Anesthesia E-ssential

AANA Anesthesia E-ssential, May 21, 2020
 
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Vital Signs


Important Announcement: 2020 Annual Congress Converted to Virtual Experience

Dear Colleagues,

Since the start of the COVID-19 pandemic, the AANA has continuously monitored health advisories to ensure your safety and well-being. Given the latest directives for large gatherings in California, the 2020 Annual Congress scheduled for August 14-18, 2020, at the San Diego Convention Center is unable to proceed.

Annual Congress is the largest networking and education event in nurse anesthesia. In its commitment to keeping you updated on the latest practice trends and reinvigorating your passion for your career, the AANA staff is developing an exciting virtual experience designed to keep you at the top of your profession. Stay tuned! Plans for the AANA Business Meeting also will be announced soon.

While the AANA Board of Directors regret that Annual Congress cannot proceed as planned, the health and safety of our attendees, exhibitors, speakers, and staff is paramount. Many stakeholders are involved in making Annual Congress a “must-attend” event every year, and the board is deeply grateful for their efforts and support. As we anticipate the time when our community can once again gather face-to-face, the AANA team is committed to fostering inspiring opportunities to bring us together in meaningful ways. Again, stay tuned!

A full refund will be provided for those who have registered for the in-person Annual Congress. Information will be forthcoming for all involved. In the meantime, please direct your questions about registration to meetings@aana.com. For the latest updates and resources on COVID-19, please visit AANA.com/aana-covid-19-resources.

On behalf of the AANA Board of Directors, thank you for your patience and understanding, and I sincerely hope you can stay healthy during this time.

Kate Jansky, MHS, CRNA, APRN, USA LTC (ret)
AANA President

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AANA Annual Business Meeting to Proceed Virtually

On Monday, the AANA Board of Directors announced that the in-person gathering of the 2020 Annual Congress scheduled for August 14-18 cannot proceed as planned. While plans for an exciting virtual experience are well underway, the AANA Board has exercised its “emergency amendment powers” to allow AANA’s Annual Business Meeting to proceed virtually.

Although AANA Bylaws allow for electronic meetings to be conducted for board and/or committee meetings, there was no provision for electronic membership business meetings, such as those held at Annual Congress. This past week, the AANA Board of Directors formally incorporated the electronic meeting concept into the bylaws, which are posted on AANA.com (Member login required).

Additional details regarding the virtual business meeting are forthcoming.
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AANA CEO Randall Moore and Rep. Rodney Davis (R-IL-13) to Discuss HHS Emergency Relief Funds

This Friday, May 22, at 10 a.m. CDT, AANA CEO Randall Moore, DNP, MBA, CRNA, is going to do a Facebook Live Question & Answer session with Rep. Rodney Davis (R-IL-13). No Facebook account needed to view the session.

Rep. Davis and Moore will discuss H.R. 6809, the Nurse Workforce Protection Act, introduced last week by Rep. Davis and Rep. Tulsi Gabbard (D-HI-2). The bill aims to help nurses, including CRNAs, maintain employment and salary during the COVID-19 pandemic. It requires facilities that take emergency relief funds or Paycheck Protection Program (PPP) loans to maintain at least 75% of their nurses on payroll and to cover at least 75% of their salaries. The requirement will be retroactive to the declaration of the Public Health Emergency, and any facilities that do not meet this requirement will be required to repay the funds within 30 days.

The AANA is supporting this important legislation to help ensure the financial stability and security of CRNAs. We urge you to join us, in taking action to support this bill today.

Please follow the instructions below to take action today!
  1. Go to AANA Federal Government Affairs and click "Get Started" on the Support the Nurse Workforce Protection Act action.
  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!
If you have any questions, please don't hesitate to contact AANA Federal Government Affairs at info@aanadc.com.

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AANA Partners with 47 Nursing Organizations to Remove Practice Barriers in the VA

In a letter to U.S. Vice President Mike Pence and leaders of the U.S. Department of Veteran Affairs and Veterans Health Administration, the American Association of Nurse Anesthetists (AANA) partnered with 47 national nursing organizations to request support for the Veterans Affairs’ (VA) Directive 1899 to permanently remove barriers and allow Certified Registered Nurse Anesthetists (CRNAs) to practice to the full extent of their education and training.

According to the Nursing Community Coalition signatories, “allowing CRNAs to practice independently … illustrates CRNAs’ extensive education and training, as well as their expertise in providing high-quality care for their patients and our nation’s veterans.”

“Particularly during these unprecedented times, ensuring the health care of our veterans and patients across the country is crucial,” cited the letter. “By providing anesthesia services across the entire care continuum, CRNAs not only bring much needed support and expertise during this crisis, but their full range of skills are imperative in the future as well.”

As advanced practice nurses, CRNAs have vast experience in critical care settings and advanced education and training in anesthesiology. CRNAs provide care across all settings and in all patient populations and are the primary providers of anesthesia care in rural and underserved areas and on the battlefield in forward surgical teams.

“Full practice authority of CRNAs is not new or just in times of emergencies. In fact, other federal health care systems, the Army, Navy, and Air Force, have been utilizing full practice authority for CRNAs,” stated the letter.

Granting full practice authority to the VA’s CRNA workforce during and after the COVID-19 emergency aligns with principles outlined with President Trump’s October 2019 Executive Order aimed at Protecting and Improving Medicare for Our Nation’s Seniors. The Centers for Medicare & Medicaid Services has already taken action to remove physician supervision requirements for CRNAs during the public health emergency.

Members of the Nursing Community Coalition are the cross section of stakeholders in education, practice, research, and regulation within the nursing profession and have long supported full practice authority for all Advanced Practice Registered Nurses (APRNs).
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Psychological Impact of COVID-19 Can Last for Years, Nurses Ask U.S. Administration for Help

Gravely concerned about the psychological health and well-being of nurses and other healthcare professionals serving on the pandemic’s frontline of care, leaders of the nation’s nursing organizations have urgently asked the U.S. Administration for help.

In a May 19 letter, leaders representing the voice of 5 million nurses, including advanced practice registered nurses (APRNs), requested that behavioral health agencies and staff develop resources, activate U.S. mental health and service access teams to address the psychological impacts of COVID-19, and deploy military disaster mental health teams and behavioral health servicemembers to heavily impacted areas to provide psychological assistance and care for civilian nurses and other healthcare professionals.

“Urgent action is needed now to address the emotional toll among nurses and others who are experiencing trauma during this pandemic. Acting now can help prevent threats to the psychological well-being among nurses and help save the lives of patients suffering from the virus. Proactive support may help avoid the impending mental health crisis expected, once the national public health emergency is over,” said Kate Jansky, MHS, CRNA, APRN, USA LTC (ret), president of the American Association of Nurse Anesthetists (AANA). The AANA collaborated with nursing organizations and the American Psychological Association (APA) to address with the U.S. Administration the mental health and well-being of nurses and APRNs, who are not only first responders, but also sustained responders for patients and their families.

“America’s front-line nurses risk their lives and the lives of their families each day that they tend to people with COVID-19, under some of the most stressful working conditions imaginable,” said APA CEO Arthur C. Evans Jr. “Our government must provide them the help they need now in order to mitigate the threats to their psychological health and well-being.”

Nurses who tend to patients with the coronavirus, and previously with severe acute respiratory syndrome (or SARS), report more severe degrees of psychological distress such as depression, anxiety, and insomnia than other healthcare workers. Nurses are facing extraordinary workloads, often without adequate access to personal protective equipment (PPE). And, in recent surveys, nurses reported extreme to moderate concern about the safety of their family and friends (87 percent), about adequate testing (84 percent), and about access to PPE (75 percent).

“We urgently ask for your help to preserve and protect the profession for the sake of our nation’s future,” the nursing leaders wrote, adding evidence-based interventions, such as psychological first aid and skills for psychological recovery, which can increase resiliency and reduce anxiety among those going through a crisis.

In their letter, the leaders also expressed gratitude for the presidential proclamations on designating May 6 as National Nurses Day and May as National Mental Health Awareness Month. “These proclamations recognize the impact that the COVID-19 pandemic is having on the mental and psychological health of nurses and their communities,” they wrote. “Nurses in many specialties are the primary providers of patient care, and their psychological health and well-being are essential to addressing the COVID-19 public health crisis.”

The full text of the letter is available here.
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Nurse Anesthetists Responding to COVID-19 in Rural America

Certified Registered Nurse Anesthetists (CRNAs) stand at the ready as the threat of COVID-19 threatens the nation’s rural communities. CRNAs are the primary provider of anesthesia care in rural America.

“As CRNAs, we’re uniquely qualified to help with airway management, which can be difficult in COVID patients,” said Brian Kvamme, CRNA, a member of the South Dakota Association of Nurse Anesthetists’ Board of Directors. “At my hospital we put in central lines, arterial lines, and we’re a major resource for our critical patients that we’ll be taking care of. We’ll also be helping with sedation and ventilator management. We’re lucky because the state of South Dakota has CRNAs positioned to work as full-service providers and care for our community members in their most critical time of need.”

Earlier this year, South Dakota’s governor signed a law that granted CRNAs prescriptive authority and allows them to collaborate with other providers in chronic pain practice. By removing barriers to practice, this law increased access to care for South Dakota residents.

In South Dakota and across the country, CRNAs have stepped into leadership roles, preparing their facilities to confront COVID-19 head on using their skills and expertise, particularly in ventilator management, intubation, airway management, and critical care to treat patients and save lives, according to Kate Jansky, MHS, CRNA, APRN, USA LTC (ret), president of the American Association of Nurse Anesthetists (AANA).

“Our group of CRNAs has stepped up and will be taking over 100 percent of the intubations and central lines in the facility to limit others’ exposure. We will be taking over the code team and the rapid response team as well as responding to needs from the ICU and ER. We will be utilizing our skills in ventilator management and hemodynamic management, as well as critical care, to open an additional ICU space, which we will run as needed,” said Mike MacKinnon, DNP, FNP-C, CRNA, who works in rural Arizona and is one of five owners of a 16 CRNA-only group.

The AANA has partnered with the National Rural Health Association (NRHA) to promote and release the AANA infographic, CRNAs in the Rural Setting: APRN Leaders with the Expertise and Skills to Respond to COVID-19. The document describes how CRNAs can help rural facilities prepare for and meet the challenges of COVID-19, including directing, managing, and providing anesthesia-related services for urgent surgeries and procedures and providing life-saving critical care management for patients impacted by COVID-19. Rural facilities are encouraged to discuss with them how CRNAs can lead and contribute value-added services and capabilities to the COVID-19 response. This infographic also can support CRNAs in discussions with rural facility leaders to support the CRNA role during the COVID-19 crisis.

As advanced practice providers with critical care nursing experience, CRNAs possess a global perspective, making them uniquely qualified to contribute to advanced airway management, advanced hemodynamic monitoring, and advanced ventilator management, including turning operating room ventilators into ICU ventilators and leading rapid response teams to provide life-saving interventions. Both hospitals and patients benefit from the work of these competent and versatile providers.
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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 and 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 SupportTheFront.com. See also AANA.com/covidwellness

 

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Hot Topics


New MIPS Improvement Activity for Participation in COVID-19 Clinical Trials

The Centers for Medicare & Medicaid Services (CMS) approved the addition of a new Improvement Activity in 2020 for Merit-based Incentive Payment System (MIPS)-eligible clinicians that attest to participation in COVID-19 clinical trials. To receive credit for the IA (IA_ERP_3), providers must participate in a trial using a drug or biological product for the treatment of COVID-19 patients, and report their data to a clinical trial repository or registry. Clinical trials can include those listed in the U.S. National Library of Medicine’s Clinical Trial website. The activity is high-weighted, meaning it will be worth 20 points toward the maximum of 40 points required for the IA performance category. More information about the Improvement Activity is available by calling the Quality Payment Program support at 1-866-288-8292 or sending an e-mail to QPP@cms.hhs.gov.
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Healthcare Facilities Accreditation Program COVID-19 FAQs and Resources

The Healthcare Facilities Accreditation Program (HFAP) issued Customer FAQs: Requirements and Considerations Related to COVID-19. These responses to frequently asked questions cover survey updates, governance, clinical privileging, PPE, and required certifications (e.g., ACLS). If you work in an HFAP-accredited facility, be sure to review these FAQs, as well as HFAP COVID-19 Resources and General Infection Control, and check these pages frequently for updates.
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Call for Comments on Proposed Revisions to the Accreditation Standards and Policies

At its January 2020 meeting, the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) reviewed proposed revisions to its Standards and policies based on recommendations from the joint COA/AANA Full Scope of Practice Competency Task Force (FSOPCTF) and the COA's Standards and Policies Committee. In addition, the COA reviewed revisions to the U.S. Department of Education’s recognition requirements for accrediting agencies. As a result of these reviews, the COA is proposing several changes to the accreditation Standards, policies and procedures.

Feedback from the community of interest is very important in considering the proposed revisions. To obtain feedback, a Call for Comments survey on the proposed revisions was developed and is now open and available.

The survey will take approximately 30 minutes to complete, and it can be completed in multiple sittings. After clicking “Save,” a page will appear with a new link to access your saved survey:
  • Please click the above Call for Comments survey link to view the proposed revisions. Please note the COA is continuing its review of the remaining FSOPCTF recommendations and will issue another Call for Comments later this year.
  • A mark-up of the proposed revisions from the COA’s Standards and Policies Committee is posted on the COA website as a PDF.
The Call for Comments will remain open until June 15, 2020. Should you have any questions regarding the Call for Comments, please contact the COA at 847-655-1160 or by e-mail at accreditation@coacrna.org.
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Open Sessions at COA Meetings in 2020

The business portions of the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) meetings are open to the public. The meetings are open to program representatives and others who are interested in observing the proceedings; however, the meetings are closed to observers while the COA deliberates on accreditation decisions.

The COA meetings are normally held at the AANA Headquarters, 222 S. Prospect Avenue, Park Ridge, IL 60068. Due to COVID-19 restrictions, the remaining 2020 COA meetings will have the following format:
  • June 3-5, 2020 – virtual meeting
  • October 7-9, 2020 – TBD, notification regarding the format will be posted closer to the meeting date
Please notify the COA if you plan on attending the open sessions. Please call the COA office (847-655-1160) or email accreditation@coacrna.org for further information and specific times of the open sessions.
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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 AANA.com Committee Page. If you have any questions, please contact Catharine Harris, AANA Associate Director of Political Affairs, at charris@aanadc.com.

Disclaimer
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 Aaron Gopp Serves on Front Lines in New York

As an Army Reserve member of the Urban Augmentation Medical Task Force for the Department of Defense, LTC Aaron Gopp, MSN, CRNA, was mobilized to Javits Center in New York City in April. His responsibilities included providing critical care management and intubation and ventilator duties. "Overall, the combined teams that worked at Javits took care of 1,095 patients," said Gopp. "I've been in medicine for 30 years, and I've never seen anything like this. It's not like the flu, this is nasty stuff—it's just a crazy disease.

"One of the memories of a patient that will stay with me is a grandmother in her 70s that I cared for in the ICU," continued Gopp. "She really just wanted to see her newborn grandson, and you could tell that it meant a lot to her to do that—just in case she didn't make it. We were able to arrange a video conference through a cell phone for her, so that she could see her grandson, and you could tell that it just brought her so much joy. That is the kind of experience that really reminds you of why you are there." Learn more.
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Meetings and Workshops


Upcoming Webinar and Replays Available

Stay up to date with the latest webinars and replays. Earn Class A CE credits with this series.

Upcoming Webinar
:
  • Lessons from the Frontlines: CRNAs and the COVID-19 Pandemic
    Tuesday, May 26, 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*
  • Pediatric Anesthesia During the COVID-19 Pandemic* (New this week)
  • Impact of Drug Shortages During the COVID-19 Pandemic (New this week)
View available courses.

Previous/Other Topics

  • Resuming Elective, Non-urgent Surgical Procedures during the COVID-19 Pandemic
Get the latest schedule!

* Webinar series supported, in part, by an educational grant provided by Medtronic and Johnson & Johnson.
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Foundation and Research


AANA Foundation and OREF Collaboration: Multimodal Musculoskeletal Perioperative Pain Management Grant Available

Grant Deadline: July 30, 2020

The application for Principal Investigator for the joint study with the Orthopaedic Research & Education Foundation (OREF) is now available. The principal investigator must be a CRNA. Research to tentatively commence in October 2020. Visit the OREF Research-Specific Grants 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 Foundation Open Submission: Dean Hayden Student Research & Evidence-Based Practice Grant

This grant is open to student registered nurse anesthetists (SRNAs) 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 Member Benefits


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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Jobs



CRNACareers

CRNACareers.com - 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, CRNACareers.com 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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CRNA: Tobey 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.

Tobey Hospital is a major healthcare resource for greater Wareham, MA. By combining modern technology with personalized patient care, Tobey features a state-of-the-art surgical wing and Intensive Care Unit that make today's advanced medical procedures available to area residents. Key services include a bariatric weight loss surgery program, as well as maternity and general surgery programs.

Case Assignments
Endoscopy, General, Orthopedics, GYN, Radiology, Chronic Pain.

Position Responsibilities
  • Pre-anesthesia assessment.
  • Obtains and/or verifies patient consent.
  • Discuss anesthetic options and risks with the patient.
  • Induction, maintenance and emergence from anesthesia.
  • Monitoring of the patient's physiological condition.
  • Performance of clinical intervention as needed.
Learn more.
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CRNA: The William W. Backus Hospital, North American Partners in Anesthesia, Connecticut

NAPA is actively recruiting to enhance our practices in Connecticut! Elective Surgeries to begin as early as May 15th. Full-time call- $93.38/hr. plus sign-on bonus.

Backus Hospital is a 213-bed, not-for-profit acute care community hospital providing state-of-the-art comprehensive medical services, personalized attention and care. The hospital seeks to meet the total healthcare needs of people from throughout eastern Connecticut and along the shoreline.

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

Position Responsibilities
  • Pre-anesthesia assessment.
  • Obtains and/or verifies patient consent.
  • Discuss anesthetic options and risks with the patient.
  • Induction, maintenance and emergence from anesthesia.
  • Monitoring of the patient's physiological condition.
  • Performance of clinical intervention as needed.
Learn more.
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CRNA: Catholic Medical Center (CMC), North American Partners in Anesthesia, New Hampshire

NAPA is actively recruiting to enhance our practices in New Hampshire! Elective Surgeries to begin as early as May 15th. Full-Time Call Rate $106/hr. plus sign-on bonus.

Catholic Medical Center (CMC), a member of GraniteOne Health, is a nonprofit acute-care hospital and regional health system based in Manchester, New Hampshire, with a commitment to delivering the highest quality and most advanced healthcare to patients across the state. CMC is one of New Hampshire's largest health systems, licensed for 330 beds, with an affiliated medical staff of over 400 physicians and 3,000 employees. We serve more than 180,000 patients each year, offering a wide variety of healthcare services in a highly technical and mission-oriented environment. Our history is rich with religious connection and commitment to the well-being of the human race, yet we constantly evolve to meet and exceed patient expectations.

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

Position Responsibilities
  • Pre-anesthesia assessment.
  • Obtains and/or verifies patient consent.
  • Discuss anesthetic options and risks with the patient.
  • Induction, maintenance and emergence from anesthesia.
  • Monitoring of the patient's physiological condition.
  • Performance of clinical intervention as needed.
Learn more.
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CRNA: Exeter Hospital, North American Partners in Anesthesia, New Hampshire

NAPA is actively recruiting to enhance our practices in New Hampshire! Elective Surgeries to begin as early as May 15th. Full Time $90/hr., plus sign-on bonus.

Exeter Hospital is a 100-bed community-based hospital and one of three affiliates of Exeter Health Resources. At each of the affiliated companies, we are committed to providing healthcare services that are innovative, progressive, and focused on quality and the well-being of patients. The scope of care allows us to offer comprehensive healthcare services in breast health, birthing and reproductive medicine, cardiovascular, occupational and employee health, oncology and orthopedics.

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

Position Responsibilities
  • Pre-anesthesia assessment.
  • Obtains and/or verifies patient consent.
  • Discuss anesthetic options and risks with the patient.
  • Induction, maintenance and emergence from anesthesia.
  • Monitoring of the patient's physiological condition.
  • Performance of clinical intervention as needed.
Learn more.
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CRNA: Banner Health, California

Banner Health, a Top 5 Large Health System and one of the country's premier non-profit healthcare networks is expanding its team of advanced practice providers and is seeking an experienced CRNA to join our highly trained surgical team where you’ll enjoy a smaller hospital setting and become part of the fabric of the community.

Banner Lassen Medical Center (BLMC), built in 2004, in Susanville, California, has a growing younger population with four seasons and a short winter and is located just 90 minutes from Reno, Nevada. Proximity to Eagle Lake and the mountains, the area offers many outdoor recreational opportunities, including hiking, biking, golfing, fishing and hunting. Susanville and Lassen County are an outdoor paradise where the beautiful Sierra Nevada and Cascade mountains meet the desert of the Great Basin. The unique and diverse terrain offers something for everyone with an ideal year-round climate with an average summer high of 89 degrees and daytime temps of 40 degrees during the winter months.

This represents an excellent opportunity for a passionate and energetic CRNA to join a well-respected surgical team providing Orthopaedic, General Surgery and Scopes.
  • CRNA-only practice model.
  • Responsible for performing general, regional, and monitored anesthesia services. including ultrasound-guided block, and OB.
  • 3 years’ experience preferred.
  • 2 weeks on, 1 week off.
  • SIGN-ON BONUS.
Banner Health offers a competitive salary and recruitment incentives along with an industry leading benefits package that provides security for you and your family:
  • Comprehensive medical, dental, vision and pharmacy plans.
  • Paid time-off plans.
  • Eligible for benefits coverage within 30 days.
  • Financial savings resources.
  • Career advancement and optimal work-life balance.
  • Employee Discounts.
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.

'Pain Switch' Is Discovered in an Area of the Brain Associated with Negative Emotions and Responses That Could Lead to a New Wave of Anesthetics

In a discovery that promises to shape the next generation of pain-relieving drugs, scientists have located an area of the brain where pain is turned off instead of on. The studies in mice focus on the almond-shaped amygdala, a cluster of neurons located on each side of the brain. The work suggests that "CeAga" neurons, nerve cells within the amygdala, inhibit multiple pain-promotion centers in the brain when exposed to beams of light. Led by Fan Wang, PhD, of Duke University, investigators also found that low doses of the general anesthetic ketamine also activated the CeAga center. In lab research, activating the CeAga neurons significantly and immediately curtailed paw-licking, rubbing, and other signs of discomfort in mice that were subjected to a mild pain stimulus. While the murine amygdala is bigger than that of humans, researchers believe the system of controlling pain is likely comparable. Based on that presumption, the team plans to pursue development of new analgesics that can activate only those CeAga cells to suppress pain. Wang and colleagues published their research in Nature Neuroscience.

From "'Pain Switch' Is Discovered in an Area of the Brain Associated with Negative Emotions and Responses That Could Lead to a New Wave of Anesthetics"
Daily Mail (05/18/20) Chadwick, Jonathan

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Comparison of Analgesic Effect Between Erector Spinae Plane Block and Transversus Abdominis Plane Block After Elective Cesarean Section

A study out of Egypt compared pain relief with bilateral erector spinae plane (ESP) block versus bilateral transversus abdominis plane (TAP) block in the setting of elective cesarean section. Sixty participants were randomly divided into two treatment arms, with one group undergoing ESP block and the other receiving ultrasound-guided TAP block. Researchers were primarily interested in how long analgesia lasted with each technique, and they found that block duration was a median 12 hours in the ESP patients compared with 8 hours in the TAP patients. Mean visual analog pain scores at rest were also lower in the ESP group during the first 24 hours. In addition to delivering more effective pain relief for a longer period of time, ESP was superior to TAP block in terms of time to first analgesic requirement and overall tramadol consumption. Researchers also lauded its suitability for multimodal analgesia and opioid-sparing regimens following c-section.

From "Comparison of Analgesic Effect Between Erector Spinae Plane Block and Transversus Abdominis Plane Block After Elective Cesarean Section"
Journal of Pain Research (05/20) Vol. 2020, No. 13, P. 1073 Boules, Maged Labib; Goda, Abeer Shaban; Abdelhady, Mahdy Ahmed; et al.

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Doctors Say Protective 'Aerosol Boxes' Really Do More Harm Than Good

New research published in Anaesthesia suggests that "aerosol boxes" meant to protect nurses and doctors from coronavirus actually could increase risks to providers and their patients, too. One of numerous innovations in response to the pandemic, the clear plastic boxes allow clinicians to work through cut-outs for their arms and hands. Despite an endorsement from a key medical journal and widespread distribution around the world, physician-researchers in Melbourne, Australia, point out a woeful lack of testing to demonstrate the safety and efficacy of the simple invention. Working with donated materials, the team from Cabrini Hospital evaluated two types of boxes in more than two dozen simulated intubation procedures. Instead of potentially protecting users from infectious droplets, the research observed a "concerning" rate of damage to personal protective equipment as gowns snagged on the arm holes and exposed the skin. Additionally, intubation took much longer to perform—up to three minutes, compared to under one minute normally—the study found. Although the study used mannequins, that length of time to intubate a real patient would have dire consequences, the investigators warned, with a critically ill coronavirus patient likely passing away under real-world conditions.

From "Doctors Say Protective 'Aerosol Boxes' Really Do More Harm Than Good"
Sydney Morning Herald (Australia) (05/15/20) Dow, Aisha

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Using Actual Body Weight with Sugammadex Speeds Reversal in Morbidly Obese Patients

Researchers have discovered that reversal of moderate or deep neuromuscular blockade occurs more quickly in morbidly obese patients who receive sugammadex based on actual body weight instead of ideal body weight. Their multinational study included 188 patients who were recovering from rocuronium- or vecuronium-induced block. Participants were randomized into five different treatment groups based on depth of block (moderate or deep) and reversal agent (sugammadex or neostigmine). The primary outcome was time needed to reach a ratio of at least 0.9 in supramaximal train-of-four (TOF) stimulation of the ulnar nerve, which came in at a median 1.8 minutes for patients who were dosed on actual body weight. By comparison, patients who received dosing according to their ideal body weight required a median 3.3 minutes to achieve the desired TOF target. Investigators also observed that the effect was more pronounced in patients who were given sugammadex, rather than neostigmine, as a blocking agent. Additionally, although more adverse events were expected with actual body weight dosing, the team found that not to be true. Despite the apparent superiority of actual body weight dosing with sugammadex in morbidly obese patients recovering from neuromuscular blockade, questions remain over whether the extra cost associated with this approach is justified.

From "Using Actual Body Weight with Sugammadex Speeds Reversal in Morbidly Obese Patients"
Anesthesiology News (05/14/20) Vlessides, Michael

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The Association Between Labor Epidural Analgesia and Postpartum Depression

Collaborators from Harvard and Brown universities undertook a quantitative systematic review targeting the relationship between epidural analgesia for labor and postpartum depression. A search of the current literature unearthed nine relevant and appropriate studies, with a collective 4,442 participants. Based on meta-analysis of the trials, women who received epidural analgesia were not significantly more likely than control patients to screen positively for postpartum depression within three months of giving birth. The researchers therefore conclude that while earlier studies have shown that effective treatment of postoperative pain may alleviate depressive symptoms, use of epidural analgesia to relieve labor pain does not appear to influence the likelihood of postpartum depression. More work is needed, they say, to uncover other possible interventions for preventing the condition.

From "The Association Between Labor Epidural Analgesia and Postpartum Depression"
BMC Women's Health (05/11/20) Vol. 20, No. 99 Almeida, Marcela; Kosman, Katherine A.; Kendall, Mark C.; et al.

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Comparison of Effectiveness of Ropivacaine Infusion Regimens for Continuous Femoral Nerve Block for Recovery After Total Knee Arthroplasty

Chinese researchers studied how different doses of ropivacaine for continuous femoral nerve block affect patient rehabilitation after total knee arthroplasty (TKA). The trial enrolled 60 participants scheduled for knee replacement surgery, dividing them into three equally sized treatment arms. Following the procedure, one group of patients received infusion of 10 mL of 0.1% ropivacaine per hour at a dose of 10 mg/hour for 48 hours. The other two cohorts received 6.7 mL of 0.15% ropivacaine per hour and 5 mL of 0.2% ropivacaine per hour, respectively, at the same dose. The main outcome was time to readiness for discharge, with secondary endpoints including time to first walk, manual muscle testing scores, pain scores, morphine demand, rescue analgesia, and adverse events. Patients in the 0.15% and 0.2% groups were prepared for discharge sooner after TKA than those in the 0.1% group. Because 0.15% ropivacaine also correlated to less quadriceps muscle strength weakness than the 0.2% regimen, the investigators recommend it for postoperative pain relief following total knee replacement.

From "Comparison of Effectiveness of Ropivacaine Infusion Regimens for Continuous Femoral Nerve Block for Recovery After Total Knee Arthroplasty"
Journal of Pain Research (05/20) Vol. 2020, No. 13, P. 997 Zhang, Yujian; Liu, Le; Zheng, Liangyu; et al.

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News summaries © copyright 2020 SmithBucklin



Anesthesia E-ssential is an executive summary of noteworthy articles of interest to nurse anesthetists. It is distributed weekly to AANA members.

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May 21, 2020