state of burnout in healthcare providers and its tie to quality, safety, experience, and retention. The presentation also will help identify everyday opportunities to incorporate resilience into our personal and work lives. Register for the webinar.

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Malpractice Insurance Company Capson Put into Rehabilitation

Less than two years after Oceanus Insurance Company was declared insolvent, another malpractice insurance company insuring CRNAs has run into financial difficulties. Read John Fetcho’s latest Business of Anesthesia article in the May issue of the AANA NewsBulletin to learn more.

If you currently have a policy with Capson or a Granite State Insurance Company policy through Capson, contact us today to learn about your options.

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National #NursesWeek: Free Webinar

National Nurses Week is celebrated May 6-12, 2019. A free webinar will be held on May 8, 2019, at 1 p.m. ET, "Elevating the Profession," and will be followed by a Twitter chat.

The webinar will provide insider strategies from top nursing leaders, including the new president of the American Nurses Association (ANA), Dr. Ernest Grant.


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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 Barbara Grover Works With The Tooth Fairy

WTOL 11, the CBS affiliate in Toledo, Ohio, covered the story of six-year-old Ean who was having surgery and also had a loose tooth. "Turns out loose teeth are pretty common for the anesthesiology department at ProMedica Toledo Children's Hospital," said the report.

Barbara Grover, DNP, CRNA, who works at the hospital, said, "The tooth fairy has found where we're located, and now that she knows where we're located, she shows [up] very regularly when someone's losing a tooth in the operating room."  Learn more.

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NewsMaker: CRNA Adrienne Rochleau Is 2019 Morningside College Nursing Alumna of the Year

Adrienne Rochleau, DNP, CRNA, has been named the 2019 Morningside College Nursing Alumna of the Year. She received the award on April 10 at the 37th Annual Maud Adams Nursing Research Day on the Morningside College Campus in Sioux City. 

She also was recognized by the Nebraska Action Coalition as one of the 40 recipients receiving the "40 Under 40" award. Learn more.

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Meetings and Workshops

Students and CRNAs Needed for the Anesthesia College Bowl!
Deadline: May 6

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.

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AANA Member Benefits

You Don’t Need 20% Down on Your Mortgage

There is a common misconception that you need 20% down in order to buy a home. Quicken Loans offers a variety of loan product options, some of them allow down payments as low as 3% of the purchase price of your new home. When you purchase or refinance through Quicken Loans®, you can save even more by receiving $500 cash back after closing, plus up to $1,000 in closing cost credit.1 Speak with a Home Loan Expert today by calling (855) 245-5911. Learn more.

Save 1,500 with Quicken Loans

1Valid on new applications received between 01/01/2019 and 06/30/2019 for loan amounts of $100,000 or greater. The client will receive a check 2 – 4 weeks after closing in the amount of $500, plus the client will receive a closing cost credit on their Closing Disclosure in the amount of $1,000. For loans of $99,999 or less, the client will receive a check 2 – 4 weeks after closing in the amount of $500, plus the client will receive a closing cost credit on their Closing Disclosure in the amount of $750. This offer is only available to clients who call the dedicated benefit phone number or go through the dedicated benefit website. Offer does not apply to new purchase or refinance loans submitted to Quicken Loans through a mortgage broker. Offer is non-transferrable. Offer cannot be retroactively applied to previously closed loans or loans already in process. Quicken Loans reserves the right to cancel this offer at any time. Not valid with any other discount or promotion aside from the Rocket Homes discount mentioned in this offer. Acceptance of this offer constitutes the acceptance of these terms and conditions, which are subject to change at the sole discretion of Quicken Loans. This is not a commitment to lend. Additional restrictions and conditions may apply.

Quicken Loans Inc.; NMLS #3030; Equal Housing Lender. Licensed in 50 states. AR, TX: 1050 Woodward Ave., Detroit, MI 48226-1906, (888) 474-0404; AZ: 1 N. Central Ave., Ste. 2000, Phoenix, AZ 85004, Mortgage Banker License #BK-0902939; CA: Licensed by Dept. of Business Oversight, under the CA Residential Mortgage Lending Act and Finance Lenders Law; CO: Regulated by the Division of Real Estate; GA: Residential Mortgage Licensee #11704; IL: Residential Mortgage Licensee #4127 – Dept. of Financial and Professional Regulation; KS: Licensed Mortgage Company MC.0025309; MA: Mortgage Lender License #ML 3030; ME: Supervised Lender License; MN: Not an offer for a rate lock agreement; MS: Licensed by the MS Dept. of Banking and Consumer Finance; NH: Licensed by the NH Banking Dept., #6743MB; NV: License #626; NJ: New Jersey – Quicken Loans Inc., 1050 Woodward Ave., Detroit, MI 48226, (888) 474-0404, Licensed by the N.J. Department of Banking and Insurance.; NY: Licensed Mortgage Banker – NYS Banking Dept.; OH: MB 850076; OR: License #ML-1387; PA: Licensed by the Dept. of Banking – License #21430; RI: Licensed Lender; WA: Consumer Loan Company License CL-3030. Conditions may apply. Quicken Loans, 1050 Woodward Ave., Detroit, MI 48226-1906

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Nine Family Vacation Ideas Everyone Will Enjoy

Taking a kid-friendly vacation can help you and your family make the most of your break. Get the planning started with these fun family vacationideas.

Fun Family Vacations

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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.

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CRNA II: Novant Health, Inc., North Carolina

Novant Health is seeking a Full-Time Weekender CRNA to grow and develop within a professional setting. Team members utilize skills obtained through additional training, education and/or experience in the provision of anesthesia care to patients who present with complex and unique anesthetic requirements. Come join a remarkable team where quality care meets quality service, in every dimension, every time. Let Novant Health be the destination for your professional growth. It is the responsibility of every Novant Health team member to deliver the most remarkable patient experience, in every dimension, every time. Our team members are part of an environment that fosters teamwork, team member engagement and community involvement. The successful team member has a commitment to leveraging diversity and inclusion in support of quality care. All Novant Health team members are responsible for fostering a safe patient environment driven by the principles of "First Do No Harm." Offering excellent benefits and a $15,000 sign on bonus!! Learn more.

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CRNA: Fox Chase Cancer Center, Philadelphia, Pennsylvania

As one of the first cancer hospitals in the country, Fox Chase Cancer Center has been a national leader in cancer treatment, research, and prevention for more than 100 years. Fox Chase Cancer Center, part of the Temple University Health System, is committed to providing the best treatment options for our patients, and delivering that care with compassion. The Certified Registered Nurse Anesthetist (CRNA) delivers procedural anesthesia care as part of a team under the supervision of an anesthesiologist. As part of this team, the CRNA is expected to engage in accurate, ongoing patient assessments, communicate with members of the healthcare team, use resources efficiently to deliver optimal care and document care thoroughly in the appropriate records. The CRNA is expected to perform intubations and respond to emergencies outside the OR as required. As part of the department, the CRNA is expected to approach process improvement proactively and professionally, and work collegially with members of the department to advance care. Success mandates regular attendance at departmental meetings and active participation in departmental projects. Learn more.

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CRNA: Bassett Medical Center, Cooperstown, New York

A progressive health care network in central New York and major teaching affiliate of Columbia University, is seeking full time CRNAs to join our growing anesthesia practice. Bassett Healthcare Network is an integrated health care system that provides care and services to people living in an eight-county region covering 5,600 square miles in Central New York. The organization includes six corporately affiliated hospitals, as well as skilled nursing facilities, community and school-based health centers, and health partners in related fields. Enjoy an outstanding quality of life in this lakeside resort town located south of the Adirondack Mountains and north of the Catskills. The combination of a modern practice within a growing academic and research-oriented healthcare system, coupled with excellent schools and multiple outdoor recreational, cultural and artistic activities, makes this a unique opportunity. Learn more.

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Open Rank Anesthesia for Nurses Faculty Position: Medical University of South Carolina in Charleston, South Carolina

The Division of Anesthesia for Nurses (AFN) invites applicants for a faculty member position. We are seeking a motivated Certified Registered Nurse Anesthetist (CRNA) who has demonstrated skills in nurse anesthesia education and clinical practice. Qualified applicants must have a minimum of three years of clinical experience; graduate preparation in the basic and clinical sciences relevant to nurse anesthesia practice; and prior classroom teaching experience. Applicants must also have knowledge of Certified Registered Nurse Anesthetists (CRNA) practice and professional issues and must possess active recertification as a CRNA. Responsibilities will include teaching in the nurse anesthesia program, curriculum development, scholarship and doctoral student advising. The most qualified applicant will have experience in teaching the basic sciences and anesthesia principles. The position also involves related duties such as college committee work, departmental duties, and continuing professional development. Faculty clinical practice is required with contracted time at MUSC. 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.

Magnesium Infusion Lowers Shivering Risk in Patients Undergoing Surgery

A study out of Japan evaluated the effect of perioperative magnesium in preventing shivering, a surgical complication that can tax the cardiovascular system. The review and meta-analysis included 64 clinical trials that collectively compared outcomes in 2,300 participants who were administered magnesium during or immediately following an operation with outcomes in 2,003 patients who did not receive it. The overall incidence of shivering was 23 percent in the control group, but that rate dropped to 9.9 percent for patients who received magnesium. The evidence also showed that magnesium effectively curtailed shivering when delivered via intravenous infusion, by epidural, and through a direct injection into the cerebrospinal fluid. Furthermore, administration of magnesium did not elevate the risk for adverse events such as sedation, low heart rate, or length of stay in the post-anesthesia care unit. The review findings are published in Anesthesia & Analgesia.

From "Magnesium Infusion Lowers Shivering Risk in Patients Undergoing Surgery"
Specialty Medical Dialogues (04/30/19) Baranwal, Medha

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Overlapping Surgery Shown Safe, But with Caveats

Researchers studied operations on tens of thousands of adults in an effort to evaluate the safety of "overlapping surgery." The term was applied when a procedure's start and end time overlapped with any other operation performed by the same surgeon for at least 60 minutes or, if less than an hour, when the start and end time overlapped with the other surgery completely. The in-depth investigation looked at nearly 66,000 adult patients undergoing coronary artery bypass graft (CABG); total knee or hip replacement; lumbar, thoracic, or cervical spine operations; and craniotomies at eight U.S. centers from 2010 to 2018. Some level of overlap occurred in nearly 12 percent of the cases; and while this prolonged the procedure by about 30 minutes, it was not significantly associated with postoperative complications or in-hospital mortality. "This study strengthens the evidence that overlapping surgery is a reasonable practice for many cases," the authors reported in the Journal of the American Medical Association. They noted, however, that there were two exceptions to finding that overlapping surgery is safe: when a patient has an elevated perioperative risk of complications and death, and when he or she is undergoing CABG.

From "Overlapping Surgery Shown Safe, But with Caveats"
Anesthesiology News (04/30/19) Frangou, Christina

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IV Hydromorphone Superior to IV Lidocaine for Abdominal Pain in the ED

Intravenous (IV) hydromorphone appears to be superior to IV lidocaine in soothing acute abdominal pain, according to a study conducted at a pair of Bronx, N.Y., emergency departments. Patients seeking care at the two locations were randomized to 1 mg of IV hydromorphone or 120 mg of IV lidocaine, creating two treatment arms with 77 participants each. A half-hour after the initial dose, study participants were asked if they needed another dose of medication; and improvement in pain intensity, the main endpoint, was measured one hour after that. Patients in the hydromorphone group reported greater relief in pain intensity at 90 minutes and were less likely to require "off-protocol" rescue analgesics, including opioids. While it is possible that the initial lidocaine bolus may not have been an adequate dose, the researchers said in the Annals of Emergency Medicine that the "data do not provide any compelling reasons to choose [IV] lidocaine as a first-line analgesic over hydromorphone for abdominal pain."

From "IV Hydromorphone Superior to IV Lidocaine for Abdominal Pain in the ED"
Clinical Pain Advisor (04/29/19) May, Brandon

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Wide-Awake Surgery Yielded Less Pain, Shorter Hospitalization for Distal Radius Fractures

New evidence demonstrates the benefits of wide-awake local anesthesia with no tourniquet (WALANT) for patients having volar plating surgery to correct distal radius fractures. The study included 47 patients—26 of whom received general anesthesia and 21 of whom underwent WALANT—whom the team followed for one year post-surgery. According to the researchers, who report in BMC Anesthesiology, the wide-awake technique reduced postoperative pain and shortened hospital stays. It also was associated with more blood loss, but not enough to interfere with the surgical field. Meanwhile, other outcomes—including operative time or time to union as well as wrist extension, wrist flexion, and Mayo wrist score at 12-month follow-up—were comparable between the groups. WALANT "simplifies surgical preparations" and "also provides a low-risk and reliable method for volar plating of distal radius fractures," said lead researcher Chun-Yu Chen, MD. The results appear in Orthopedics.

From "Wide-Awake Surgery Yielded Less Pain, Shorter Hospitalization for Distal Radius Fractures"
Healio (04/26/2019) Tingle, Casey

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Effect of Albuterol Premedication vs Placebo on the Occurrence of Respiratory Adverse Events in Children Undergoing Tonsillectomies

The Reducing Anesthetic Complications in Children Undergoing Tonsillectomies (REACT) study examined whether premedication with albuterol sulfate would curtail respiratory adverse events during this common pediatric procedure. Conducted in Australia, the trial randomly divided patients no older than age eight years into two treatment arms: inhaled albuterol or placebo, administered just prior to surgery under general anesthesia. The primary outcome was occurrence of bronchospasm, laryngospasm, airway obstruction, oxygen desaturation, coughing, and/or stridor up to the point of discharge from the post-anesthesia care unit. Perioperative respiratory events were documented much more frequently in the control group, affecting 47.9 of 238 placebo recipients versus 27.9 percent of 241 patients in the albuterol group. The biggest between-group differences were observed with laryngospasm, desaturation, and coughing. Based on the study results, the researchers believe albuterol premedication should be considered when planning anesthesia for pediatric tonsillectomy.

From "Effect of Albuterol Premedication vs Placebo on the Occurrence of Respiratory Adverse Events in Children Undergoing Tonsillectomies"
JAMA Pediatrics (04/19) von Ungern-Sternberg, Britta S.; Sommerfield, David; Slevin, Lliana; et al.

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A Novel Approach to Neuraxial Anesthesia

Researchers in Singapore designed a prospective cohort study to test their automated spinal landmark identification technique for administering neuraxial anesthesia. The intelligent image processing system, which is guided by ultrasound instead of palpation, was applied to 100 surgical patients who required spinal anesthesia. Dural puncture was achieved on the first try in 92 percent of the sample population, and just 45 seconds were needed to detect posterior complex. The robust success rate and rapid capture of surface landmark speak to the viability of the new approach. More investigation is needed, the researchers conclude, to define the use of ultrasound-guided neuraxial techniques in more complex patients undergoing neuraxial blocks.

From "A Novel Approach to Neuraxial Anesthesia"
BMC Anesthesiology (04/16/19) Vol. 19, No. 57 Oh, Ting Ting; Ikhsan, Mohammad; Tan, Kok Kiong; et al.

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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.

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


May 2, 2019