Anesthesia E-ssential

AANA Anesthesia E-ssential, May 23, 2019

Vital Signs

AANA Releases Official Statement on Anesthesia Care Delivery

The AANA Board of Directors is pleased to introduce the AANA's official statement on anesthesia care delivery in the United States titled "CRNAs: We are the Answer," and an essential supporting document titled "America's Anesthesia Workforce: Current Status and Emerging Trends." Both documents were approved by unanimous vote during the Board's May conference call.

"CRNAs: We are the Answer" is found on the public side of the AANA website; "America's Anesthesia Workforce" is found on the members side (login required). The intent of both documents is to provide a truthful, evidence-based analysis of CRNAs, physician anesthesiologists, and anesthesiologist assistants in today's U.S. healthcare system that may be used for public education, advocacy, media relations and other purposes by CRNAs, state associations, and nurse anesthesia educational programs.

Development of "We are the Answer" and "America's Anesthesia Workforce" was motivated by the ASA House of Delegates' adoption in October 2018 of an amended version of the Statement on the Anesthesia Care Team that inaccurately portrays and seeks to minimize the invaluable role of CRNAs and student nurse anesthetists in the U.S. healthcare system, while overinflating the role and value of physician anesthesiologists.

Work on the AANA documents was spearheaded by an AANA Board task force and AANA staff, with invaluable contributions from the membership at large. Both documents will be updated on a regular schedule or as needed.

Questions and feedback about "CRNAs: We are the Answer" and "America's Anesthesia Workforce" may be sent to Garry Brydges, PhD, DNP, MBA, ACNP-BC, CRNA, FAAN at

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NBCRNA Research Initiative Adds Two Subcommittees: Simulation, Methods

Professional Practice Analysis Survey Coming May 31

The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) is committed to evaluation and research to determine the best ways to assess knowledge as a component of competence. To further focus on this, two subcommittees of the NBCRNA Evaluation and Research Advisory Committee (ERAC), comprised of subject-matter experts, have been established and are working on various research projects and initiatives. The NBCRNA is looking at potential options for the CPCA as a knowledge-only assessment.
The subcommittees include:
  • Simulation-Based CPC Assessment Subcommittee
  • Methods to Assess Knowledge and Competence Subcommittee
Additionally, the NBCRNA will launch an all-CRNA Professional Practice Analysis of CRNA practice on May 31 to update the content outline for the Continued Professional Certification Assessment (CPCA). This work is a critical step to ensure the CPCA reflects changing practice requirements. Watch your email on May 31 for this important survey.

Learn more about NBCRNA's focus on research, and upcoming and recent studies:
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What’s Going on Legislatively in Your State? Find Out With New Interactive Map

The AANA State Government Affairs division is happy to announce an exciting new resource: an interactive map that can be used to monitor all state legislation AANA is currently tracking. It’s available to all members by visiting the State Government Affairs – Member Resources page (Member login required) on the AANA website. This map empowers members to understand the legislative world that affects CRNAs, both in their own state and other states. The map also highlights the extent of the hard work being done to support the profession at the state legislative level.
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Hot Topics

Recent Grads: Save up to 50% on Malpractice Insurance Coverage Through AANA Insurance Services

As our way of welcoming you to the profession, AANA Insurance Services is offering you a 50% premium discount on full-time and supplemental malpractice insurance coverage. Caring has its risks. Learn how we can help safeguard your career.
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Register Now!
AANA State Leadership Workshop, June 22-23, 2019, in Nashville

Save the date for the AANA State Leadership Workshop, "Taking the Show on the Road," June 22-23, 2019 in Nashville, Tenn.

These leadership workshops are designed for state leaders to effectively lead and govern state associations. Join your peer leaders for this interactive day and a half workshop and be inspired and engaged to:
  • Conduct an effective crucial conversation and learn how to influence change for positive outcomes.
  • Describe the applied skills in emotional intelligence and understand how this relates to your role as a state leader.
  • Develop strategies for improving association board governance.
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Future of Nursing 2020-2030 Committee to Hold Twitter Chats

The Committee on the Future of Nursing 2020-2030 is holding three Twitter Chats to solicit public input. These chats will take place in conjunction with each of the regional Town Hall Meetings. Learn more and sign up to join @theNAMedicine at the first Twitter Chat on May 30.
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Certified Registered Nurse Anesthetist: Memorial Health System, Springfield, Illinois

This position embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision and values. Our CRNAs administer general, regional, and MAC anesthesia to patients of all ages and any ASA status. The CRNAs work in a collaborative team environment with 50 CRNAs, 21 Anesthesiologists and 12 Anesthesia Techs to assist with room turnover and stocking. The CRNAs serve as Clinical Instructors for SIUE and Millikin/Decatur Nurse Anesthesia programs.

Due to our continued growth, Memorial Medical Center has multiple needs for Certified Registered Nurse Anesthetists. Positions are available full time in the Main OR, CVOR or as a split 50/50 between Main OR and CVOR. Learn more.
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Certified Registered Nurse Anesthetist: Rush Oak Park Hospital, Oak Park, Illinois

The CRNA functions under the medical direction of the Anesthesiologist with regard to pre-anesthetic and post-anesthetic patient management functions. Good oral and written communication skills; time management/priority-setting; familiarity with basic body mechanics; flexibility with schedule to accommodate staffing needs; ability to transport equipment; work environment includes probability of exposure to adverse, hazardous, or unpleasant conditions; routinely comes in contact with potentially infectious patients and specimens. Master's Degree, Graduate of an accredited C.R.N.A. Program, current Illinois RN license, Current CPR and ACLS (from AHA). Learn more.
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Assistant Director of Nurse Anesthesia DNP Program: University of Arkansas for Medical Sciences College of Nursing, Little Rock, Arkansas

The Assistant Director of the Nurse Anesthesia Program, a certified registered nurse anesthetist with a doctoral degree, assists the Program Director with administrative and day-to-day operations of the DNP Nurse Anesthesia Program and engages in the education, practice, and scholarship missions of the College of Nursing. This individual reports directly to the Nurse Anesthesia Program Director and Associate Dean for Practice. This is a 12-month, full-time faculty appointment with the option for tenure or non-tenure track. Academic rank will be commensurate with qualifications and experience relative to the position. Learn more.
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Simulation Coordinator/DNP Advisor: Fairfield University & BHNAP Simulation Coordinator, Bridgeport, Connecticut

The Fairfield University & Bridgeport Hospital Nurse Anesthesia Program, located in Fairfield, Connecticut, is seeking a doctorally prepared, innovative leader to serve as the program’s Simulation Coordinator/DNP Advisor with a rank of Assistant Professor within the Fairfield University Egan School of Nursing & Health Studies. The Simulation Coordinator works with the program director and assistant program director to plan, implement and evaluate the program’s simulation curriculum and serves an active role in programmatic change. In addition, he/she will serve as advisor for the development, implementation, evaluation and dissemination of doctoral projects. Learn more.
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Certified Registered Nurse Anesthetist: Nemours in Multiple Locations

Nemours, Delaware, Pennsylvania, New Jersey

As one of the nation’s leading pediatric health care systems, Nemours is committed to providing all children with their best chance to grow up healthy. We offer integrated, family-centered care to more than 300,000 children each year in our pediatric hospitals, specialty clinics and primary care practices in Delaware, Florida, Maryland, New Jersey and Pennsylvania. Nemours strives to ensure a healthier tomorrow for all children – even those who may never enter our doors – through our world-changing research, education and advocacy efforts. At Nemours, our Associates help us deliver on the promise we make to every family we have the privilege of serving: to treat their child as if they were our own.

As a member of the anesthesia care team, the CRNA will provide anesthesia care appropriate to the neonatal, pediatric, adolescent and occasional adult population. The CRNA will provide services as assigned in both operative and non-operative anesthesia locations at the Alfred I. duPont Hospital for Children; the Alfred I. duPont Hospital for Children Surgery Centers at Bryn Mawr, PA, and Deptford, NJ; and the Christiana Care Health System Operating Room for NICU Surgical Cases. Provide anesthesia call coverage at the Alfred I. DuPont Hospital for Children as needed. 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.

Satisfactory Analgesia with Minimal Emesis in Day Surgeries

A study out of Canada's McMaster University evaluated whether morphine or hydromorphone is superior for achieving satisfactory analgesia with minimal emesis (SAME). Researchers worked with 402 patients undergoing ambulatory surgery across multiple sites. Based on randomized assignment, 199 participants received morphine and 203 received hydromorphone. The likelihood of SAME was roughly equivalent with the two opioids, despite some chatter that hydromorphone was the better agent. In addition, adverse events—including severe itching, respiratory depression, and sedation—were no better or worse with hydromorphone than with morphine. Outcomes such as discharge times, post-discharge endpoints, and patient satisfaction also were similar between the two groups. With no clear difference in terms of analgesia or common adverse effect, the researchers recommend that the choice of opioid for postoperative pain be based on individual patient responses.

From "Satisfactory Analgesia with Minimal Emesis in Day Surgeries"
British Journal of Anaesthesia (06/19) Vol. 122, No. 6, P. 107 Shanthanna, H.; Paul, J.; Lovrics, P.; et al.

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Analgesic Efficacy and Safety of Intravenous Meloxicam in Subjects with Moderate-to-Severe Pain After Open Abdominal Hysterectomy

A Phase II study assessed the safety and efficacy of intravenous meloxicam for postoperative pain management following open abdominal hysterectomy. Nearly 500 women who experienced moderate-to-severe pain after their procedure were randomly assigned to a single dose of placebo, morphine, or meloxicam IV—which is still working toward U.S. regulatory approval. Treatment was administered six hours after morphine dosing on the first postoperative day, with follow-up for 24 hours. A total of 295 women participated in the open-label extension, which called for daily meloxicam IV until the end of the hospital stay or as deemed necessary. The evidence pointed to superiority of meloxicam IV over placebo in terms of summed pain intensity difference and total pain relief up to 24 hours after treatment administration. Taken once a day, at a dose of 5 mg to 60 mg, meloxicam IV delivered perceptible pain relief within six to eight minutes—similar to morphine. The effect was maintained over a 24-hour dosing interval; and the drug was well tolerated, with no deaths and no treatment-related serious adverse events. In addition to greatly improving pain intensity and pain relief compared to placebo, meloxicam IV appeared to curtail opioid consumption. Based on the findings, the investigators support the move to Phase III trials of meloxicam IV.

From "Analgesic Efficacy and Safety of Intravenous Meloxicam in Subjects with Moderate-to-Severe Pain After Open Abdominal Hysterectomy"
Anesthesia & Analgesia (06/19) Vol. 128, No. 6, P. 1309 Rechberger, Tomasz; Mack, Randall J.; McCallum, Stewart W.

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Early Sedation with Dexmedetomidine in Critically Ill Patients

A randomized clinical trial aimed to learn more about the use of dexmedetomidine in the intensive care unit, where it has shown potential in shortening the duration of mechanical ventilation and curtailing delirium. The study population included critically ill adults who had been on ventilation for no more than 12 hours but were expected to remain on it for at least 12 months. A total of 4,000 patients were enrolled, 3,904 of whom were included in the modified intent-to-treat population. About one-half received dexmedetomidine as the primary or only sedative for mechanical ventilation, while the remainder received standard care consisting of propofol, midazolam, or other sedative agents. The 90-day, any-cause mortality rate was the same for both treatment arms: 29.1 percent. However, about three-quarters of the patients assigned to dexmedetomidine needed supplemental sedatives to achieve the desired level of sedation. In addition, the dexmedetomidine patients reported bradycardia and hypotension more often than did patients who received usual care.

From "Early Sedation with Dexmedetomidine in Critically Ill Patients"
New England Journal of Medicine (05/19/19) Shehabi, Yahya; Howe, Belinda D.; Bellomo, Rinaldo; et al.

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Midazolam for the Prevention of Emergence Agitation in Pediatric Patients with Extreme Fear and Non-cooperation Undergoing Dental Treatment

Sevoflurane is a popular anesthetic for general anesthesia in children, but it is associated with emergence agitation. Researchers in Japan examined whether intraoperative administration of midazolam would curb this complication following pediatric dental procedures performed under sevoflurane anesthesia. The 120 study participants were equally divided into three treatment groups that received 0.1 mg/kg of intravenous midazolam, 0.05 mg/kg of midazolam, or saline about 30 minutes before the dental procedure ended. Investigators then measured outcomes in the operating room and in the recovery area. They discovered that while midazolam reduced sedation and drowsiness during the emergence phase in the operating room, it did not mitigate agitation and delirium during the recovery phase. However, they also realized, using the Richmond Agitation and Sedation Scale score to assess sedative and agitation condition at emergence is a good tool for predicting agitation during recovery.

From "Midazolam for the Prevention of Emergence Agitation in Pediatric Patients with Extreme Fear and Non-cooperation Undergoing Dental Treatment"
Drug Design, Development and Therapy (05/17/19) Vol. 13, P. 1729 Kawai, Mari; Kurata, Shinji; Sanuki, Takuro; et al.

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Intubation of Non-Difficult Airways Using Video laryngoscope Versus Direct laryngoscope

Researchers in China wondered if video laryngoscope, recommended for intubation of difficulty airways, might also be superior in the setting of non-difficult airway. The team from Affiliated Hospital of Zunyi Medical College randomly allocated 179 abdominal surgery patients to intubation with video laryngoscope and 181 to intubation with direct laryngoscope. None of the patients had a history of difficult airway. Clinicians registered a 100 percent success rate with the former technique, compared with 94.5 percent for the latter. The success rate for achieving intubation on the first try, meanwhile, was 96.1 percent with video laryngoscope versus 90.1 percent for direct laryngoscope. Not only was intubation successfully completed more often with the video approach, postoperative complications were fewer. Compared with 5.1 percent of patients who underwent intubation by direct laryngoscope, for example, only 1.1 percent of the video laryngoscope group suffered immediate oropharyngeal injury. Additionally, the share of patients who presented with unmistakable hoarseness on the first postoperative day was 7.9 percent and 2.8 percent, respectively.

From "Intubation of Non-Difficult Airways Using Video laryngoscope Versus Direct laryngoscope"
BMC Anesthesiology (05/15/19) Vol. 19, No. 75 Liu, De-Xing; Ye, Ying; Zu, Yu-Hang; et al.

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Proximal vs Distal Ultrasound-Guided Approach for Greater Occipital Nerve Block for Chronic Migraine

New evidence suggests that the proximal ultrasound-guided approach has an edge over the distal ultrasound-guided approach for delivering greater occipital nerve (GON) block in migraine sufferers. The small study included 40 patients with refractory chronic migraine—each randomized to one technique or the other, and all receiving the block with bupivacaine and methylprednisolone acetate. Patients in both groups reported a significant improvement in sleep interruption after one week of treatment and markedly fewer headache days per week after one month. The difference in numeric rating score (NRS) for headache intensity 1 month after treatment also was significant in both groups, with patients registering meaningful reductions. The effect continued, however, for recipients of ultrasound-guided proximal GON, who still reported big drops in NRS pain score at three months. "With potentially longer-lasting analgesia with equivalent steroid exposure, we recommend using an US-guided proximal GON injection approach first for the treatment of [chronic migraines]," said the researchers, who published their findings in Regional Anesthesia and Pain Medicine.

From "Proximal vs Distal Ultrasound-Guided Approach for Greater Occipital Nerve Block for Chronic Migraine"
Neurology Advisor (05/14/19) Dellabella, Hannah

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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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Attn: Cathy Hodson
E–ssential Editor
May 23, 2019
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