Anesthesia E-ssential

AANA Anesthesia E-ssential, May 9, 2019

Vital Signs

AANA Advocates for CRNAs Who Provide Holistic, Multimodal Pain Management Services

In a letter to the Health and Human Services (HHS) Pain Management Best Practices Inter-Agency Task Force, the AANA advocated for the recognition of CRNAs as well-qualified pain practitioners who provide access to excellent care in many practice settings to treat patients suffering from a wide range of acute and chronic pain conditions.

Suffering from chronic and acute pain is a personal experience that, if left undertreated or mismanaged, can radically change an individual's quality of life and impact important relationships. The mission of the task force is to:
  • Identify, review, and determine whether there are gaps or inconsistencies between best practices for pain management, including chronic and acute pain, developed or adopted by federal agencies;
  • Propose updates to best practices and recommendations on addressing identified gaps or inconsistencies; and
  • Develop a strategy for disseminating such proposed updates and recommendations to relevant federal agencies and the general public.

The AANA's letter states that many patients rely on CRNAs as their primary pain specialist. The AANA believes that moving from a unimodal, opioid management of chronic and acute pain, to a patient-centered, multidisciplinary, multimodal, opioid-sparing treatment approach engages patients in their own pain relief care and decreases the risk of chronic pain and substance use disorder. Acute and chronic pain is best treated and managed by an interdisciplinary, collaborative team that actively engages with the patient to diagnose and manage their pain over time for improved well-being, functionality, and quality of life.

Furthermore, as anesthesia professionals, CRNAs' goal is to collaborate with the patient and the interdisciplinary team on a comprehensive plan for pain relief known as enhanced recovery. CRNA services are crucial to the successful development and implementation of techniques such as enhanced recovery programs. CRNAs and other anesthesia professionals play an integral role in these episodes of care as proper anesthesia services management can make a tremendous difference in terms of improving patient flow, patient safety, and cost savings.
Share Facebook  LinkedIn  Twitter 

Happy National Nurses Week (May 6-12)!

Happy National Nurses Week! The AANA wants to thank our members and student members for representing not only the nurse anesthesia profession, but also the nursing profession. The nursing profession has garnered the Most Trusted Profession for 17 consecutive years, and part of that reason is you - the trust, the compassion, the dedication to excellence, safety, and to our patients. Thank you for all you do. Keep up the good work!
Share Facebook  LinkedIn  Twitter 

Building Brydges Preview: Resistance is Futile

Some important topics in tomorrow's edition of Building Brydges:
  • CEO Update: Why Resisting APRN Scope of Practice Expansion is a Losing Battle
  • Opting Out
  • The Future Looks Bright a.k.a Inspiration 
Stay tuned for the latest Building Brydges blog post, coming your way this Friday, May 10.

Share Facebook  LinkedIn  Twitter 

Hot Topics

Beyond the Mask Podcast: What If the AANA Didn't Exist?

Current AANA CEO Randall Moore, DNP, MBA, CRNA, joins the hosts of the Beyond the Mask podcast live at the Mid-Year Assembly to discuss some thought-provoking hypotheticals. Who would advocate for CRNAs if the AANA didn't exist? How would the profession be different today without the organization? Find out on the series' first episode of the "What If" Series.
Share Facebook  LinkedIn  Twitter 

500 Nurses Report on Community Needs

To explore how nurses can shape the future health of our nation, the Robert Wood Johnson Foundation conducted dozens of one-on-one interviews, focus groups, and listening sessions with hundreds of nurses from across the country.

The thoughts and ideas of these nurses were the first step in an important discovery process, and shaped the recently released report: In Their Own Words: Nurse Insights on the Unmet Needs of Individuals, which I hope you’ll read and share with other members of your organization. To download the report, visit the RWJF website. You can also request a copy of the report from Sarah Schmidt at or 202-868-4829.
Share Facebook  LinkedIn  Twitter 

Be Sure to Vote in the AANA 2019 Election!
Voting ends May 21 at noon CDT

The AANA 2019 election, which started on April 23, will continue until May 21 – 12 noon CDT. For more information, visit the AANA Election Center webpage 
(member login required).

To vote online, visit and enter your member number and the election passcode provided to you by SBS. If you do not have your election login information, click on the “Email me my login information?” link on the login page 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

Board Candidates Video Speeches
Board candidates’ speeches presented at the April Mid-Year Assembly are available on the Candidate Videos page of the AANA website (member login required)
Share Facebook  LinkedIn  Twitter 

New AANA Resources on MIPS Cost and Promoting Interoperability

CRNAs can now access new information about merit-based incentive payment system (MIPS) reporting through the AANA’s website. The Quality-Reimbursement page was updated with new video presentations and FAQs about participation in the 2019 Cost and Promoting Interoperability performance measure categories. These brief videos provide overviews of participation, reporting requirements and scoring, while the FAQs go into greater detail. You can also download the slides from the video presentation.
Share Facebook  LinkedIn  Twitter 

All of AANA’s Insurance Offerings In One Place

From malpractice to medical – and everything in between. Visit the new AANA Insurance homepage to review all of the insurance options exclusive to members of the AANA. Learn more. For a complete list of member-exclusive deals, visit the Member Advantage Program.
Share Facebook  LinkedIn  Twitter 

Save the Date: 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.
Share Facebook   LinkedIn   Twitter  

Pacira BioSciences Funds Educational Webinar Series

In support of Certified Registered Nurse Anesthetists (CRNAs), who as anesthesia and pain management experts are at the forefront of providing solutions to the opioid misuse crisis, Pacira BioSciences, Inc., has partnered with the American Association of Nurse Anesthetists (AANA) to provide educational resources to fund a webinar series concerning various aspects of enhanced recovery.

As millions of Americans suffer from prescription opioid use disorder, CRNAs advocate for patients by educating themselves and other healthcare providers about the importance of enhanced recovery. Enhanced recovery after surgery protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining preoperative organ function, reducing the profound stress response following surgery, optimizing physiologic function, and facilitating recovery. Stay tuned.  Learn more.
Share Facebook  LinkedIn  Twitter 

Meetings and Workshops

Continuing Education
NEW! The APM Reimbursement Educational Series: The Key to Value-Based Care

Learn about reimbursement in four hours—it will pay you back for years. The Alternative Payment Model (APM) incentivizes practitioners to provide high-quality and cost-efficient care. APMs are complex and that is why AANA put together a four-part educational series based on Medicare data. Each part will teach CRNAs how the anesthesia care we provide ties into APMs and affects our reimbursements. Each module is one hour long and divided into subsections that break down how anesthesia care ties into APMs and affects your reimbursements. Because it’s online, it’s easy to fit into your busy schedule and is even accessible on your smartphone, laptop or tablet. AANA Members get more than 30% off the four-part series and the first module for free! Learn more.

Share Facebook  LinkedIn  Twitter 

Spinal Epidural with Obstetric Essentials Workshop
May 16-18, Cincinnati, Ohio, University of Cincinnati, College of Nursing

Expert lectures, hands-on instruction, and group discussions of representative clinical cases. Register.
Share Facebook  LinkedIn  Twitter 

AANA 2019 Annual Congress
August 9-13, Chicago, Illinois

ENGAGE. UNITE. EVOLVE. #AANA2019 will refresh your passion for your profession with unparalleled opportunities to engage, unite, and evolve. Plus, earn up to 22.50 Class A CE credits with up to 10.00 Pharmacology credits while meeting CPC requirements! Register now.
Share Facebook  LinkedIn  Twitter 

NEW! AANA Leadership Summit
November 8-10, Naples Grande Beach Resort, Naples, Florida

Discover your leader within! Join us at the new AANA Leadership Summit in beautiful Naples, Florida. Whether you are a state association leader, chief CRNA, administrator, practice owner, manager, facility leader, or aspiring to a leadership role—this meeting is for you. You will emerge empowered with the life skills that will take your career to the next level. Add to Calendar.
Share Facebook  LinkedIn  Twitter 


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.
Share Facebook  LinkedIn  Twitter 

CRNA II: Novant Health, Inc., Charlotte, North Carolina

Novant Health is seeking a CRNA to grow and develop within a professional setting. Team members utilize skills obtained through additional training, education and/or experience in the provision of anesthesia care to patients who present with complex and unique anesthetic requirements. Come join a remarkable team where quality care meets quality service, in every dimension, every time. Let Novant Health be the destination for your professional growth. This position is located at our Center City Charlotte Orthopedic Hospital Location. The schedule is a combination of 10- and 12-hour shifts, one day off per week. This position will cover 7 OR orthopedic suites and also cover a 7 OR outpatient surgery center (peds urology, peds general, outpatient ortho, GYN, robotic hysterectomies). Highlights: No OB, No out of department, both facilities on the same floor located just down the hall from each other. Beeper call approximately 3 times per month. MDs currently do spinals/blocks. Weekend on-call cases urgent emergent only. AANA dues paid, Current Reviews CE provided, paid education time, great benefits and retirement matching, surgical services bonus plan. $15,000 Sign-on Bonus and Relocation Assistance! Learn more.
Share Facebook  LinkedIn  Twitter 

CRNA Part Time: Confidential, Harrisonburg, Virginia

A great opportunity for a CRNA looking for part time (Mondays and Tuesdays), low stress work environment in Harrisonburg, Virginia. Dual trained pediatric dentist/dental anesthesiologist needs CRNA to oversee the anesthesia during dental treatment. Cases average about 90 minutes each and all are intubated with ventilator support. Lodging available if needed. Learn more.
Share Facebook  LinkedIn  Twitter 

CRNA: Dominion Anesthesia, Arlington, Virginia

Join a dynamic group of talented CRNAs in Arlington, VA. Dominion Anesthesia provides anesthesia services exclusively at Virginia Hospital Center, a 394-bed facility that was recently designated a member of the prestigious Mayo Clinic Care Network. Virginia Hospital Center comprises 21 ORs as well as a busy endoscopy center, labor and delivery suite, and various other locations (cardiac Cath lab, MRI suite, interventional radiology). The position offers CRNAs exposure to a wide variety of cases, including orthopedics, general surgery, gynecology, urology, neurosurgery, ENT, vascular, thoracic, robotic, bariatric, and colorectal, as well as pediatric ophthalmology, ENT and dental cases. There is limited involvement by CRNAs in on-pump cardiovascular cases (CABG/valve replacements). OB experience (spinal placement, epidural and c-section management) is desirable. The call requirement is approximately one overnight shift per month. Dominion Anesthesia consists of 15 anesthesiologists and 35 CRNAs and operates in an anesthesia care team model. CRNAs are medically directed. Dominion Anesthesia offers a collegial working environment that provides growth opportunities for experienced CRNAs and new grads alike. Learn more.
Share Facebook  LinkedIn  Twitter 

CRNA: Carteret Health Care in Morehead City, North Carolina

Our exceptional Anesthesia team is looking for CRNA professionals who want to work in a team that supports one another, provides great care to our community and is always looking for ways to improve. Make a life change not just a job change—the best of beach life! Learn more.
Share Facebook  LinkedIn  Twitter 

Certified Registered Nurse Anesthetist: Sanford Health in Fargo, North Dakota

Sanford Health Fargo Anesthesia Department is currently seeking Certified Registered Nurse Anesthetists (CRNA) to join its current group of 21 anesthesiologists and 72 CRNAs. Department provides anesthesia for approximately 28,000 cases per year at two hospitals as well as a freestanding ASC. All specialties are represented, with the exception of heart or liver transplants. Department practice is the Anesthesia Care Team model. Family Birth Center epidural service is CRNA managed 24/7. Strong relationships within our department and with the surgical staff. SRNA clinical site for two nurse anesthesia programs. Excellent compensation, relocation allowance and benefits. Learn more.
Share Facebook  LinkedIn  Twitter 


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!


Share Facebook  LinkedIn  Twitter 

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.

How Long Should Patients Fast Before Elective Surgery?

Although 2017 guidelines loosened the longstanding mantra of no food or drink after midnight in preparation for an elective surgical procedure, the new recommendations have yet to become routine clinical practice. The guidance, from the American Society of Anesthesiologists, permits clear liquids for up to two hours and light meals or nonhuman milk up to six hours before procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia. Based on a Twitter survey with more than 3,800 responses, however, many hospitals are stuck on the old protocol despite evidence of a better way. A large-scale 2017 study published in the European Journal of Anesthesia, for example, found that postoperative nausea and vomiting was significantly reduced when patients were allowed to have unrestricted clear fluids before elective surgery. A review the same year in BJA Education, meanwhile, concluded, "Preoperative carbohydrate loading modifies insulin resistance, improves patient comfort and well-being, minimizes protein losses, and improves postoperative muscle function." In addition, hospital length of stay is shortened, and risk of aspiration is no worse than under the traditional paradigm. With one related paper estimating that research findings may not find their way into clinical practice for as long as 17 years, surgical patients can expect to give up preoperative food and liquids for several more years.

From "How Long Should Patients Fast Before Elective Surgery?"
Physician's Weekly (05/06/19)

Share Facebook  LinkedIn  Twitter 

Fascia Iliaca Compartment Blockade May Decrease Narcotic Use, Pain After Hip Arthroscopy

Preoperative fascia iliaca compartment blockade improves outcomes after hip replacement, according to evidence presented at the recent Arthroscopy Association of North American Annual Meeting in Orlando. Working with 74 patients who were randomized to the technique or to normal saline injection, researchers found that fascia iliaca compartment blockade significantly shortened length of stay in the post-anesthesia care unit. "There was nearly a one-point difference in the numeric pain rating scale, which is not very significant as compared to our other endpoints," added study lead Blake Bodendorfer, MD. "We also saw a larger decrease in pain in the immediate postoperative period." The multi-site, prospective trial also pointed to a marked reduction in postoperative narcotic use in the fascia iliaca compartment blockade recipients.

From "Fascia Iliaca Compartment Blockade May Decrease Narcotic Use, Pain After Hip Arthroscopy"
Healio (05/04/2019) Tingle, Casey

Share Facebook  LinkedIn  Twitter 

Vegans Asking for Different Egg-Free General Anesthetic — But It's Less Green

Anesthesia providers in the United Kingdom are facing an unusual dilemma as vegan patients increasingly request alternatives to propofol, which contains egg. Favored for its rapid onset and recovery, propofol is the safest and most commonly used general anesthetic available; but it does contain slightly more than 1 percent egg as an emulsifying agent. Besides forcing the use of other options such as inhaled anesthetics, which are more detrimental to the environment, there is also the threat of legal repercussions if providers use propofol on vegans—even if they do so inadvertently. According to one anesthesia provider in charge of intensive care at a major U.K. hospital, "There is a lot of concern in my profession that we could be charged with assault if we use propofol on a vegan patient. There are alternative drugs I can use to put them to sleep. The worry is that we use this drug when we don't know their beliefs in advance, say in a medical emergency, then they object afterwards."

From "Vegans Asking for Different Egg-Free General Anesthetic — But It's Less Green"
Mirror (UK) (05/03/19) Perry, Keith

Share Facebook  LinkedIn  Twitter 

Gradual Withdrawal of Remifentanil Delays Initial Post-Operative Analgesic Demand After Thyroid Surgery

Researchers in Belgium compared outcomes associated with two different styles of remifentanil management in a randomized controlled study. The final analysis included 29 patients who underwent thyroid surgery at the same hospital. Overall morphine consumption, numeric rating scale scores, Ramsay Sedation Scale scores, and quality of recovery scores were about the same, regardless of whether patients were assigned to abrupt discontinuation of remifentanil after surgery or if they were allocated to gradual withdrawal of the drug. A difference was observed, however, in the primary endpoint: initial postoperative demand of analgesic medication. The first morphine bolus was administered after 76.3 +/- 89 minutes in the group that was slowly weaned off remifentanil. The need for morphine came much more quickly for the other group, who needed relief after just 9.0 +/- 13.5 minutes. The researchers note that while gradual withdrawal of remifentanil after thyroid surgery is safe and delays the first postoperative call for analgesia, the process does require training and vigilance.

From "Gradual Withdrawal of Remifentanil Delays Initial Post-Operative Analgesic Demand After Thyroid Surgery"
BMC Anesthesiology (04/25/19) Saxena, Sarah; Gonsette, Kimberly; Terram, Willy; et al.

Share Facebook  LinkedIn  Twitter 

Effects Of Surgery on a Warming Planet: Can Anesthesia Go Green?

Most of the anesthesiology gases administered to patients—who metabolize only about 5 percent—end up in the atmosphere, where they contribute to the medical community's substantial environmental footprint. According to Jodi Sherman, an associate professor of anesthesiology at Yale School of Medicine, the U.S. health sector accounts for about 10 percent of the nation's greenhouse gases. A number of hospitals have tried to "go green," largely by dropping the biggest offender among the gases—desflurane—from the menu of options. While they have experienced mixed results, Sherman says the approach taken by an anesthesia provider in Oregon has had a big impact. Brian Chesebro of Providence Hospital in Portland is making it his mission to effect a shift away from desflurane, which lingers in the atmosphere for as long as 14 years versus just one year for sevoflurane. After educating himself on anesthesiology gases and learning how to compute the carbon footprint of individual users based on the amount and type of gas they use, Chesebro shared the results. His calculations convinced all eight Providence Health hospitals in Oregon to prioritize the use of sevoflurane—which is not only more environmentally friendly but also less expensive. As a result, the hospital system now saves about $500,000 annually. Baxter International, which manufacturers desflurane, notes that the overall contribution of inhaled anesthetics to global warming is relatively low, with the climate impact of 0.01 percent of fossil fuels. That is a valid point, Chesebro agrees. However, "if it's there, it's bad," he declares. "And if I can reduce my life's footprint by a factor of six … why wouldn't you do it?"

From "Effects Of Surgery on a Warming Planet: Can Anesthesia Go Green?"
WBHM Birmingham (Ala.) (05/06/19) Foden-Vencil, Kristian

Share Facebook  LinkedIn  Twitter 

Oral Acetaminophen Superior to IV Acetaminophen for Reducing Opioid Use After THA, TKA

Results from a population-based study suggest that oral administration of acetaminophen (APAP) dials back opioid use after knee or hip replacement more so than intravenous acetaminophen. Researchers analyzed more than 1 million total hip or knee arthroplasties indexed in the Premier Healthcare claims database between 2011 and 2016, with just under a quarter of them involving intravenous APAP. In their paper in Regional Anesthesia and Pain Medicine, the team reported that oral APAP on postoperative day 1 was associated with significantly and consistently lower opioid use—which, in turn, was tied to fewer opioid-related adverse effects, such as respiratory complications and gastrointestinal problems. "[W]henever feasible, APAP can be administered orally, producing similar, if not slightly better effects," the study authors wrote.

From "Oral Acetaminophen Superior to IV Acetaminophen for Reducing Opioid Use After THA, TKA"
Clinical Pain Advisor (05/03/19) May, Brandon

Share Facebook  LinkedIn  Twitter 

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.

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:

222 S. Prospect Avenue
Park Ridge, IL 60068
Phone: (855) 526-2262 (toll-free)/(847) 692-7050
Fax: (847) 692-6968

Attn: Cathy Hodson
E–ssential Editor
May 9, 2019
Earn Your DNAP