AANA Anesthesia E-ssential
AANA Anestehsia E-ssential 
Anesthesia E-ssential

May 29, 2015

 

Vital Signs

Be Sure to Vote in the AANA 2015 Election!
Voting Ends June 2
Have you voted yet? The AANA 2015 election will continue until June 2, 2015, 12 noon CDT. Active AANA members received their ballot materials, including their election passcode and voting instructions from Survey and Ballot Systems (SBS), the AANA's election coordinator. The email with the voting credentials originated from noreply@directvote.net. Please make sure this email did not end up in your spam or junk mail folder. To access the AANA election site visit https://www.directvote.net/aana/ and enter your AANA member number and the Election passcode provided to you by SBS. If you do not have this information, click on the "Email me my login information" link 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 support@directvote.net.
 
IMPORTANT NOTE: If you requested an electronic ballot, SBS has suggested that you add the following email address to your contact list as an approved sender: noreply@directvote.net.
 
 

 

The Pulse

 
  • More About the CPC Exam  
  • Tennessee Law Enacted Clarifying CRNA Ordering Authority
  • Annual Congress Early Bird Rates End June 1
  • AANA Foundation Friends for Life Deadline - June 15, 2015
  • Support the AANA Foundation: Shop AmazonSmile
  • Annual Golf Tournament to be Held at Eaglewood Golf Course in North Salt Lake
 
  • Register Now for Business of Anesthesia Conference
  • Register Now for the Nurse Anesthesia Annual Congress
  • Fall Leadership Academy: Save the Date
  • Registration Open for Upper and Lower Extremity Block Workshop
  • Coming This Fall: Popular Hands-On Workshops
 
  • House Veterans Affairs Committee Holds Hearing on VA Staffing Issues; AVANA Submits Testimony
  • Update on Current Status of AANA’s Efforts to Ensure Veterans Access to Quality Care
  • ASA-backed Rural Pass-through Proposal would Boost Costs, Not Quality, Says AANA
  • House Passes National Defense Authorization Act, Continuing Pay Incentives for DoD CRNAs
  • AANA Requests that Draft National Pain Strategy Address CRNA Barrier to Pain Management
  • Amendments
  • FEC REQUIRED LEGAL DISCLAIMER FOR CRNA-PAC
 
 

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.
 
 

 
 

Information in this section is provided to help CRNAs keep their finger on the pulse of what’s happening with the NBCRNA’s Continued Professional Certification (CPC) program, which will launch on Aug. 1, 2016

More About the CPC Exam
One frequently asked question about the CPC Exam is whether the test will include knowledge that is outside the CRNA’s average scope of practice. The exam won’t repeat the National Certification Exam (NCE), and it won’t be a comprehensive test of specialty knowledge. The exam will focus on the knowledge that CRNAs learn over time, through clinical practice, continuing education, and evidence-based literature. About five years ago, the NBCRNA asked clinical CRNAs in practice to participate in a national survey to learn what knowledge was common to the clinical practice of nurse anesthesia. This survey, or professional practice analysis, was used to help identify the core nurse anesthesia knowledge regardless of practice focus. This knowledge settled into four domains that will make up the bulk of the exam — airway management, equipment and technology, pharmacology, and physiology and pathophysiology. If you have questions about the exam, you can find a content outline for the first exam on the NBCRNA website, or contact the NBCRNA to learn more.
For more information, go to the AANA and NBCRNA websites.

 
Inside the Association
Tennessee Law Enacted Clarifying CRNA Ordering Authority
Tennessee House Bill 629 was signed into law by the governor on May 20 and takes effect immediately. The law clarifies that CRNAs may order drugs without obtaining prescriptive authority, in accordance with clinical privileges. The law also explicitly authorizes registered nurses to implement CRNA orders.

 

Annual Congress Early Bird Rates End June 1
August 29-Sept. 1
Salt Lake City
Register today for the #AANA2015 Annual Congress and save $100. Enjoy more education, more networking, more fun! Come for the education and stay for the experience at the world's largest educational, professional, and social event for nurse anesthetists. Choose from seven education tracks, including practical hands-on learning and networking, in addition to the largest exhibit of its kind. Register Now!

 
 
 

  
 
AANA Foundation Friends for Life Deadline – June 15, 2015
Friends for Life help support the future of the nurse anesthesia profession through meaningful, lasting gifts. Contributions through Friends for Life help fund and sustain programs that further research and education in anesthesia.
 
Friends for Life receive a medallion at the AANA Annual Congress Opening Ceremonies, an engraved plaque in the AANA Park Ridge office, and an invitation to the Annual Awards and Recognition Event.
 
The minimum gift commitment to join Friends for Life is $25,000. Members may fulfill this commitment through a cash gift, but there are many other ways to meet the commitment through planned gifts. Some of the most popular planned gift options for becoming a Friend for Life include:
  • A gift (bequest) in the will for a specific amount or a percentage of the total estate
  • Gift of personal property or real estate
  • Including the Foundation as a beneficiary on a retirement plan or a whole life insurance policy
For further information, please contact Nat Carmichael at (847) 655-1175 or ncarmichael@aana.com. The Friends for Life submission deadline for recognition at this year’s Annual Congress in Salt Lake City, Utah, is June 15, 2015. Read more about becoming a Friend for Life.
 
 
Support the AANA Foundation: Shop AmazonSmile
AmazonSmile is a simple way to support the AANA Foundation every time you shop, at no cost to you. AmazonSmile is a website operated by Amazon that offers the same wide selection of products and exact same low prices as Amazon.com; the difference is that the AmazonSmile Foundation will donate 0.5 percent of the price of eligible purchases to the AANA Foundation.
 
To shop at AmazonSmile, go to smile.amazon.com. You may want to add a bookmark to make it even easier to return and shop. To go directly to the AmazonSmile webpage supporting the AANA Foundation, click on http://smile.amazon.com/ch/36-3145692. Please log on and shop today! There are millions of products marked “Eligible for AmazonSmile donation” on their product detail pages. Thank you in advance for participating in this easy way to support the AANA Foundation.
 
 
Annual Golf Tournament to be Held at Eaglewood Golf Course in North Salt Lake
The AANA Foundation will host its 18th Annual Golf Tournament on Friday, Aug. 28, 2015, at Eaglewood Golf Course with tee off at 1:30 p.m. Eaglewood offers spectacular views of the Great Salt Lake, and its mountainside design demands precision on every tee. Accuracy, not distance, is the key. Each round played will be exciting, for each hole has its own personality. Moose, deer, red foxes, and coyotes make regular appearances on Eaglewood's terrain, and bald eagles soar high above the links, so even though you may not putt for eagle, you'll most likely see one.
 
Visit the AANA Foundation 18th Annual Golf Tournament webpage for more details including information on club rental, sponsorship, contests, and photos from past AANA Foundation golf tournaments. The fee is $250. To register, visit the AANA Annual Congress Registration Page. Please plan to participate in this fun event and experience Eaglewood Golf Course with CRNAs and SRNAs from across the country while benefiting the AANA Foundation and its mission to advance the science of anesthesia through education and research.
 
For further information contact Luanne Irvin, AANA Foundation Development Officer, at (847) 655-1173 or lirvin@aana.com.
 
 

 
 
Register Now for Business of Anesthesia Conference
Join us in San Diego on June 26-27 for a two-day conference that will arm you with critical tools for navigating the business aspects of anesthesia practice. Get real-world advice from expert speakers with experience in building and maintaining a successful practice. Whether you are still in training or have owned your practice for years, you’ll benefit from best practices and strategies for success in an ever-changing healthcare climate. Register before May 26 and Save $50!
 
 
Register Now for the Nurse Anesthesia Annual Congress
August 29-Sept. 1
Salt Lake City
The Nurse Anesthesia Annual Congress is the world's largest educational, professional, and social event for Certified Registered Nurse Anesthetists. Choose from seven education tracks, including practical hands-on learning and networking, in addition to the largest exhibit of its kind. Register now!
 
 
Fall Leadership Academy: Save the Date!
November 6-8, 2015
Westin O'Hare, Rosemont, Ill.
The Fall Leadership Academy is a unique opportunity to meet current and future leaders, catch up with old friends, and create new relationships. Choose from five distinct educational tracks designed to meet your specific leadership needs: Lobbyist/State Government Affairs, Workplace Leadership, Federal Political Director, State Reimbursement Specialist, and State President-elect.
 
Watch the AANA website and future issues of the NewsBulletin and E-ssential for more information!
 
Registration Open for Upper and Lower Extremity Block Workshop
Expand your skills and expertise in upper and lower extremity block anesthesia through this hands-on workshop, to be held on Sept. 26-27, 2015, in Park Ridge, Ill. The program will include case studies, hands-on demonstrations, return demonstrations, and skill validation. Register now!
 
Coming This Fall: Popular Hands-On Workshops
Check out the Meetings and Workshops webpage on the AANA website and future issues of the AANA NewsBulletin and Anesthesia E-ssential for further information.
• Essentials of Obstetric Analgesia/Anesthesia Workshop: October 21, 2015, Park Ridge, Ill.
• Spinal and Epidural Workshop: October 22-24, 2015, Park Ridge, Ill.
• Jack Neary Advanced Pain Management Workshop Part II, October 10-11, 2015, Rosemont, Ill.
 


 
 
 
House Veterans Affairs Committee Holds Hearing on VA Staffing issues; AVANA Submits Testimony
The House of Representatives Veterans’ Affairs Subcommittee on Health held a hearing May 15 on “Overcoming Barriers to More Efficient and Effective VA Staffing” and the Association of Veterans Affairs Nurse Anesthetists (AVANA) was invited to submit testimony outlining the role and benefits of CRNA services for our veterans.
 
Among the panelists were representatives from healthcare and veterans organizations, including the Immediate Past President of Nurses Organizations of Veterans Affairs, Joan Clifford, MSN, RN FACHE, who expressed support for the VHA adopting full practice authority for APRNs including CRNAs, plus the Chief Officer of Nursing for the Veterans Health Administration, Donna Gage, PhD, RN, NE-BC, and the Assistant Deputy Under Secretary for Health for Clinical Operations for the Veterans Health Administration, Thomas Lynch, MD. Allowing APRNs, including CRNAs, to practice as full practice providers was touted as a way to reduce inefficiencies within the VHA and increase the quality of care provided to our nation’s veterans. In testimony submitted by AVANA President Garrett Peterson, CRNA, DNP, RN, wrote, “To promote patient safety, access to care, and cost-efficient care delivery, I will offer a recommendation that the VHA recognize CRNAs and other Advanced Practice Registered Nurses (APRNs) to their full practice authority.”
 
The AANA, AVANA and other veterans coalition partners continue to work together to advance the Nursing Handbook Full Practice Authority proposal. The hearing was a positive step in affirming the committee is dedicated to investigating ways to improve staffing inefficiencies in the VHA. To read the testimony submitted by AVANA, see: http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150515%20Testimony%20HVAC-H%20AVANA%20Pres%20Peterson%20on%20VA%20Staffing%20-%20FINAL.pdf. The hearing record is at https://veterans.house.gov/hearing/overcoming-barriers-to-more-efficient-and-effective-va-staffing. The hearing was covered in the May 17 Washington Post at http://www.washingtonpost.com/blogs/federal-eye/wp/2015/05/17/vas-ability-to-increase-health-professionals-is-seriously-fractured/.
 
 
Update on Current Status of AANA’s Efforts to Ensure Veterans Access to Quality Care
The AANA and its members continue to advocate for legislation and a Veterans Health Administration (VHA) proposal that would authorize all advanced practice registered nurses (APRNs), including CRNAs, to practice as full practice providers in the VHA and help improve access to quality healthcare for all veterans. Here is a status update:
  • The AANA is supporting legislation in the House, HR 1247, the “Improving Veterans Access to Quality Care Act,” sponsored by Reps. Sam Graves (R-MO) and Jan Schakowsky (D-IL). The bill now has 23 bipartisan cosponsors. The AANA is requesting that members contact their U.S. Representatives to cosponsor this bill. Please do so here. View the AANA and APRN Workgroup letter of support here and also view the Nursing Committee letter here.
  • The Senate Veterans Affairs Committee has scheduled a June 3 hearing on several bills including S 297, the “Frontlines to Lifelines Act,” sponsored by Sen. Mark Kirk (R-IL). The AANA and CRNAs have expressed concerns about S 297 because it recognizes only three of the four APRN specialties for full practice authority in the VHA, omitting CRNAs, unlike HR 1247. The AANA encourages CRNAs to contact their U.S. Senators with similar concerns about S 297, and to request that the bill be amended to include CRNAs. Please do so here. See AANA’s letter on S 297 here.
  • The AANA continues to strongly support the VHA’s efforts to update its Nursing Handbook to recognize CRNAs and other APRNs to their full practice authority, consistent with the recommendations of the Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health. According to the VHA, the agency intends to publish regulatory rulemaking later this year, recognizing CRNAs and other APRNs to their full practice authority in the VHA. Thousands of AANA members have already contacted the VHA in support of this work; AANA members are currently being requested to focus on contacting Congress.
  • The Senate Appropriations Committee moved its Fiscal Year 2016 Military Construction and Veterans Affairs Appropriations Act on May 21, approving $77.6 billion in FY 16 funding, a $1.5 billion increase over FY 15 enacted levels. Final language has not been published as of press time.
Since mid-February, AANA members have sent over 13,000 messages to their federal legislators expressing support for HR 1247 and concern for S 297 as written.
 
 
ASA-backed Rural Pass-through Proposal would Boost Costs, Not Quality, Says AANA
New legislation backed by the American Society of Anesthesiologists would increase rural healthcare costs without improving quality, according to an AANA letter sent to Congress May 21. AANA members should stand at the ready for CRNAdvocacy alerts for contacting Congress about this bill.
 
The legislation, introduced by Rep. Lynn Jenkins (R-KS), “The Medicare Access to Rural Anesthesiology Act of 2015” (HR 2138), “establishes parity between anesthesiologists and certified registered nurse anesthetists (CRNAs) by allowing anesthesiologists to receive pass-through payments in the same fashion CRNAs receive pass-through payments.”
But in a letter signed by President Sharon Pearce, CRNA, MSN, the AANA said, “As proposed, HR 2138 will increase the overall cost of anesthesia delivery in rural America without improving outcomes or access for rural Americans, placing additional financial burdens upon rural hospitals already facing financial challenges.” Similar legislation was introduced in the last several Congresses but did not move. However, this summer Congress is working on hospital payment legislation, providing backers of this bill a legislative vehicle for moving it.
 
 
House Passes National Defense Authorization Act, Continuing Pay Incentives for DoD CRNAs
Legislation adopted by the U.S. House of Representatives on May 15 continues for another year a military incentive program to recruit and retain CRNAs and ensure our men and women in uniform have access to the highest possible quality anesthesia care.
 
The House-passed “National Defense Authorization Act” (HR 1735) included a provision extending the authorization for incentive special pay (ISP) programs for military CRNAs through December 31, 2016. Adopted on a vote of 269-151, the measure now goes to the U.S. Senate for consideration. See how your Representative voted here: http://clerk.house.gov/evs/2015/roll239.xml.
 
 
AANA Requests that Draft National Pain Strategy Address CRNA Barriers to Pain Management
Barriers to CRNA pain management education, practice and reimbursement should be eliminated as health industry leaders carry out a newly issued draft National Pain Strategy developed with the involvement of leading CRNAs, according to comments the AANA has submitted to the National Institutes of Health (NIH) on May 19.
 
The letter signed by AANA President Sharon P. Pearce, CRNA, MSN, stated, “[L]eading physician subspecialty organizations in pain management research, practice guideline development, and education are known to use economic and advocacy means to exclude other members of the pain management team, such as CRNAs, from educational and practice opportunities, thereby limiting patient access to care, diagnosis, treatment, and ultimately improved patient quality of life. A report issued in April 2015 by the Federal Trade Commission (FTC), Competition and the Regulation of Advanced Practice Registered Nurses, underscores the point that for CRNAs and other APRNs, ‘even well intentioned laws and regulations may impose unnecessary, unintended, or overbroad restrictions on competition, thereby depriving health care consumers of the benefits of vigorous competition.’ Therefore, we recommend that the strategy include a task force to identify and develop strategies to address all barriers, including federal, state and facility restrictions on scope of practice, that limit an APRN’s ability to provide comprehensive pain management care. In the interest of patients and the public, the education, regulation, and reimbursement of each member of the pain management team should allow the team to practice to the full extent of their education and training.”
 
The comment letter also recommended that the draft National Strategy:
  • Include AANA and CRNAs as stakeholders and collaborators in all six areas of focus and on committees named in the strategy.
  • Ensure that the development of reimbursement and quality-related programs should be patient-centered.
  • Have multiple education accrediting bodies lead the effort on further development of subspecialty training and certification in pain care.
On Memorial Day, May 25, the Arlington National Cemetery site marking the grave of a pillar of the AANA, LTC Ira P. Gunn, CRNA, MLN, FAAN, U.S. Army Nurse Corps, received a visit from AANA’s staff team. Learn more about Ira Gunn’s legacy at http://www.aana.com/newsandjournal/inmemoriam/Pages/Ira-Gunn.aspxand about the AANA award in her name at http://www.aana.com/aboutus/recognitionawards/Pages/Ira-P.-Gunn-Award-for-Outstanding-Professional-Advocacy.aspx. With thanks to all of the men and women who gave their all for our country.
 
Amendments
  • A U.S. Supreme Court decision is expected in June on the King v. Burwell case on subsidized health coverage offered through federal exchanges in states. A Court ruling in favor of the plaintiff could eliminate federal subsidies in states where a federally-facilitated healthcare marketplace exists, which has the potential to substantially disrupt coverage for several million Americans. To learn more, see http://www.scotusblog.com/case-files/cases/king-v-burwell/.
  • Some 2016 Senate election contests are already taking shape. In Wisconsin, former Democratic Sen. Russ Feingold announced that he will challenge current Sen. Ron Johnson (R-WI) in a rematch of the 2010 Senate race. In Indiana, former Democratic Rep. Baron Hill announced he will join the Indiana race for the Senate to replace retiring Sen. Dan Coats (D-IN). In Arizona, Rep. Ann Kirkpatrick (D-AZ-1) announced that she will challenge current Sen. John McCain (R-AZ) for his Arizona Senate seat in 2016. The AANA encourages all members to get involved in local races and to share any photos or experiences with us at info@aanadc.com.
  • Stay up to date on CRNA reimbursement issues by obtaining Version 3 of the AANA’s “Issues Briefs on Reimbursement and Nurse Anesthesia,” available only for AANA members at http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150413%20AANA%20Issue%20Briefs%20Regarding%20Reimbursement%203d%20ED%20FINAL.pdf (requires AANA member login and password).
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 US Citizen.
 
 

 
 
 

 
 
 
Reduced Opioid Use and Lower Pain Scores Found With Use of Dual Nerve Block
Research indicates better pain outcomes after foot and ankle surgery when two continuous nerve blocks are used for anesthesia instead of one continuous popliteal block with a single-injection saphenous block. In a study of 60 patients undergoing major procedures of the foot or ankle, those who received the dual block required significantly less opioid analgesia in the first two days following surgery. They also reported lower pain scores, both at rest and in motion, and were much more satisfied with their pain management. Patients who received the single continuous block, meanwhile, were 2.85 times more likely to need medicine to treat post-discharge nausea. The findings were presented at the annual meeting of the Association of American Society of Regional Anesthesia and Pain Medicine.
 
From "Reduced Opioid Use and Lower Pain Scores Found With Use of Dual Nerve Block"
Healio (05/26/2015) Tingle, Casey
 
 
Prolonged Paracetamol Use in Pregnancy Could Harm Male Offspring
U.K. researchers believe that taking paracetamol for longer than a week while pregnant could cause reproductive problems for baby boys later in life. The study adds paracetamol to a number of factors that can reduce the production of testosterone in male fetuses—which, in turn, has been linked to conditions included undescended testes, low sperm count, and testicular germ cell cancer. Tests on laboratory mice reflected no long-term suppression of hormone production in fetal testes after a single day of exposure to paracetamol; but after seven days, it declined by 45 percent. University of Edinburgh researcher Rod Mitchell said expectant mothers who use paracetamol should take the lowest effective dose of the analgesic and see a physician or pharmacist if they plan to use it over a long period of time. "This research is a reminder that we need to be careful with all medicines during pregnancy and [also] during the first few years of life," remarked Steve Tomlin, consultant pharmacist for children services at the Evelina London Children's Hospital. "And it is essential that we carry on doing these studies."
 
From "Prolonged Paracetamol Use in Pregnancy Could Harm Male Offspring"
Pharmaceutical Journal (05/26/15) Balakrishnan, Vijay Shankar
 
 
 
Serious Adverse Events Unlikely From Pediatric Dexmedetomidine Use
Serious adverse events (SAEs) are unlikely for pediatric procedural sedation with dexmedetomidine, no matter which practitioner administers it. A research team analyzed the Pediatric Sedation Research Consortium database, finding that rates of minor complications did vary from provider to provider. The researchers reported at the 44th Critical Care Congress of the Society of Critical Care Medicine on more than 13,000 children who were sedated using dexmedetomidine. The drug was administered by a variety of providers, including nurse anesthetists, emergency medicine physicians, and hospitalists. The SAEs studied included cardiac arrest, airway obstruction, death, laryngospasm, emergent airway intervention, unplanned hospital admission or increased level of care, aspiration, or need for an emergency anesthesia consult. There were only about 45 SAEs reported, or 0.34 percent of patients, and the SAE rates between specialties were comparable. The adjusted odds ratio for having an AE, however, was 8.5 times greater for emergency physicians and 5.3 times greater for intensivists. Whatever the reasons for this disparity, the researchers concluded that dexmedetomidine is a good drug for pediatric procedural sedation under any clinician.
 
From "Serious Adverse Events Unlikely From Pediatric Dexmedetomidine Use"
Anesthesiology News (05/01/15) Vol. 41, No. 5 Vlessides, Michael
 
 
 
WHO Plan Aims to Combat Resistance to Antibiotic Drugs
A new plan to combat antibiotic drug resistance is set to be adopted by the World Health Organization this week. The guidelines—agreed to unanimously by United Nations member states on Monday—highlight the need to develop surveillance of resistance, act more fully to prevent infections, improve control of existing antibiotics, and establish mechanisms to support investment in new antibiotics. Under the plan, all countries must prepare action plans within two years. A recent report from Jim O'Neil—a former chief economist for Goldman Sachs, who conducted the research at the request of the British government—said that without intervention to stem antimicrobial resistance, superbugs would lead to 10 million deaths annually and cost the global economy at least $60 trillion by 2050.
 
From "WHO Plan Aims to Combat Resistance to Antibiotic Drugs"
New York Times (05/26/15) Cumming-Bruce, Nick
 
 
Venlafaxine May Be Effective for Depression, Chronic Pain in Older Patients
A high dose of venlafaxine, an antidepressant, could alleviate chronic low back pain and depression in the geriatric patient population, say researchers. "We need to treat these linked conditions," insists Jordan Karp, MD, of the University of Pittsburgh Medical Center. "Late-life treatment-resistant depression is the rule, not the exception when treating older adults." With this in mind, Karp spearheaded the Addressing Depression and Pain Together (ADAPT) trial. The results indicated that patients given 150 mg or 330 mg per day of venlafaxine for six weeks reported a significant drop in pain levels and depression symptoms. However, the findings also suggested that incorporating problem-solving therapy for depression and pain, which entails talk therapy and cognitive-behavioral therapy, did not offer an added benefit. Karp intends to follow up with ADAPT participants at 12 months to see if they relapse.
 
From "Venlafaxine May Be Effective for Depression, Chronic Pain in Older Patients"
Neurology Advisor (05/20/15) Block, Jonathan
 
 
 
Oral Steroids for Acute Radiculopathy Due to a Herniated Lumbar Disk
A recent study investigated the use of oral prednisone for improving function and reducing pain among patients with acute sciatica. The research, conducted by Kaiser Permanente Northern California from 2008-2013, involved 269 adults with radicular pain for three months or less, an Oswestry Disability Index (ODI) of 30 or higher, and a herniated disk confirmed by MRI. Patients were randomly assigned to receive a tapering 15-day course of oral prednisone or matching placebo. According to the data, the prednisone group saw greater improvement in ODI scores at three weeks and 52 weeks than the placebo group. In addition, the prednisone group had an adjusted mean 0.3-point greater reduction in pain at three weeks and a mean 0.6-point greater reduction at 52 weeks compared with placebo. There was also an adjusted mean 3.3-point greater improvement in the Short Form 36 Health Survey (SF-36) Physical Component Summary (PCS) score at three weeks in the prednisone group, but no difference in the SF-36 PCS score at 52 weeks, no change in the SF-36 Mental Component Summary (MCS) score at three weeks, and an adjusted 3.6-point greater improvement in the SF-36 MCS score at 52 weeks. Adverse events were more common in the prednisone group compared with the placebo group. The findings, note the researchers, suggest that a short course of oral steroids leads to modestly improved function for patients with acute radiculopathy due to a herniated lumbar disk, though there was no improvement in pain.
 
From "Oral Steroids for Acute Radiculopathy Due to a Herniated Lumbar Disk"
Journal of the American Medical Association (05/19/15) Vol. 313, No. 19, P. 1915 Goldberg, Harley; Firtch, William; Tyburski, Mark; et al.
 
 
Researchers Determine Best Anesthesia Option for Infants
With some surgeries performed in infants, such as hernia repair, regional anesthesia could yield better recovery than general anesthesia, researchers from Royal Children's Hospital in Melbourne concluded in two studies in Anesthesiology. In one study, led by Andrew Davidson, MD, researchers compared rates of apnea after general or regional anesthesia among 722 infants. There was little evidence for a difference in late apnea, but regional anesthesia may have reduced the risk of significant apnea in the first 30 minutes after surgery. Another study, led by Geoff Frawley, MD, looked at the first study's 339 patients who had spinal anesthesia. Researchers looked for factors that affected the failure or success of the anesthetic technique. Frawley found that 16.8 percent of cases required an additional form of anesthesia. Factors associated with failure included the anesthesia provider's experience in spinal anesthesia. The studies were part of an ongoing study to compare the long-term effects of anesthesia on neurodevelopmental outcomes.
 
From "Researchers Determine Best Anesthesia Option for Infants"
Newswise (05/12/15)
 
 
 
Feds Tell Insurers to Pay for Anesthesia During Screening Colonoscopies
Insurers must not charge patients for anesthesia administered during a free colonoscopy to screen for colorectal cancer, the federal government has clarified. The health law requires most insurance plans to provide care recommended by the U.S. Preventive Services Task Force without charging patients out-of-pocket. Such recommendations include periodic colonoscopy, sigmoidoscopy, or fecal occult blood test in people aged 50 years and older. Originally, the health law required the colonoscopy itself to be free for patients, but it did not clarify how anesthesia or other charges should be handled. Some Americans have been charged hundreds of dollars for anesthesia administered for what they thought would be a free test. Although consumers do not have to pay for the anesthesia, they may still have to pay for facility or pathology charges related to a screening colonoscopy, according to Anna Howard, a policy principal at the American Cancer Society Cancer Action Network, and Mary Doroshenk, director of the National Colorectal Cancer Roundtable.
 
From "Feds Tell Insurers to Pay for Anesthesia During Screening Colonoscopies"
NPR Online (05/15/15) Andrews, Michelle
 
 
 
'Light Was as Rewarding as Morphine' in Mice With New Opioid Receptors
Laboratory testing suggests that light could play a big role in future strategies to treat pain. Certain anesthetics are known to bind to opioid receptors in the brain and the spinal cord, triggering specific chemical pathways that block pain. Now, researchers have created opioid receptors that react to light in the same manner. The new receptors—modified with rhodopsin, protein from the retina that responds to light—produced a "reward" response, similar to that created by opiates, when injected into the brains of mice and stimulated by light. "By activating the receptors with light, we are presumably causing the brain to release more dopamine," explained lead investigator Michael Bruchas, PhD, an assistant professor of anesthesiology and neurobiology at Washington University School of Medicine in St. Louis. "Rather than a drug such as morphine activating an opioid receptor, the light provides the reward." First author Edward Siuda, a graduate student, added that ultimately, it may be possible to manipulate light to alleviate pain without patients having to take painkillers and risk their side effects.
 
From "'Light Was as Rewarding as Morphine' in Mice With New Opioid Receptors"
Medical News Today (05/04/15) MacGill, Markus
 
 
 
Lethal-Injection Case Exposes Deep Top-Court Fissures on Death Penalty
The Supreme Court on April 2 debated lethal-injection drugs used in executions, exposing deep fissures among the justices over the death penalty. The case, heard one year to the day after a botched execution in Oklahoma ignited controversy over lethal injection, was brought by three men on the state's death row. They claim that midazolam, the anesthetic the state plans to administer before introducing paralytic and heart-stopping drugs to their bloodstreams, is unreliable, exposing them to an unconstitutional risk of severe pain as they are put to death. Justice Samuel Alito asserted that opponents are conducting "a guerrilla war against the death penalty" by pressuring pharmaceutical manufacturers to deny access to more effective chemicals, then suing to block alternatives that raised the risk of pain. Justice Sonia Sotomayor, meanwhile, accused Oklahoma of slanting scientific evidence in its legal briefs to mislead the court about midazolam's effectiveness in preventing pain. The legal issue before the justices is whether a federal district judge who upheld the use of midazolam was wrong.
 
From "Lethal-Injection Case Exposes Deep Top-Court Fissures on Death Penalty"
Wall Street Journal (04/30/15) Bravin, Jess
 
 
 
Increasing Incidence of the Neonatal Abstinence Syndrome in U.S. Neonatal ICUs
Neonatal abstinence syndrome (NAS) is sending an increasing number of infants to the neonatal ICU every year. Research presented at the annual meeting of the Pediatric Academic Societies in San Diego indicates that out of more than 674,800 infants admitted to 299 NICUs from 2004-2013, 10,327 were identified with NAS. The rate of admissions for NAS increased during that period from 7 cases per 1,000 admissions to 27 cases per 1,000 admissions, while the median length of stay increased by 6 days to 19 days. The total percentage of NICU days nationwide that were associated with NAS rose from 0.6 percent to 4 percent—and eight centers said that more than 20 percent of all NICU days were related to NAS care in 2013. The researchers call for effective methods of antenatal NAS prevention as well as postnatal treatment of affected babies.
 
From "Increasing Incidence of the Neonatal Abstinence Syndrome in U.S. Neonatal ICUs"
New England Journal of Medicine (04/26/15) Tolia, Veeral N.; Patrick, Stephen W.; Bennett, Monica M.; et al.
 
 
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