Anesthesia E-ssential

AANA Anesthesia E-ssential, May 3, 2018
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Vital Signs

Local Anesthetic Critical Shortages Affecting Anesthesia Services

The United States is currently experiencing critical drug shortages that are resulting in a direct impact on patient care. Critical drugs, including bupivacaine solutions, are currently in short supply. The AANA continues to monitor this shortage and has posted relevant information. Nurse anesthetists are encouraged to work with their healthcare facilities and pharmacy to address drug shortages and determine solutions in order to provide safe anesthesia and analgesia care. Additional recommendations and alternative strategies are delineated by the Society for Obstetric Anesthesia and Perinatology (SOAP) in their Advisory in Response to Shortages of Local Anesthetics in North America. If your facility is experiencing a shortage, it can be reported to to help the FDA gauge the extent of the shortage. Please note, this email address is to provide information to the FDA and may not result in an immediate response or resolution. If you have practice-related questions, please contact the Professional Practice Division at
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Board of Directors Approves Two Updated Practice Documents

At Mid-Year Assembly, the Board of Directors approved two updated practice documents: Other professional practice documents can be accessed in the Professional Practice Manual for the CRNA.
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Hot Topics

OSANA Receives Excellence in State Government Relations Advocacy Award

At the AANA Mid-Year Assembly on April 22, the 2018 Excellence in State Government Relations Advocacy Award was presented to the Ohio State Association of Nurse Anesthetists. The AANA Government Relations Committee selects the recipient of the award, which is not tied to a specific “victory,” but focuses instead on the overall quality of the effort. OSANA’s government relations effort resulted in increased member engagement, increased state PAC funding, and valuable coalitions with other state nursing groups.
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Arlington National Cemetery Military Funeral Held for LTC John Hlavnicka, CRNA

Retired Army LTC John Paul Hlavnicka, 65, passed away on December 11, 2017, at his home surrounded by family and friends after a short but valiant battle with cancer. He was buried in Arlington National Cemetery in Arlington, Virginia, with full military honors on April 24, 2018.

Family members, friends, and former co-workers in attendance accompanied the flag-draped casket, which was on a horse-drawn wagon. As per military tradition, three volleys were fired in salute from rifles.

Read more about LTC Hlavnicka, and see photos from the Arlington ceremony.
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National Nurses Week is May 6-12, 2018

National Nurses Week is May 6-12, 2018. Celebrate the nurse in you with campaign materials from the American Nurses Association. Inspire, Innovate, Influence.

Be sure and watch the AANA website beginning May 6th for more information about nurses and interesting historical tidbits.
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AANA Connect Community for Candidates for the AANA Board of Directors

The AANA Connect Community for Candidates for the AANA Board of Directors is now available for members to interact with Board candidates and will remain open until May 23, 2018. After that date, the forum will remain open through the end of the voting cycle (June 5, 2018) for members to view, but members won’t be able to post additional questions.

To participate in the community, log on to AANA Connect and click on the orange Join Community button.

In this year’s Candidate Forum Community, each office will have its own thread: a thread for President-Elect, a thread for Vice President, one for Treasurer, and so on. Here members will be able to ask questions of the candidates running for that particular office.

If you have questions or need assistance, please email We look forward to your participation.
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NewsMaker: CRNA Andrew Johnson Featured in Daily Nurse Article

Andrew J. Johnson, CRNA, APRN, is the sole anesthesia provider in a rural critical access hospital in Olivia, Minnesota. In this Q&A article, he talks about the challenges and rewards of working in a rural setting.

"I feel like the patients and staff have closer relationships in small communities," says Johnson. "We all know each other, and many times are related to each other. I hear weekly from patients that they feel so comfortable knowing I will be doing their anesthesia because of our relationships in the community."

Read the full Daily Nurse article.
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NewsMaker: CRNA Jeremy Chance Wins Special Election

Jeremy Chance will retain his seat on the Lamar County School Board in Mississippi after winning a special election Thursday for the District C spot.

Purvis resident Chance beat Lumberton's Gladys Parker Rogers, 598 votes to 287 votes, in an election with low turnout.

The Lamar County and Lumberton school boards voted in January to approve the special election, which was necessary as part of the consolidation of Lumberton Public School District into Lamar County School District. District C was expanded to include not only much of Purvis but also Lumberton.

Chance, 38, works as a Certified Registered Nurse Anesthetist. He was appointed to Lamar County School Board in early 2016 and elected in a special election in November 2016. He has two children who attend Purvis Lower Elementary.

Learn more.
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MHAUS Masseter Muscle Rigidity Recommendation Available for Public Comment

The Malignant Hyperthermia Association of the United States (MHAUS) has released a draft recommendation regarding Masseter Muscle Rigidity. CRNAs are encouraged to review and leave professional, diplomatic, and concise comments directly on the MHAUS site.
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Enhanced Recovery After Surgery Infographic Now Available

For the better part of a year now, the AANA has been aggressively promoting CRNAs’ role in the fight against the nation’s opioids crisis, emphasizing the importance of Enhanced Recovery After Surgery (ERAS) to reduce or eliminate reliance on opioids to manage patient’s pain. As part of the AANA’s campaign, a new infographic on CRNAs, ERAS, and the opioids crisis is available for members, state associations, and others to use for PR and advocacy purposes. The two-page infographic, which can be printed as a two-sided document, is available in the Public Relations area of the AANA website (login required) and also on the Future of Anesthesia Care Today site.
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Public Relations Toolkit Relaunches on AANA Website

Prior to the launch of the new AANA website last fall, the Public Relations area was taken down for a redesign and refresh. The PR Tools area is now up and running again with a fresh look; it’s also much easier to navigate. This area of the site provides easy access to the CRNA Fact Sheet, CRNAs at a Glance, Power of the Pen (POP) press releases, brochures, the public education campaign “CRNAs: The Future of Anesthesia Care Today,” and more. New POP releases, Power Point presentations and other PR materials are in development with support from the AANA Communications Committee. As content is added, announcements will be made via your Anesthesia E-ssential newsletter, social media, and the AANA NewsBulletin. Visit the Public Relations area on the member side of the website.
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Changes to the PR Recognition Awards

Start gathering examples of your state association, education program, or own public relations efforts for submission as an entry to the 2018 PR Recognition Awards contest. Revised guidelines are now available in the Recognition Awards area of the website. Note: This year there will be four award categories instead of five, with the small states category being absorbed into the other four. The deadline for entries is July 27, 2018. If you have any questions, please contact PR Department Administrative Associate Karen Sutkus.
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Looking for an AANA Volunteer Opportunity? Apply for a FY2019 AANA Committee Now!

President elect Garry Brydges is looking for volunteers to fill committee positions in fiscal year 2019. Many committees have positions available for CRNAs and student registered nurse anesthetists. Check out the committee page on the AANA website to read about the various opportunities. Deadline for submission of a committee request is May 15, 2018. Please note: If you currently serve on a fiscal year 2018 committee, you must reapply for fiscal year 2019.
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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.

Predicting Severity of Acute Pain After Cesarean Delivery: A Narrative Review

A number of predictive tools have been developed in an effort to flag women who may be at higher risk for severe pain after delivering a child surgically, with an eye toward possibly approaching their analgesic care differently. To compare the available options, researchers performed a review based on 13 published articles that evaluated methods for predicting acute pain and/or opioid demand in the first 48 hours after cesarean section. They included quantitative sensory testing, assessment of wound hyperalgesia, and response to local anesthetic infiltration as well as preoperative psychometric evaluations such as the State-Trait Anxiety Inventory, the Pain Catastrophizing Scale, the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, and simple questionnaires. While an association was noted between some of the techniques and pain outcomes, most of the correlations were weak to modest and the modalities were not necessarily clinically viable. Pain with local anesthetic infiltration, along with a screening tool posing three simple questions, were the two methods with the most promise. More research is needed, however, to evaluate the utility of these predictive tests in clinical practice and to help build a decision algorithm for analgesia after cesarean childbirth.

From "Predicting Severity of Acute Pain After Cesarean Delivery: A Narrative Review"
Anesthesia & Analgesia (05/18) Vol. 126, No. 5, P. 1606 Gamez, Brock H.; Habib, Ashraf S.

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Transversus Abdominis Plane Block for Post Hysterectomy Pain

University of Ottawa researchers conducted a systematic review of transversus abdominis plane (TAP) block for pain control after hysterectomy. Through Medline, Embase, and Cochrane Library searches, they identified 14 randomized clinical trials that compared TAP block with no block or with placebo in this setting. For the purpose of the review, the investigators were interested in mean differences in visual analog score (VAS) and total morphine demand at two and 24 hours postoperatively. At the first interval, mean VAS scores were markedly lower for the TAP block recipients, regardless of whether they received total abdominal hysterectomy (TAH) or total laparoscopic hysterectomy (TLH). TAP block also was associated with lower pain scores 24 hours after both types of procedures. Lastly, morphine consumption was reduced in the women who underwent TAP block for TAH; however, the same was not true for women who had the block for TLH.

From "Transversus Abdominis Plane Block for Post Hysterectomy Pain"
Journal of Minimally Invasive Gynecology (04/30/18) Bacal, Vanessa; Rana, Urvi; McIsaac, Daniel I.; et al.

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Thermal Imaging Camera Detects Unilateral Epidural Blockade

Researchers in Canada may have found a solution to inadequate analgesia with unilateral epidural blockade, which normally cannot be assessed until after the block is established. Because laboring mothers who undergo unilateral block experience significant temperature increase in the lower extremities, the group from St. Michael's Hospital and the University of Toronto theorized that a thermal imaging camera could quickly and noninvasively detect this physiological change and confirm the adequacy of the blockade. To investigate, the team led by Inna Oyberman, MD, performed a small observational study involving seven women who needed an epidural top-up due to unilateral blockade. Before administering additional local anesthetic, researchers used a thermal imaging camera to record each patient's skin temperature. They also questioned participants about their pain, finding that temperatures were higher on the side with the sensory block and lower on the side with the worse pain. The preliminary results suggest that thermal imaging technology could be beneficial for laboring women with unilateral epidural blockade. "This was a pilot study, so future studies are needed to validate other potential uses for this technology," Oyberman said. "Certainly we need studies that assess the sensitivity and specificity of this technology, and perhaps we'll need to determine the minimal clinically significant temperature difference in the future as well."

From "Thermal Imaging Camera Detects Unilateral Epidural Blockade"
Anesthesiology News (04/30/18) Vlessides, Michael

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A 50-50% Mixture of Nitrous Oxide-Oxygen in Transrectal Ultrasound-Guided Prostate Biopsy

Researchers in Brazil tested the efficacy of a 50-50 mix of nitrogen oxide (NO) and oxygen (O2) as analgesia and sedation in patients undergoing transrectal ultrasound-guided biopsy (TUSPB) for prostate cancer. The study randomized 42 patients to receive 100 percent oxygen inhalation and a like number of participants to receive inhalation of the gas mixture. Pain intensity, degree of satisfaction, and frequency of adverse events were compared between the two sets of men. The investigators found that mean pain intensity was lower and satisfaction was higher among the patients who received the NO-O2 mix than among the controls. The incidence of adverse effects—which included dizziness, nausea, vomiting, somnolence, discomfort, and euphoria—were comparable between the two groups. Based on the evidence, the combination of 50 percent NO and 50 percent O2 effectively alleviates pain intensity and improves the extent of satisfaction during TUSPB, with manageable side effects.

From "A 50-50% Mixture of Nitrous Oxide-Oxygen in Transrectal Ultrasound-Guided Prostate Biopsy"
PLOS ONE (04/27/18) Vol. 13, No. 4 Cazarim, Gabriel da Silva; Verçosa, Nubia; Carneiro, Leonel; et al.

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Periarticular Injection vs Psoas Block for THA-Associated Postoperative Pain

A prospective clinical trial set out to identify differences between periarticular injection and psoas compartment block (PCB) in the setting of total hip arthroplasty (THA), where they both are commonly used as part of multimodal pain relief. The study population included 99 participants, randomized in a 1:1 ratio to one technique or the other. Resting and ambulatory pain at postoperative days one and two—and also at follow-up after three weeks—were about the same for both treatment arms. Inpatient narcotic consumption, a secondary endpoint, also was comparable between the groups. Periarticular analgesia presented only a slight benefit over PCB, due to lower resting pain scores three hours after THA. That, however, combined with fears of overblockade effects with PCB, led the researchers to recommend periarticular injection over PCB during hip replacement surgery. The findings are reported in the Journal of Arthroplasty.

From "Periarticular Injection vs Psoas Block for THA-Associated Postoperative Pain"
Clinical Pain Advisor (04/26/18) Rothbard, Gary

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Common Analgesics Beat Opioids for Dental Pain Relief

An assessment of five systematic reviews suggests that over-the-counter pain medications are safer and more effective than prescription opioid analgesics for controlling pain following dental procedures. Data analyzed by researchers included randomized trials on the use of oral medication for the most severe types of postoperative dental pain. More than three dozen drugs and drug combinations were tested in various dosages. Researchers concluded that the most effective pain relief with the fewest adverse effects comes from a combination of 400 milligrams of ibuprofen with 1,000 milligrams of acetaminophen. While there may be some individuals who can only get relief with opioid analgesics, study co-author Anita Aminoshariae—an associate professor at Case Western Reserve University—noted that for most patients, opioids are less effective and have unpleasant adverse effects. In addition, they carry a high risk of addiction. The study is published in the Journal of the American Dental Association.

From "Common Analgesics Beat Opioids for Dental Pain Relief"
New York Times (04/25/18) Bakalar, Nicholas

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

Anesthesia E-ssential is for informational purposes, and its contents should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

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May 3, 2018