Anesthesia E-ssential

AANA Anesthesia E-ssential, May 7, 2020

Vital Signs

CRNAs Who Received Initial HHS Funding Relief Can Now Apply for Additional Funds

The U.S. Department of Health and Human Services (HHS) has announced that it has begun distributing the remaining $20 billion of the general distribution fund provided for in the Coronavirus Aid, Relief, and Economic Security (CARES) Act, and has opened up its application process. CRNAs who have a billing tax identification number (TIN)—such as CRNAs practicing solo or who own their own group—and who also received initial HHS relief funding as of April 24 are eligible to apply. CRNAs also will need to agree to the Terms and Conditions for this additional funding. These are payments—not loans—to healthcare providers and will not need to be repaid.

As part of the application process, HHS is collecting:
  1. A provider's "Gross Receipts or Sales" or "Program Service Revenue" as submitted on its federal income tax return.
  2. The provider's estimated revenue losses in March 2020 and April 2020 due to COVID-19.
  3. A copy of the provider's most recently filed federal income tax return.
  4. A listing of the TINs any of the provider's subsidiary organizations that have received relief funds but that do not file separate tax returns.

For more information see the HHS-provided FAQs.

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Iowa Governor Appoints CRNA Mark Odden to Board of Nursing

Mark Odden, MBA, BSN, CRNA, ARNPCongratulations to Mark G. Odden, MBA, BSN, CRNA, ARNP, who was appointed to the Iowa Board of Nursing (BON) by Governor Kim Reynolds. Odden will serve as chair of the board, and a representative of nursing practice, until 2022.

The board consists of seven members, five nursing professionals and two public members. The mission of the board is to protect the public health, safety and welfare by regulating the licensure of nurses, the practice of nurses, nursing education and continuing education.
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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 for further information and specific times of the open sessions.
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New Infographic: Resuming Elective, Non-Urgent Surgical Procedures During the COVID-19 Pandemic

As parts of the U.S. begin to resume elective non-urgent surgical services, the AANA has developed an infographic to help facilities and clinicians determine whether the timing of reopening and the safety of the working environment are appropriate prior to return to work.
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Let Your Voice Be Heard! The AANA 2020 Election is Now Open

Exercise your AANA member privilege. The 2020 election for fellow members to serve on the FY2021 Board of Directors and elected committees (Nominating and Resolutions) is now open. Candidates’ information can be viewed on the AANA website. (Member login required.)

Active AANA members should have received their voting credentials and voting instructions, via an email from (Survey & Ballot Systems). If you don’t see yours, please check your junk email.

Be sure to cast your secure vote by Tuesday, May 19, at noon (CDT).
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CPC Application for Certification Renewal Now Open

The 2020 Continued Professional Certification (CPC) Application window for certification renewal is now open on the NBCRNA portal for CRNAs due to renew their certification by July 31, 2020. The deadline is now extended to November 30, 2020. For this first CPC cycle, you will need 60 Class A credits and 40 Class B credits (or can use extra Class A credits over the required 60 towards the Class B requirement). Core Modules are not required in this first cycle. If you have all your requirements, visit to complete your application. Find all CPC information at
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Hot Topics

NewsMakers: CRNAs Sowka, Asselin and Sieger an Integral Part of UMMC's "Intubation Team"

While some CRNAs have been furloughed or laid off, the University of Massachusetts Medical Center (UMMC) found the unique skills of their nearly two dozen nurse anesthetists the perfect fit for ICU airway management. The CRNAs were retrained for work in the expanded ICUs at the hospital and University campuses.

"When I went in, I was happy about being able to help," said William Sowka, MS, CRNA, in an article that appeared in The Telegram & Gazette about UMMC CRNAs. "If you're with a patient for an extended period of time you get to know them and their families."

Emily Asselin, CRNA, said, "We're taking those skills that we normally use in the operating room and have moved them to the ICU." 

Chief CRNA Keith Sieger, MS, CRNA, said that CRNAs are a unique bunch. "Our hospital asked us to step up to a higher level and manage a group of patients instead of just one. There's a great sense of pride that leadership feels comfortable that you can handle that upgrade in responsibility." Learn more.
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NewsMaker: Philadelphia Magazine Profiles Front-Line CRNA Marta Waraksa

In April, Philadelphia Magazine profiled Marta Waraksa, MSN, CRNA, not just because she is planning a summer wedding in Poland, but also because she is working at-risk on the front lines of COVID-19. Waraksa discusses how her patients keep her grounded and how staying positive and flexible won't let the disease affect her wedding plans.

"Being a healthcare provider on the front lines makes this situation extremely real," says Waraksa. "I can't check out and ignore what is happening in the world. Every day when I see COVID-19 positive patients, I fear that the world won't be back to normal for a very long time." Learn more.
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NewsMakers: Diary of a Night at Our Central Park Hospital

International relief organization Samaritan's Purse has provided a look at what a night-shift nursing staff experiences on the front lines of the COVID-19 pandemic in a tent hospital in Central Park, New York.

A CRNA identified only as "Nurse Anesthetist Kirsten" is quoted: “It’s like at midnight each night, you can see the cytokine storms erupt. They all spike fevers at the same time, and their bodies become chaos. All of them. All at the same time. Every night. This isn’t the flu. This is nothing like the flu.”

Learn more.
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NewsMakers: CRNAs Lyon and Brangman Included in Article of Notable Nurses

Second Lieutenant Edward T. Lyon, CRNA, and Goldie Brangman, CRNA, are credited in a ScienceDirect article about notable nurses—Lyon for becoming the first male nurse to be commissioned as an officer in the U.S. Army Nurse Corps, and Brangman for her roles as founder and director of the Harlem Hospital School of Anesthesia and becoming the first and so far only African-American president of the AANA. Learn more.
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SUPPORT THE FRONT: Free Virtual Mental Well-being Support for Healthcare Professionals

Committed to supporting the wellness and reducing stress of healthcare professionals serving on the frontlines of the COVID-19 pandemic, the Parkdale Center and the American Association of Nurse Anesthetists (AANA) have partnered to bring you “Support the Front.”

Join one of many free virtual support groups, and meet with peers to share common concerns and insights on dealing with trauma, stress, burn-out, recovery, and prioritizing self-care.

View the available topics and full schedule at
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National Nurses Month in May Celebrates Nurses All Month Long

As part of the "Year of the Nurse and Midwife" celebration, the American Nurses Association "will expand National Nurses Week, traditionally celebrated from May 6 to May 12 each year, to a month-long celebration in May."

National Nurses Month will have four different themes, celebrated by week. Week 2 (May 10-16) has a theme of Recognition.

Learn more.
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Abstract Submissions: Assembly of Didactic and Clinical Educators 2021

The abstract submission process for the 2021 Assembly of Didactic and Clinical Educator programs opens March 4 and closes May 12, 2020. Please visit the AANA website for complete details.
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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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Deadline Extended: June 30, 2020 - FY2021 CRNA-PAC Committee

Deadline: June 30, 2020
CRNAs and SRNAs interested in serving on the CRNA-PAC Committee beginning in the AANA 2021 fiscal year are encouraged to submit an application through the AANA online committee submission form located on the committee page

Responsibilities of Committee members include:
  • Setting the CRNA-PAC income and expenditure policy;
  • Participating in fundraising duties;
  • Reviewing open-seat and challenger candidates for federal office; and
  • Volunteering at CRNA-PAC events and national meetings.
Committee members are expected to attend two in-person meetings per year (Joint Committee Conference in September 2020 and Mid-Year Assembly in April 2021) and conference calls on an as-needed basis.

If you have any questions, please contact Catharine Harris, AANA Associate Director of Political Affairs, at or call (202) 741-9087.

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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War Stories: Recording the Contributions of CRNAs in Service of Our Country

The American Association of Nurse Anesthetists (AANA) seeks to record the histories of our Certified Registered Nurse Anesthetists (CRNAs) who served in any of the United States' military operations and maneuvers of the 20th or 21st centuries (World War I, World War II, Korean War, Vietnam, The Invasion of Grenada, Gulf War, Iraq War). The AANA is interested in preserving your experiences as a matter of historical record. The AANA hopes to share these experiences with our membership, legislators, and the general public as a means of enlightening, healing, and reaching back into history so that the many accomplishments and sacrifices of CRNAs are not forgotten.

Submission guidelines are provided on the War Stories and Vietnam Voices pages. If you have any questions, or would like assistance in crafting your narrative, please contact Cathy Hodson, managing editor, digital publications and public relations.
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Foundation and Research

AANA Foundation Open Submission: Dean Hayden Student Research & Evidence-Based Practice Grant

This grant is open to student registered nurse anesthetists (SRNAs) who are nurse anesthesia students 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 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 Member Benefits

Members, Take Advantage of Free Class A and Pharmacology Credits!

Earn up to 9.5 Class A CE and 1.75 pharmacology credits with exclusive AANA Learn® courses, including topics like enhanced recovery, respiratory compromise, and multimodal pain management. Free to AANA members and associate (student) members—just log in and add the course(s) to your cart. Get started today!
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Medtronic and Johnson & Johnson Show Their Support for CRNAs

We’d like to thank AANA Corporate Partner Medtronic and Johnson & Johnson for providing financial support of the COVID-19 Webinar Series through a medical educational grant. With their support, the AANA can continue to provide members with essential tools and clinical resources during this challenging time. This complimentary webinar series is a resource for all CRNAs working to update their skills and knowledge related to managing patients with expected or confirmed COVID-19 infections. Earn AANA Class A credits with this series.

Topics include:
  • Impact of Drug Shortages During the COVID-19 Pandemic (Join tonight, May 7, 2020, at 5 p.m. CDT)
    1.0 Class A Credit
    Learn of the causes and implications of current drug shortages and how they impact clinical practice, particularly for drugs needed in the critical care of ventilated COVID-19 patients. Presenters: Erin R. Fox, PharmD, BCPS, FASHP; Daniel Kistner, PharmD; David J. Margraf, PharmD, MS; Brian D. Berry Jr., CRNA, MBA, MS; and Lorraine Jordan, PhD, CRNA, CAE, FAAN.
  • Peer Support, Self-Care, and Resilience for Health Care Providers During COVID-19
  • Pediatric Anesthesia During the COVID-19 Pandemic, 1.25 Class A CE Credit. Presenters: James Furstein, PhD, DNAP, CPNP-AC, CRNA; and Heather J. Rankin, DNP, MBA, CRNA.
  • COVID-19 Infection Prevention Pearls
  • Acute Respiratory Distress Syndrome (ARDS): What You Need to Know Today
    Available on CRNA Knowledge Network, 1.0 Class A CE Credit
    This webinar covers recent findings related to ARDS and the current COVID-19 pandemic, reviewing current literature, physiology, patient profiles, and at-risk groups. The webinar also discusses how COVID-19 can tie into sepsis, and will identify critical diagnosis, therapies, and best practices for treatment.
  • AANA Townhall
    Aired April 2, 2020, 1.0 Class A CE Credit
    AANA President Kate Jansky, MHS, CRNA, APRN, USA LTC (ret), and CEO Randall Moore, DNP, MBA, CRNA, joined AANA staff leading the organization’s efforts to combat COVID-19 and responded to common questions and concerns expressed by the AANA membership. Learn more.
Get the latest schedule!
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Replay: Student Loan Repayment During Uncertain Times Webinar

Student Loan Repayment During Uncertain Times
Presented by Laurel Road

Receive information on the federal response to student loans during the COVID-19 crisis, considerations in your decision to refinance, and available student loan repayment options.
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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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Refresh Your Knowledge of Hemodynamic Monitoring

Join a webinar presented by Edwards Lifesciences. Learn to reinforce the value of hemodynamic monitoring in managing the fluid and hemodynamic needs of critically ill patients including those with COVID-19. Key takeaways from this webinar include:
  • Review principles of oxygen supply and demand in critically ill patients.
  • Provide a foundational understanding of concepts of pressure and flow to assure adequate perfusion, including the components of cardiac output (preload, afterload, contractility).
  • Demonstrate through simulated case studies basic assessment of the hemodynamically unstable patient.
  • Provide direction on available online educational resources and support material.
Learn More!
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CRNACareers - 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, 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 Jobs: Locum Tenens and Permanent Placement Opportunities Across the Country

United Anesthesia – Various Locations. United Anesthesia has been a leading CRNA and Anesthesiologist Locum Tenens and Permanent Placement firm in the country for 40 years. By specializing in only anesthesia placement, we can partner with you to find the ideal situation to suit your strengths, your priorities, your dreams. Your dedicated personal coordinator is looking forward to your call! Learn more.
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CRNA: Envision Healthcare, Florida

Enjoy a great lifestyle as a CRNA in beautiful North Miami Beach!

Envision Physician Services is looking for a full-time experienced CRNA to join the established Anesthesia Care Team at North Miami Beach Surgical Center. This quick-paced, dynamic practice offers the highest of quality patient care and a great work environment.

Highlights of the opportunity include:
  • Anesthesia Care Team is comprised of 3 Physicians and 3 Anesthetists.
  • Annual Case volume approximately 5,000 with 5 ORs.
  • Cases are primarily "Bread & Butter" including Plastics, General Surgery, Podiatry, GYN, ENT, some Ortho and a high percentage of Ophthalmology.
  • Great schedule of five 8s with approx. 7 weeks paid time off.
  • Quality bonus, CME and relocation assistance offered.
  • Benefits eligible day one—no waiting period! Package includes medical, dental and vision, disability and life insurance, 401K contribution and paid malpractice with tail coverage.
Learn more.

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CRNA: Banner Health, Nebraska

Come Home to the clean air quality of life in rural Nebraska!

Nebraska isn't for everyone, but if you enjoy unique adventures, beautiful scenery, calm pace of life, and a solid compensation package, this opportunity is just right for YOU!

Banner Health is one of the largest non-profit healthcare systems in the country with 28 hospitals, six long-term care centers and an array of other services, including family clinics, home care services and home medical equipment, in six Western states.

We have an excellent opportunity for a dynamic CRNA to join our highly trained team!
  • CRNA-only practice model.
  • Responsible for performing general, regional, and monitored anesthesia services including Ultrasound-guided block, and OB.
  • Experience preferred.
  • One week on, one week off, one week call.
Ogallala Community Hospital (OCH) is an 18-bed critical access hospital committed to meeting the health care needs of western Nebraska and was one of four Banner Health facilities named HealthStrong™ Top 100 Critical Access Hospitals scoring best among critical access hospitals on the iVantage Health Analytics’ Hospital Strength Index™. The Hospital Strength Index is a comprehensive rating of critical access hospitals, and results recognize the Top 100 Critical Access Hospitals that provide a safety net to communities across rural America. Service area 15,653.

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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CRNA, Operating Room: University of Virginia, School of Medicine, Virginia

Administer anesthesia and anesthesia-related care in collaboration and consultation with attending anesthesiologists in the main OR and satellite areas.
  • Participates in pre-anesthetic preparation and evaluation.
  • Formulates a patient-specific plan for anesthesia care in collaboration with attending anesthesiologist.
  • Implements monitors and adjusts patient's physiologic condition as appropriate for type of anesthesia and specific patient's needs.
  • Transfers the responsibility for care of the patient to other qualified providers post-operatively to assure continuity of care and patient safety.
  • Supports operating room procedures.
  • Participates in additional areas of responsibility which are within the expertise of the individual CRNA.
  • Assumes responsibility for professional development of self and contributes to and assists with the professional development of others.
  • In addition to the above job responsibilities, other duties may be assigned.
Position Compensation Range: $64.00 - $98.50 Hourly


Education: Master of Science in Nursing from accredited nursing program.
Experience: No experience required.
Licensure: Licensed to Practice as a Registered Nurse in the Commonwealth of Virginia required. Licensed to practice as a Nurse Practitioner in the Commonwealth of Virginia required. Certified Registered Nurse Anesthetist in the Commonwealth of Virginia required. American Heart Association (AHA) Health Care Provider BLS certification required.


Job requires sitting for prolonged periods, frequently bending/stooping, reaching (overhead, extensive, and repetitive); Repetitive motion: (squeezing an ambu bag). Proficient communicative, auditory and visual skills; Attention to detail and ability to write legibly; Ability to lift/push/pull 50 - 100lbs and lift/push/pull > 100lbs. May be exposed to fumes, chemicals, cold, heat, blood/body fluids and infectious disease.

Learn more.
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Faculty CRNA: WellSpan Health, Pennsylvania

WellSpan Health, a sophisticated medical community in south central Pennsylvania is seeking a full-time faculty member to join the staff of our Nurse Anesthetist Program at York College. Employment with WellSpan Medical Group allows you to enjoy a fulfilling career in an organization with strong physician leadership, a culture of support and low turnover. WellSpan Health is a top rated integrated health system with a focus on high-quality patient care.

About the Opportunity
  • Participates in didactic instruction, simulation laboratory and clinical instruction.
  • Works collaboratively with the clinical and didactic faculty of the Nurse Anesthetist Program and the York Hospital CRNA Clinical Coordinator in maintaining school activities and policies.
  • Participates on program, college, hospital and other committees as required.
  • Assists with coordination of all aspects of the program, academic and clinical, ensuring patient safety.
  • Participates in the admissions procedures including recruitment interviews and selection of students.
  • Performs continuous evaluation of the clinical aspect of instruction at York Hospital.
  • Master’s degree required; PhD or DNP preferred.
  • Graduate of an accredited program of nurse anesthesia with certification to practice anesthesia; 2-3 years clinical experience required, didactic experience preferred.
Learn more.
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CRNA: Envision Physician Services, New Jersey

Envision Physician Services is seeking a qualified CRNA for a full-time opportunity at Mountainside Medical Center in Montclair, NJ. This opportunity will offer CRNAs open flexible scheduling, excellent work-life balance, great compensation, and true autonomy. Mountainside Medical Center is a member of the Hackensack Meridian Health network.

Highlights of the opportunity include:
  • Anesthesia Care team is comprised of 8 FT physicians and 10 FT CRNAs.
  • Case types include General, Ortho, OB, Endo; no trauma, no heads, no hearts.
  • Open schedule.
  • Opportunities for overtime.
  • Ability for proficient CRNAs to do Spinals, Epidurals, & Regional.
The position offers a compensation and benefits package that includes great base salary, bonus structure, health, dental and vision benefits, CME allowance and comprehensive malpractice coverage. 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.

Intravenous Dexmedetomidine Versus Tramadol for Treatment of Shivering After Spinal Anesthesia

A meta-analysis focused on the efficacy of dexmedetomidine versus tramadol for the treatment of patient shivering, which often occurs following spinal anesthesia. A search of the literature yielded 13 randomized controlled trials that satisfied the researchers' inclusion criteria. According to the evidence, which captured results from 864 study participants, dexmedetomidine is the better choice of the two for treating patient shivering induced by spinal anesthesia. Intravenous dexmedetomidine was superior to intravenous tramadol in terms of effective shivering control, faster onset of action, less recurrence of shivering, less nausea and vomiting, and higher incidence of sedation. However, the analysis authors wrote from China, dexmedetomidine also was tied to greater prevalence of hypotension and bradycardia compared with tramadol.

From "Intravenous Dexmedetomidine Versus Tramadol for Treatment of Shivering After Spinal Anesthesia"
BMC Anesthesiology (05/04/20) Vol. 20, No. 104 Wang, Jinguo; Wang, Zaitang; Liu, Junyan; et al.

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Prophylactic Intrathecal Morphine and Prevention of Post–Dural Puncture Headache

Researchers wondered if a prophylactic dose of intrathecal morphine would reduce the likelihood of post-dural headache following unintentional dural puncture in women about to give birth. While prophylaxis has been successful via epidural morphine administration, outcomes were uncertain when delivering morphine through the intrathecal route. To learn more, the investigators conducted a randomized trial, populated by 61 women who sustained unintentional dural puncture during an attempt at epidural catheter placement. After giving birth, participants received either intrathecal morphine or normal saline. Post-dural puncture headache occurred in 78 percent of the 27 patients in the morphine group and 79 percent of the 34 patients in the control group. The findings do not suggest any clinical value from administering prophylactic intrathecal morphine after an unintentional dural puncture.

From "Prophylactic Intrathecal Morphine and Prevention of Post–Dural Puncture Headache"
Anesthesiology (Spring 2020) Vol. 132, No. 5, P. 1045 Peralta, Feyce M.; Wong, Cynthia A.; Higgins, Nicole; et al.

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Modifiable Analgesia-/Anesthesia-Related Factors and Risk of Severe Gastrointestinal Complications After Lower Extremity Total Joint Arthroplasty

Researchers investigated the occurrence of severe gastrointestinal (GI) complications after total hip and knee arthroplasty (THA/TKA) and the anesthesia- or analgesia-related factors that may influence them. GI complications are unusual in this setting—as the numbers reflect in the study led by New York's Hospital for Special Surgery—but they can be life-threatening. Among 591,865 THA cases and 1.13 million TKA cases sampled from a commercial claims database, only 1.03 percent and 0.79 percent, respectively, documented GI complications within a month of joint replacement. Meanwhile, just 0.08 percent and 0.05 percent of the cases, respectively, required emergency surgery. The researchers analyzed the association of GI complications with multiple factors, including type of anesthesia and use of peripheral nerve block, patient-controlled analgesia, nonopioid analgesics, and opioids. After adjusting for relevant covariates, they found that almost all of those factors—all of which are modifiable—correlated to a significantly lower risk of GI complications. Cyclooxygenase-2 inhibitors, nonsteroidal anti-inflammatory drugs, and peripheral nerve block stood out in this respect.

From "Modifiable Analgesia-/Anesthesia-Related Factors and Risk of Severe Gastrointestinal Complications After Lower Extremity Total Joint Arthroplasty"
Journal of Arthroplasty (04/20) Bekeris, Janis; Fiasconaro, Megan; Della Valle, Alejandro Gonzalez; et al.

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Hemidiaphragmatic Paresis May Occur Regardless of Local Anesthesia Volume

Reducing the amount of local anesthesia administered for nerve block during upper-extremity surgery does not prevent hemidiaphragmatic paresis, researchers report. All 21 study participants received a combination of mepivacaine 1.5% and bupivacaine 0.5% for supraclavicular block, starting with a 35-mL dose in the first three patients. Provided that none developed hemidiaphragmatic paresis, the next three patients received 40 mL. If the condition presented in any of those patients, the next group of three would be bumped down to the next-lowest dose. Study parameters called for enrollment to end when hemidiaphragmatic paresis occurred at the lowest dose or when six patients remained free of the complication at any other dose. Hemidiaphragmatic paresis was evident at all of the anesthetic dosages evaluated, affecting 14 participants—who also registered statistically significant reductions in negative inspiratory force and oxygen saturation 30 minutes after block administration. "Even the smallest volume of local anesthetic could cause paresis of the diaphragm on the side getting the supraclavicular block," summarized lead researcher Hannah Lin, MD. "In our study, while the paresis was not clinically relevant and did not require respiratory intervention, it may impact patients with underlying respiratory disease or diaphragmatic impairments."

From "Hemidiaphragmatic Paresis May Occur Regardless of Local Anesthesia Volume"
Healio (04/29/2020) Tingle, Casey

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A Step-by-Step Guide to Preventing PPE-Related Skin Damage

An expert spells out best practices for health care workers to prevent and treat skin damage caused by prolonged use of personal protective equipment (PPE). Fears related to transmission of coronavirus, coupled with a deep shortfall of PPE supplies, saw the health care community start wearing masks, goggles, gloves, and gowns for longer periods. Additionally, N95 respirators fit tightly to the face, causing indentations and red marks following hours of use. The pressure and moisture caused by long-term use of PPE, according to Kimberly LeBlanc PhD, RN, chair of the Association of Nurses Specialized in Wound Ostomy Continence of Canada, has produced an uptick in cases of dermatitis, acne, and other skin irritation. She recommends that nurses and other health care workers use a moisturizer one or two hours before going to work. Ideally, this routine should be performed daily, at home, and immediately after showering or washing the face. On the job, but about five minutes before donning PPE, they should apply an alcohol-free skin barrier wipe to their forehead, nose, cheeks, and ears and let dry for 90 seconds. They can then put on their PPE, taking care to remain hydrated throughout their shift as another way to protect their skin.

From "A Step-by-Step Guide to Preventing PPE-Related Skin Damage"
Medscape (04/28/20) Stokowski, Laura A.

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Is It Time to Shelve PCA for As-Needed Opioid Administration?

Scientists at the University of Toronto are challenging the need for patient-controlled analgesia (PCA) with intravenous opioids for the management of postoperative pain. Rather, their research suggests, administering opioids on an as-needed basis is more beneficial. The work involved 76 patients undergoing primary knee replacement with care based on a multimodal analgesic protocol. All participants received standardized anesthetic treatment during the perioperative and intraoperative periods as well as during prosthesis implantation. Postoperatively, though, patients were randomized into one of two treatment arms and monitored for 48 hours. Those assigned to as-needed opioid administration required a total of 32.5 mg median morphine equivalents (MMEs), half of the 65 mg MME needed by participants in the I.V. PCA group. Contrary to what researchers had anticipated, however, there were no significant between-group differences in terms of median overall hospital length of stay or patient satisfaction scores. “There is quite a bit of literature showing that I.V. PCA is better because it gives patients control and improved their satisfaction,” noted lead study author Naveed Siddiqui, MD. “As a result, more and more people were moving toward I.V. PCA. But in this day and age—when we are giving much more than just opioids for pain control—these patients may not require I.V. medications after surgery, especially if they haven't undergone general anesthesia and can take oral medications when they need to.”

From "Is It Time to Shelve PCA for As-Needed Opioid Administration?"
Anesthesiology News (04/22/20) Vlessides, Michael

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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.

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

If you are interested in advertising in Anesthesia E-ssential contact HealthCom Media at 215-489-7000.

For more information on AANA and Anesthesia E-ssential, contact:

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Phone: (855) 526-2262 (toll-free)/(847) 692-7050
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Attn: Cathy Hodson
E–ssential Editor
May 7, 2020