Anesthesia E-ssential

AANA Anesthesia E-ssential, November 14, 2019

Vital Signs

USP <800> Hazardous Drugs – Handling in Healthcare Settings Becomes Official December 1, 2019

On December 1, 2019, USP General Chapter <800> standards adopted by the United States Pharmacopeial Convention (USP) for the safe handling of hazardous drugs will become official as an informational resource. These standards have the goal of protecting patients, staff, and the environment from hazardous drug (HD) exposure. The National Institute for Occupational Safety and Health (NIOSH) identifies hazardous drugs subject to USP 800. These drugs have one or more of the following characteristics in humans or animals: carcinogenicity, teratogenicity or developmental toxicity, reproductive toxicity, organ toxicity at low doses, genotoxicity, or structure and toxicity profiles of new drugs that mimic existing hazardous drugs. They may be used in many settings, from hospitals and ambulatory surgical centers to healthcare professional offices. These standards apply to all healthcare personnel who are in contact with these drugs, from entry into the facility until disposal and wasting. Facilities must have a designated qualified and trained person to oversee the USP <800> compliance program.

The USP does not enforce these standards. Accreditation entities, governmental bodies, and facilities decide whether to enforce these standards.

Some of the topics addressed in the standards include:
  • Compiling the facility HD list, which can be easily accessed by staff.
  • Developing and implementing policies and procedures that comply with the standards.
  • Wearing personal protective equipment (PPE) when in contact with hazardous drugs.
  • Deactivating, decontaminating, disinfecting and cleaning contact and surrounding areas.
  • Receiving, storing and handling hazardous drugs separately from nonhazardous drugs.
  • Following safe handling requirements and work practices, including completing risk assessments and implementing alternative strategies for eligible drugs in specified HD categories.
  • Safely transporting and disposing of HDs.
  • Educating and training staff.
For more information and details about USP <800>, including a free download of the standards, visit the USP website
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New Resource on MIPS Scoring

AANA’s Research and Quality department developed a frequently asked questions (FAQ) document to guide CRNAs through the scoring methods used to calculate the results of your 2018 merit-based incentive payment system (MIPS) performance feedback reports and determine your final score. You also can access the FAQ document on the AANA’s Quality Reimbursement page, under MIPS Frequently Asked Questions (FAQs).

This resource summarizes how the MIPS final score is used to determine your payment adjustment that will go into effect on January 1, 2020. The FAQ document will be updated annually to reflect changes in scoring, performance thresholds and payment adjustments. 
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State Association Meeting Wellness Resources

State association meetings are a great opportunity to lead members to AANA’s plethora of wellness resources. Find ideas for state association meetings, downloadable handouts, information to order AANA cards, and posters to print at your local print shop, and more! Visit to see more.
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Hot Topics

Council on Accreditation (COA) Seeking Qualified Applicants for Onsite Reviewers

Deadline to apply: December 16, 2019
The COA is seeking qualified candidates for Educator Practitioner and Educator Administrator Onsite Reviewers. Please note candidates must meet specific criteria as detailed on the COA website. Candidates must be available to conduct one onsite accreditation review per year. Onsite reviews are typically scheduled for 2-3 consecutive weekdays in April and October. To be assigned to an onsite accreditation review, appointed onsite reviewers must attend a mandatory workshop training; trainings are held in conjunction with the Assembly of Didactic and Clinical Educators (ADCE) in February and the AANA Annual Congress in August. The term of appointment is three years, beginning January 2020. The appointed candidates then would be eligible to be considered for reappointment to a second three-year term. The deadline to apply is December 16, 2019. For position criteria and application requirements, please visit
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Admitted vs. Non-Admitted Malpractice Insurance Companies: Do You Know the Difference?

There are significant differences between admitted and non-admitted malpractice insurance companies – and choosing the wrong company can put you, your reputation, and your personal assets at risk. Learn which questions to ask your insurance agent to ensure you have protection when you need it most. Learn More.
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Future of Nursing 2020-2030: Technical Panel Webinar

On November 20, 2019, the committee on the Future of Nursing 2020-2030 will hold a technical panel and discussion with healthcare industry leaders about how their organizations or members prioritize efforts to promote health equity into delivery and care models. The panel and discussion will start at 9 a.m. ET and conclude at 12 p.m. ET.

  • Tricia McGinnis, executive vice president and chief program officer, Center for Health Care Strategies.
  • Angela Patterson, chief nurse practitioner officer, CVS MinuteClinic and vice president, CVS Health.
  • Elizabeth Mitchell, president and CEO, Pacific Business Group on Health (presentation by Zoom).
  • Priya Bethija, vice president of The Value Initiative, American Hospital Association; and Robyn Begley, senior vice president, American Hospital Association and chief nursing officer, American Organization for Nursing Leadership.
Learn more.
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Seeking Candidates: Delegate to Education Committee

The AANA Education Committee is seeking candidates to serve a two-year term as a Delegate. The deadline for receiving completed candidate packets is January 6, 2020. The election will be held, and the winner announced, at the Assembly of Didactic and Clinical Educators (formerly called the Assembly of School Faculty) meeting in February 2020.

Delegates must be CRNAs who spend at least 50% of their time in the didactic and/or clinical instruction of nurse anesthesia students at the time of application. During their tenure on the committee, they must:
  • Be continuously involved in the didactic and/or clinical instruction of nurse anesthesia students.
  • Attend the February Assembly of Didactic and Clinical Educators and Nurse Anesthesia Annual Congress during both years of their term.
  • Attend Education Committee meetings and conference calls for the two-year term which begins immediately following the AANA Annual Congress in the year elected.
The candidate information packet is available on the AANA website under CE & Education, Opportunities for Educators. Questions? Contact the Education department at 847-655-1161 or
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NewsMaker: CRNA Evan Geilenkirchen Receives 2019 Caring Kind Award

Evan Geilenkirchen, MS, CRNA, was honored as Community Hospital's Caring Kind recipient during the Nebraska Hospital Association annual convention in La Vista, Neb. The Caring Kind award recognizes outstanding healthcare employees who have demonstrated compassion for patients, cooperating with coworkers and dedication to providing the best care possible. Geilenkirchen was nominated by co-workers and chosen by the Community Hospital PACT committee. Evan has worked as a nurse anesthetist at Community Hospital since 2014. Learn more.
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NewsMaker: Stars Align for Sudden Cardiac Arrest Victim

According to the Helena Reporter, "Helena Police Lt. Brad Flynn and his neighbor Mary Pat Pampu, who is a nurse anesthetist at Children’s Hospital, returned home around 1 p.m. on Wednesday, Oct. 30, and to their surprise, discovered a man who had gone into cardiac arrest while doing contracting work on a house in their neighborhood." The man had gone into cardiac arrest after feeling light-headed and dizzy. Flynn and Pampu begin CPR and called 911. Learn more.
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Meetings and Workshops

ADCE Registration is Open!

Join us in Braselton, Ga., at the Château Élan Winery & Resort for the premier nurse anesthesia educational program forum: the Assembly of Didactic and Clinical Educators (ADCE). Meet with leading educators in the field and help define the future of the CRNA profession!

When: February 19-22, 2020
Location: Château Élan Winery and Resort, Braselton, Ga.
Early Registration Savings: Save up to $100.00*

*Resort reservations for ADCE include FREE shuttles to/from Hartsfield-Jackson International Airport.

Wide-Range of Topics include:
  • Leadership to improve faculty/student satisfaction and academic outcomes.
  • Common legal issues faced within nurse anesthesia education.
  • Doctoral curriculum and scholarship.
  • Challenges of clinical education amid production pressure.
  • Health and wellness of faculty and students.
  • Research, and more!
More about the Château Élan - Southern charm meets luxury French splendor with 3,500 acres of grapes, spa treatments, gourmet dining, and golf.
  • Wine tours and tastings held daily.
  • Spa mansion with 14 spa suites.
  • 7 onsite restaurants.
  • 45 holes of championship golf.
Register Today!
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Mid-Year Assembly 2020: Advocate for Your Profession on Capitol Hill

When: April 18-22, 2020
Location: Renaissance Washington D.C. Downtown, Washington, D.C.

The Mid-Year Assembly is the most important nurse anesthesia advocacy meeting. Join us on Capitol Hill as we gather, rally, and impress the importance of nurse anesthesia on our legislators.

Save the Date
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AANA Member Benefits

Grace Period is Over - Getting Cozy With Your Student Loan Debt

Recent grads, we feel you. It’s that time of year when you’re likely staring down your very first student loan payment. The fun [aka your grace period] is coming to an end, and if you’re like many of us, you’re a little worried, a little anxious…maybe even confused. Learn more.

Laurel Road Logo
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It Pays to be Prepared: Preorder 2020 CPC Core Modules and Save!

SAVE UP TO 25% on the innovative microlearning series being released in the fall of 2020. You'll have peace of mind knowing you're all set to meet CPC requirements through all four required knowledge domains. Offer expires December 31, 2019.

Be prepared. Preview modules and sign up today at

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Certified Registered Nurse Anesthetist: UT-Regional One Physicians, Memphis, Tennessee

UT-Regional One Physicians (UTROP), a partnership between Regional One Health (ROH) and the University of Tennessee Health Science Center (UTHSC), is seeking a Certified Registered Nurse Anesthetist (CRNA) at Regional One Health in downtown Memphis. We have needs in General Surgery, Trauma Surgery and OB.

The Certified Registered Nurse Anesthetist (CRNA) is a member of the Anesthesia care team and, under the supervision of an anesthesiologist or other qualified physician, participates in rendering anesthetic services. The CRNA reports to the supervising physician for anesthesia services and all patient care activities. These activities include those which involve direct patient care such as surgical anesthesia and pain management and those which involve indirect patient care such as care of and ordering anesthesia equipment, supplies, and other duties deemed necessary. Learn more.
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Certified Registered Nurse Anesthetist: WellSpan Health, York, Pennsylvania

Join a well-respected health system in south central Pennsylvania. WellSpan Health, an integrated health system serving central Pennsylvania and northern Maryland, is comprised of a multispecialty medical group of more than 1,500 physicians and advanced practice clinicians, a regional behavioral health organization, a home care organization, eight respected hospitals, more than 19,000 employees, and 170 patient care locations.
  • Full and part-time (.8 FTE) positions available; PRN also available.
  • 4 10-hour shifts, or 5 8-hour shifts available; no weekends/no holidays.
  • CRNAs with prior Ambulatory experience are encouraged to apply.
  • Exciting opportunity to join an established surgical center.
  • Case mix includes: GI, Plastics, Urology, General, ENT, Peds, Podiatry, Ortho and Ophthalmology.
  • Enjoy a well-balanced lifestyle, excellent hours and schedule and no call.
  • Competitive salary, signing bonus, and outstanding benefits.
Learn more.
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CRNA: Banner University Medical Group, Tucson, Arizona

BANNER UNIVERSITY MEDICAL GROUP (BUMG) is seeking a CRNA to join our team at Banner University Medical Center – Tucson. BUMC-T values patient-centered care and healthcare innovation. We were named a U.S. News and World Report Best Hospital and ranked No. 3 Hospital in Arizona. Tucson, located in the Sonoran Desert surrounded by multiple mountain ranges, is a very friendly Southwestern town where you’ll have access to a multitude of yearlong outdoor activity options, from cycling to boating to golf, to simply sitting and enjoying some of Mother Nature’s most astounding creations. With resources and lifestyle opportunities like these, what you envision for your professional career and personal life environment can become your reality.

Banner Health and University of Arizona Health Network have come together to form Banner – University Medicine, a health system anchored in Phoenix and Tucson that makes the highest level of care accessible to Arizona residents. At the heart of this partnership is academic medicine – research, teaching and patient care – across three academic medical centers. Learn more.
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Cardiac CRNA: Memorial Health System, Springfield, Illinois

Status: Full Time, Non-Exempt
Schedule: Days, Weekend Call
Basic Functions:
  • Administration of anesthesia for all cardiac and vascular procedures employing a variety of techniques to render persons insensible to pain during a variety of surgical, dental, obstetric, and diagnostic procedures.
  • Evaluating the effectiveness of interventions and assist in identification of alternative strategies.
  • Demonstrate knowledge of the principles of growth and development for patients of adult age through geriatrics.
  • Assess and interpret data reflective of the patient's status and provide care relative to their age-specific needs in accordance with the department's policies, procedures, and standards of care.
CRNAs are directed by an Anesthesiologist and work in a collaborative team approach to improve quality, safety, and control costs. Serve as clinical mentor for Student Nurse Anesthetists. Learn more.
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Certified Registered Nurse Anesthetist: Memorial Health System, Springfield, Illinois

Status: Full-Time, Hospital employed
Schedule: Convenient flexible schedule with 8-, 10- and 12-hour shift options available
Basic Functions:
This position embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision and values. Our CRNAs administer general, regional, and MAC anesthesia to patients of all ages and any ASA status. The CRNAs work in a collaborative team environment with 50 CRNAs, 21 Anesthesiologists and 12 Anesthesia Techs to assist with room turnover and stocking. The CRNAs serve as Clinical Instructors for SIUE and Millikin/Decatur Nurse Anesthesia programs.

Due to our continued growth, Memorial Medical Center has multiple needs for Certified Registered Nurse Anesthetists. Positions are available full time in the Main OR, CVOR or as a split 50/50 between Main OR and CVOR. Learn more.
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CRNA: Southern Illinois Healthcare, Carbondale, Illinois

SIH Medical Group is seeking additional CRNAs to join the experienced Anesthesia Services team at our expanding health system.

We are proud to offer a successful, team-based culture combined with a balanced lifestyle and financial security.

Enjoy a high level of autonomy with MDA medical direction. Our team of 30 CRNAs and 15 MDAs perform a wide variety of cases and procedures across three hospitals and two ASTCs. Types of cases include general surgery, orthopedics, podiatry, GI, cardiac, OB/Gyn, urology, ENT, neuro, ophthalmologic, and plastic.

Southern Illinois is a hidden treasure in America’s heartland. The area is rich with lakes, wineries, arts, sporting events, parks, festivals, historic attractions, unique shops, restaurants, and outdoor activities. Carbondale is home to Southern Illinois University, a public research university featuring a medical school, law school, Division I athletics, and a comprehensive offering of fine arts. As a mid-sized community, we feature big-city amenities with smaller-town charm.

SIH is the leading provider of healthcare services in southern Illinois. Financially strong with engaged leadership and talented employees, SIH is committed to doing what’s best for our patients every day. We invite you to visit and experience our community, culture, and opportunities for yourself. Learn more.
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CRNACareers - Exclusive AANA Member Job Board, connecting CRNAs with the top employers in the U.S.

  • 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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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.

Could Underbody Blankets Be the Better Option?

Research out of Japan points to underbody-type blankets as a superior strategy for maintaining normal temperature after general anesthesia induction, which changes how heat is distributed throughout the body. Led by Shigekazu Sugino, MD, of Tohoku University School of Medicine, the team reviewed outcomes for 3,829 patients who utilized underbody forced-air warming devices and 3,829 who used overbody models. Based on the data, which was collected every five minutes for four hours after induction, underbody blankets appear to be more effective starting at about 100 minutes post-induction. "Underbody blankets, together with surgical draping, enable efficient convection of airflow over the body," said Sugino. "This warmed tent produces a larger body surface area that can be warmed by the blanket." Sugino and lead study author Kunie Sato, who presented the findings in a poster at the 2019 annual meeting of the European Society of Anaesthesiology, plan to validate their results in an upcoming prospective trial.

From "Could Underbody Blankets Be the Better Option?"
Anesthesiology News (11/11/19) Saleh, Naveed

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Injections Found to Successfully Treat PTSD Symptoms in Veterans

After much anticipation, the results are finally in from a clinical study on the effect of strategically placing anesthetic injections in the necks of patients with post-traumatic stress disorder (PTSD). Precise targeting of a series of injections to the base of the neck appears to block signals along major nerve systems, calming symptoms such as depression, distress, anxiety, pain, and physical and mental functioning. The new Army-funded project, conducted by the nonprofit research institute RTI International and just published in JAMA Psychiatry, offers statistically significant evidence that the technique—known as stellate ganglion block—effectively treats PTSD with few adverse effects. Missing the injection site is the biggest potential risk; however, that risk is reduced when clinicians use ultrasound to guide needle insertion. Co-investigator Sean Mulvaney, MD, says, "Now we have a strong study with the highest level of evidence that shows that [this treatment] can really help PTSD symptoms." Mulvaney estimates that he has used the treatment on troops more than 1,000 times.

From "Injections Found to Successfully Treat PTSD Symptoms in Veterans"
Wall Street Journal (11/06/19) Kesling, Ben

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Prospective Evaluation of Cognitive Outcomes After Anesthesia for Patients in the Beach Chair Position

Researchers launched a prospective study to examine cognitive outcomes in 80 patients undergoing anesthesia from the beach chair position, which has been associated with neurologic impairment. The anesthesia provider in half of the cases was blinded to cerebral perfusion monitoring and treated the patients based on mean arterial pressure (MAP) alone. For the remaining 40 patients, the provider was aware of the results of cerebral monitoring and was able to treat any desaturation events. There were just three desaturation events in the entire study population, with no meaningful change in cognitive performance. The results, which appear in Orthopedics, suggest that there is no advantage to cerebral perfusion monitoring for surgical patients receiving anesthesia in the beach chair position as long as MAP is tightly maintained. Therefore, the investigators conclude, the focus should be on closely monitoring MAP—not cerebral perfusion—during surgery.

From "Prospective Evaluation of Cognitive Outcomes After Anesthesia for Patients in the Beach Chair Position"
Healio (11/08/2019)

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Intravenous Ketamine Offers Postoperative Pain Relief After Total Knee, Hip Arthroplasty

A systematic review and meta-analysis reported in BMJ Open offers insight into the therapeutic benefits of intravenous ketamine for total joint arthroplasty. The project included 10 randomized, placebo-controlled studies, from which data on pain intensity, morphine demand, and gastrointestinal and psychotic adverse effects were extracted. Based on the evidence, investigators from Central South University in Changsha, China, concluded that I.V. administration of ketamine in knee or hip replacement patients effectively alleviates postoperative pain and curtails morphine consumption without elevating the risk of gastrointestinal or psychotic side effects. Although the data was limited, the research also documented significant reductions in postoperative pain intensity with intra-articular and epidural ketamine. "Psychotic and gastrointestinal adverse effects of the intravenous and intra-articular administration of ketamine in total knee or hip arthroplasty patients were similar to, or even less that of saline controls," the investigators report. "This suggests that both the intravenous and intra-articular administration of ketamine can be considered as a recommendation for patients scheduled for total knee or hip arthroplasty." However, they added, "the analgesic efficacy and safety of ketamine seem to vary by different administration routes and still warrants further studies to explore."

From "Intravenous Ketamine Offers Postoperative Pain Relief After Total Knee, Hip Arthroplasty"
Rheumatology Network (11/06/19) Robinson, Katie

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Study: AI-Powered Ultrasound-Guided System Boosts Spinal Anesthesia Success

Researchers in Singapore report that artificial intelligence is helping anesthesia providers hit the mark the first time during needle insertion for spinal anesthesia. The technology—a machine-learning algorithm, specifically—is used to detect spinal landmarks during an ultrasound. Once it identifies the appropriate location and angle for needle insertion, the device sends a real-time alert to the anesthesia provider. Investigators tested out the system on 100 women at KK Women's and Children's Hospital who required spinal anesthesia. During a one-year period that ended in May 2017, 92 percent of users successfully inserted the needle on the first pass. Researchers and providers say the new technology promises to lower the rate of complications and could help train anesthesia providers to "better identify correct spinal landmarks."

From "Study: AI-Powered Ultrasound-Guided System Boosts Spinal Anesthesia Success"
Becker's Spine Review (11/11/19) Oliver, Eric

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Lenovo Pilots VR as an Alternative to General Anesthesia for Kids

In partnership with Lenovo and SOTI—a mobile device management provider—the Starlight Children's Foundation is conducting a pilot to evaluate the use of virtual reality (VR) headsets in lieu of general anesthetics for critically ill kids. Although the project is ongoing, preliminary results reveal that distracting pediatric patients with VR has allowed doctors to perform invasive procedures with local anesthetic alone or no anesthetic at all. "The human brain has a limited bandwidth for what it can pay attention to," explains Children's Hospital Colorado's Child Life medical director Joe Albeitz, MD, one of the Starlight program's participating pediatricians. "The more I can engage you in that virtual experience, the less your brain is able to perceive the pain signals that are coming through." The age-appropriate VR content focuses the patients' attention on the games and apps rather than the medical equipment or their injuries.

From "Lenovo Pilots VR as an Alternative to General Anesthesia for Kids"
Venture Beat (11/09/19) Horwitz, Jeremy

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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
November 14, 2019