Anesthesia E-ssential

AANA Anesthesia E-ssential, November 1, 2018

Vital Signs

Webinar: Understanding Association Health Plans and the Viability of an AANA-sponsored Program

Sponsored by AANA Insurance Services and Mercer

Since the executive order allowing associations to offer group health insurance plans to its members was signed last October, AANA has been researching the possibility of setting up an Association Health Plan (AHP). Join us Monday, November 5th from 6:00-7:00 p.m. CST to better understand AHPs, determine the feasibility of an AANA-sponsored program, and discuss next steps. Register now.
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Call for Abstracts to be Presented at 2019 AANA Annual Congress

Submission process opens: October 1, 2018
Submission deadline: November 15, 2018

You are invited to submit an abstract for consideration to present at the 2019 AANA Annual Congress on August 9-13, 2019, at the Hyatt Regency Chicago, Chicago, Ill. Present your topic to thousands of CRNAs and SRNAs from across the nation, representing various practice settings and levels of leadership.

Selection Process
The new Abstract ScoreCard platform makes it easier than ever to submit your paper. AANA will accept up to three submissions per presenter with a maximum of two presenters per abstract submitted.

The submission process opened on October 1, 2018, and the deadline for submissions is November 15, 2018, at 11:59 p.m. CT. Please review the submission guidelines before submitting your abstracts.

Submit your abstracts here.
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Hot Topics

Nominations for 2018 AANA Elections Due Dec. 1

Nominations for AANA elected offices and consent forms from nominees are due in the AANA office by Dec. 1, 2018.

Each state association may submit one nominee for president-elect, vice president, and treasurer. In addition, state associations may submit one nominee for a director for their region. In 2019, directors from Regions 1, 4 and 5 are eligible for election. Finally, state associations may nominate one member from their region for the AANA Nominating Committee from Regions 1, 4 and 5 to serve a two-year term, and one member for the Resolutions Committee.

Members also are allowed to self-nominate or nominate another member as long as the nominee meets the qualifications for office found in the AANA Bylaws and Standing Rules. (Member login required.)

For information regarding the electoral process, please visit (Member login required.)
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SRNAs and CRNA Educators: Sign Up for the Student Mentoring Program at ADCE

SRNAs, are you interested in becoming a nurse anesthesia educator? CRNA educators, are you interested in mentoring students with an interest in education? Sign up for the Student Mentoring Program at the February 2019 Assembly of Didactic and Clinical Educators (ADCE).  

The program consists of a Student/Mentor Meet and Greet from 6:00 - 6:30 p.m., on Wednesday, February 13th, for the mentor/mentee pairs to meet each other. Students are paired with an educator from a program other than their own. Thursday, February 14th, is the one-day mentoring experience. Wherever the mentor goes throughout the day, the student will follow. The mentor introduces their mentee to their colleagues, involves them in their discussions, and takes them to lunch.

SRNAs: One student who has been nominated by their program director is accepted from each nurse anesthesia program, and a student may participate in the mentoring program only once. Let your program director know now if you would like your name submitted!

CRNA Educators: Volunteers are needed to serve as mentors.

Please refer to the brochure for complete details about the program. Simply email the Education department at to nominate a student and/or sign up as a mentor by December 10, 2018.
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AANA Seeks to Record CRNA Service in Vietnam

For most veterans of the Vietnam War who returned home alive to the United States, life would never be the same. They had seen the atrocities of war, had lost comrades and friends, and in some cases, had been on the receiving end of jeers, spitting and violence as they returned home. For some, there was great psychological turmoil to reconcile. For others, physical wounds required care and healing. And still others were fortunate to escape the ravages of war's mental, emotional or physical aftermath.

The American Association of Nurse Anesthetists (AANA) seeks to record the histories of our Certified Registered Nurse Anesthetists (CRNAs) who served in Vietnam. 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, soldiers, brothers, sisters, friends and loved ones, are not forgotten. See submission guidelines:
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AANA Member Benefits

New Healthcare Plan Benefits Kick Off Open Enrollment (Now Through December 15)

Healthcare plans available through the Affiliate Health Insurance Exchange now include term medical (with several carriers to choose from) and fixed indemnity plans. Healthcare plans with HMO, no medical questions asked, guaranteed acceptance, major medical coverage and prescription included also are available. Open enrollment runs now through December 15, 2018. Learn more.
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CRNA: Banner University Medical Center, Tucson (BUMC-T), Tucson, Arizona

BANNER UNIVERSITY MEDICAL GROUP (BUMG) is seeking a CRNA to join our team at Banner University Medical Center – Tucson (BUMC-T).

You’ll be involved in clinical management of patients, performance of therapeutic and diagnostic procedures, interpretation of diagnostic tests, prescribing medications, patient education, consultation, and research. Must be able to work autonomously as well as part of an integral team of clinicians and physicians. Learn more.
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Associate Professor/Clinical Associate Professor; Director, School of Nursing: University of Tulsa – Tulsa, Oklahoma

The School of Nursing at The University of Tulsa seeks applications for a Director of the School of Nursing within the Oxley College of Health Sciences. Oxley College of Health Sciences seeks creative, collaborative and committed candidates who thrive in a highly adaptable, flexible environment with strong support from top leadership. Learn more.
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Assistant Professor of Nursing/School of Nursing: University of Tulsa - Tulsa, Oklahoma

The School of Nursing at The University of Tulsa seeks applications for a full-time tenure-track position to teach in the Bachelor of Science in Nursing program, for the 2019-20 academic year beginning in August 2019. Salary and benefits commensurate with experience, teaching and current professional status. Learn more.
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CRNA Opportunities with Aurora Health Care: Aurora Health Care – Oshkosh, Wisconsin

This CRNA position will work primarily in Oshkosh, WI, and occasionally the Aurora Surgery Center (ASC) in Fond du Lac, WI. CRNAs work in a collaborative supervision model with the anesthesiologists. Learn more.
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Nurse Anesthetist: VCU Health – Richmond, Virginia

VCU Health System's ANES – Anesthesiology is seeking a Full time Anesthetist to provide anesthesia services at VCU Medical Center for all age groups. Learn more.
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CRNA: EAI at Lakeside – Loxahatchee, Florida

Opportunity to join growing multi-specialty practice in need of CRNAs to cover OR, OB, and GI at small rural hospital in Palm Beach, Florida. Learn more.
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Certified Registered Nurse Anesthetist: UHealth – University of Miami – Miami, Florida

The UHealth-University of Miami Health System, has exciting opportunities for full time and per diem Certified Registered Nurse Anesthetists. The CRNAs will work in collaboration with anesthesiologists, surgeons and other physicians, and medical professionals to deliver anesthesia for medical and surgical procedures. Learn more
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Whether you're a recent graduate looking for your first CRNA position or a seasoned professional interested in taking that next step, CRNA Careers is THE place that will help you further your career or get things started.

As an AANA member, take advantage of career resources like resume-writing tips, interview advice and an evaluation of your resume through our Career Resource center - all for FREE. Plus, you will not only have access to posted jobs, but you can have top jobs delivered directly to your inbox with customized job alerts.

CRNA Careers is here to help connect members to the best opportunities. Start Your Search Today!
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Healthcare Headlines

Healthcare Headlines is for informational purposes, and its content should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

Epidural Dexmedetomidine Infusion for Perioperative Analgesia in Patients Undergoing Abdominal Cancer Surgery

Patients undergoing major abdominal cancer surgery may get more postoperative pain relief from bupivacaine plus epidural dexmedetomidine than from bupivacaine alone, say researchers in Egypt. Their study assigned 32 participants to one approach and 32 to the other. Patients who received an epidural bupivacaine infusion for 48 hours post-surgery used significantly less morphine, lasted longer before requesting analgesia, and reported much lower overall VAS pain scores at rest and with movement. The effects were achieved with no harmful impact on hemodynamics.

From "Epidural Dexmedetomidine Infusion for Perioperative Analgesia in Patients Undergoing Abdominal Cancer Surgery"
Journal of Pain Research (10/18) Vol. 2018, No. 11, P. 2675 Hetta, Diab Fuad; Fares, Khaled Mohamed; Abedalmohsen, Abualauon Mohamed; et al.

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Epidural Block & General Anesthesia Combination Improves Lumbar Spine Surgery Pain Management, Study Finds

Adding single-shot, low-thoracic epidural anesthesia to general anesthesia may control pain more effectively than general anesthesia by itself, researchers report. The study featured 22 participants randomized into two treatment arms, with all patients undergoing general anesthesia with desflurane and cisatracurium. Patients in one group received epidural block with bupivacaine and morphine ahead of general anesthesia. Those patients used much less fentanyl in the post-anesthesia care unit and 24 hours after surgery. Intraoperative blood loss, complications, surgical field rating score, and numerical pain scores, however, were no worse than they were for the general anesthesia group. The findings appear in Spine.

From "Epidural Block & General Anesthesia Combination Improves Lumbar Spine Surgery Pain Management, Study Finds"
Becker's Spine Review (10/29/18) Korol, Shayna

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Doses Used in Fluoroscopic Lumbar Epidural Injections Overestimated

New research questions the accuracy of system-reported data on patient entrance dose-area product used in lumbar epidural injections. Although limited by the size of the study, which included just 46 participants, the results suggest that fluoroscope-reported values may be overblown. The investigators collected data from the c-arm used for the patients' injections, which were delivered to the L1-S1 vertebral region. Exposure-in-air values typically fell within an error range of 8 percent across kilovoltage levels, but transmission factors for table and support attenuation ranged from 66-76 percent. Histogram data tended to narrow toward lower values—43 percent on average for anteroposterior views and 34 percent on average for the procedure as a whole—when corrected. Reporting in Pain Medicine, the study authors concluded, "Caution should be taken when deciding how to best use system-reported [dose-area product] values for any comparison across procedures, equipment, and clinics."

From "Doses Used in Fluoroscopic Lumbar Epidural Injections Overestimated"
Clinical Pain Advisor (10/29/18) Rice, Tyler

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Radical Cystectomy in Frail Octogenarians in Thoracic Continuous Spinal Anesthesia and Analgesia

A retrospective study investigated continuous spinal anesthesia (CSA) as a substitute for general anesthesia in the setting of radical cystectomy (RC). The procedure is the gold standard for treating nonmetastatic muscle-invasive bladder cancer; however, general anesthesia presents risks for older populations, including postoperative morbidity and mortality. Rather than disqualify the elderly from having RC, investigators asked whether CSA could mitigate these outcomes in octogenarians. Their study population included five frail patients no younger than age 80, all of whom underwent RC in CSA with hyperbaric bupivacaine in combination with fentanyl. Postoperatively, patients were kept comfortable through a continuous infusion of levo-bupivacaine plus fentanyl. All of the surgeries were completed without loss of life at three-month follow-up. Additionally, no patients were admitted to the postoperative intensive care unit, and their use of narcotic analgesics was minimal. The findings are published in Therapeutic Advances in Urology.

From "Radical Cystectomy in Frail Octogenarians in Thoracic Continuous Spinal Anesthesia and Analgesia"
Uro Today (10/26/18)

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Effect of Topical Ropivacaine on the Response to Endotracheal Tube During Emergence From General Anesthesia

Researchers theorized that topical ropivacaine would curtail extubation response, such as coughing, as well as throat pain after surgery. To test the hypothesis, they randomized 54 thyroidectomy patients to have either ropivacaine or a saline solution sprayed on the tracheal mucosa, epiglottis, tongue base, and glottis before intubation. The results indicated that 0.75 percent topical ropivacaine better suppressed cough during extubation, reduced hemodynamic fluctuations, and alleviated sore throat 12 hours postoperatively. In addition, the easy, quick, and non-invasive solution did not sidetrack patient recovery.

From "Effect of Topical Ropivacaine on the Response to Endotracheal Tube During Emergence From General Anesthesia"
Medscape (10/21/18)

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Effect of Cricoid Pressure Compared with a Sham Procedure in the Rapid Sequence Induction of Anesthesia

The supposed pulmonary benefits from using cricoid pressure during rapid sequence induction (RSI) of anesthesia had yet to be validated or disproved by a large-scale randomized trial, so researchers designed one. Nearly 3,500 patients took part in the resulting noninferiority study, which separated them into two cohorts. One set of participants received cricoid pressure, otherwise known as the Sellick maneuver, while the others were subjected to a sham procedure. All were followed for 28 days or until they were released from the hospital. The primary outcome was pulmonary aspiration, which occurred at a rate of 0.6 percent in the Sellick group and 0.5 percent in the sham group. Any between-group differences in mortality, pneumonia, and time hospitalized also were not meaningful. However, results for intubation time and laryngoscopic exposure point to more difficulties with cricoid pressure than its absence. As the investigators suspected would be the case, the study demonstrates that cricoid pressure is no better than a sham procedure as prophylaxis against pulmonary aspiration during RSI anesthesia. Additional studies are required, the researchers emphasize, in pregnant women and outside of the operating room.

From "Effect of Cricoid Pressure Compared with a Sham Procedure in the Rapid Sequence Induction of Anesthesia"
JAMA Surgery (10/17/18) Birenbaum, Aurélie; Hajage, David; Roche, Sabine; et al.

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News summaries © copyright 2018 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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Park Ridge, IL 60068
Phone: (855) 526-2262 (toll-free)/(847) 692-7050
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Attn: Cathy Hodson
E–ssential Editor
November 1, 2018