Anesthesia E-ssential

AANA Anesthesia E-ssential
CRNA Week 2018

Vital Signs

Proud to be a CRNA? Celebrate National CRNA Week!

Tell the world who you are during National CRNA Week, Jan. 21-27, 2018. The theme for 2018 is “Every Breath, Every Beat, Every Second: We are There.” 

National CRNA Week brings the nurse anesthesia community together to educate its various publics about anesthesia safety and the benefits of receiving anesthesia care from nurse anesthetists.

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Hot Topics

Top Nursing Organizations Push for CRNA Full Practice Authority in VA

Twenty-two nursing organizations, including the AANA, sent a letter to U.S. Department of Veterans Affairs Secretary David Shulkin on Oct. 24, 2017, expressing their concerns about surgical cancellations and postponements for veterans due to a lack of access to anesthesia services at the Denver VA Medical Center. 

According to the AANA press release, the letter went on to say allowing CRNAs to practice to the full extent of their licensure, education, and ability would help ease the delays veterans are currently experiencing and provide better access to anesthesia care.
Be sure to watch future issues of AANA publications,, and AANA Connect for further information about the VA issue.
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CRNA Fact Sheet Updated

The concise, two-page CRNA Fact Sheet provides talking points on topics important to the profession and the association, and of interest to reporters, health aides, elected officials, hospital administrators, and healthcare professionals who work with CRNAs to provide patient care. 

Topics covered in the CRNA Fact Sheet include patient safety, cost-efficiency, military presence, supervision opt-out, educational requirements, the number of anesthetics given each year by nurse anesthetists, and more. Numbers appearing in the report (total anesthetics, members) are the official, supportable data AANA uses throughout the current fiscal year (Sept. 1, 2017, through Aug. 31, 2018). The fact sheet was updated in October 2017 and will be updated again in fall 2018, if not sooner. The AANA notifies the membership whenever the fact sheet is updated. Key revisions to the latest version of the fact sheet are as follows:

  • The “Education Requirements” section has been significantly revised as approved by the AANA Board of Directors.  The average experience of RNs entering nurse anesthesia educational programs is cited as 2.9 years, CRNAs being the only anesthesia providers who obtain acute care experience prior to beginning their anesthesia education.  Nurse anesthesia programs range from 24-42 months and CRNAs are recognized as obtaining an average of 8,636 hours of clinical experience prior to graduation. This compares favorably with the average number of hours acquired by anesthesiology residents (11,955). The fact sheet also recognizes that some CRNAs pursue a one-year fellowship in a specialized area of anesthesiology such as pain management following attainment of their degree in nurse anesthesia.
  • According to the 2017 Member Profile Survey, CRNAs administer approximately 43 million anesthetics to patients each year in the United States.
  • The “Military Presence” statement has been expanded.
  • The “Supervision Opt-Out” statement now lists the 17 opt-out states.
  • AANA membership has increased to 52,000 CRNAs and student registered nurse anesthetists, still representing approximately 90 percent of the nation’s nurse anesthesia workforce.
Use the CRNA Fact Sheet when lobbying, preparing for an interview, negotiating, testifying, public speaking: It’s the most up-to-date snapshot of the nurse anesthesia profession available.
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The Joint Commission Posts Most Challenging Standards for the First Half of 2017

The Joint Commission collects data on compliance with standards, National Patient Safety Goals (NPSGs), the Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery, and Accreditation and Certification Participation Requirements to identify trends and target educational needs.  Derived from this data are the top five most challenging requirements for each program, which are cited as not compliant during surveys and reviews from Jan. 1 through June 30, 2017 (not including for cause surveys and reviews). For hospitals, critical access hospitals, ambulatory care programs, and office-based surgery,  the top five most challenging requirements continue to include reducing infection risk associated with medical equipment, devices, and supplies.  Review the lists of the top five most challenging requirements for each Joint Commission-accredited or Joint Commission-certified program.

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SCA Pharmaceuticals Recalls Analgesic Injectable Products

SCA Pharmaceuticals is recalling several injectable products due to potential microbial contamination.  These include Succinylcholine, Hydromorphone, Fentanyl, Morphine, and Rocuronium.  See the full list and lot numbers onthe  FDA website.

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CDC Issues Health Advisory for Providers Treating Patients in or Recently Returned from Hurricane-Affected Areas

The Centers for Disease Control and Prevention (CDC) has issued a Health Advisory to remind clinicians assessing patients currently in or recently returned from hurricane-affected areas to be vigilant in looking for certain infectious diseases, including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza.  Because of compromised drinking water and decreased access to safe water, food, and shelter, the conditions for outbreaks of infectious diseases exist.  Additionally, this advisory provides guidance to state and territorial health departments on enhanced disease reporting.

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AANA Learn Member Exclusives: Take Advantage of Free Sponsored Courses Soon

Two sponsored courses that are free to AANA members are set to expire soon: Respiratory Compromise, Moving Patients from Surgery to the PACU, and Perioperative Delirium: The Latest Science in Anesthesia Management. Visit AANA Learn, and be sure to log in before taking the courses.

Respiratory Compromise: Moving Patients from Surgery to the PACU
1.0 Class A Credit
.025 Pharm Credits
Course Expiration Date: 11/30/17
Perioperative Delirium: The Latest Science in Anesthesia Management
1.0 Class A Credit
Course Expiration Date: 1/19/2018
Both are supported by an educational grant from Medtronic.
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Nurse Anesthetist - #6 in "The 100 Best Jobs"

U.S. News and World Report ranks Nurse Anesthetist as number six on the 100 Best Jobs of 2017. Read the story at U.S. News & World Report.

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Open Enrollment is Here!
AANA Member Advantage Program Partner AHIX Offers Health Insurance Options

If you're looking to purchase health insurance during the Affordable Care Act (ACA) Open Enrollment Period, check out what AANA Member Advantage Program partner AHIX has to offer. (The Open Enrollment Period lasts from Nov. 1, 2017, to Dec. 15, 2017.) You'll find savings and plenty of new options to fit your needs, including PPOs, access to doctors and hospitals throughout the United States, and lower deductibles and out-of-pocket costs. Affordable Care Act plans are also available (online only). Go to AANA Health Plans or call (888) 624-5870.

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Visit to view or place job postings

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Featured Career Opportunity

Nurse Anesthesia Program Assistant Director - The University of Tulsa


The University of Tulsa is seeking applications for an Assistant Program Director for a Nurse Anesthesia program that will launch in Fall 2018.  

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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.

In Arthroscopic Hip Surgery, Pre-op Fascia Iliaca Compartment Block Does Not Improve Pain Control

Contrary to previous research, a new study has found that patients undergoing arthroscopic hip surgery receive no analgesic benefit from the addition of a preoperative fascia iliaca compartment block. Moreover, according to investigators at the University of California, San Francisco, the technique actually elevated the risk of patient falls by dramatically weakening the quadriceps. The conclusions were based on the experience of 80 ambulatory surgery patients, all of whom received an intra-articular injection of ropivacaine postoperatively. Some additionally received preoperative analgesia with fascia iliaca compartment block, while the remainder received only a sham block. Pain scores and opioid needs were comparable between both sets of patients in the post-anesthesia care unit and in the first 24 postoperative hours, suggesting that the fascia iliaca block had no impact on pain. It did, however, appear to have a significant effect on leg strength—an almost 90 percent reduction from baseline—investigators reported at the 2017 annual meeting of the American Society of Regional Anesthesia and Pain Medicine. That compared with just a 40 percent reduction in patients who received the fake block. "Recent studies have dealt with regional anesthesia techniques," according to Matthias Behrends, MD, associate professor of anesthesiology at UCSF, "but the overall level of evidence for these nerve blocks is extremely low."

From "In Arthroscopic Hip Surgery, Pre-op Fascia Iliaca Compartment Block Does Not Improve Pain Control"
Anesthesiology News (10/28/17) Doyle, Chase

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Paracetamol May Help Reduce Post-Operative Shivering

Shivering upon anesthesia emergence affects as many as 50 percent of surgical patients, but Japanese researchers believe intraoperative paracetamol can lower the incidence rate. Their small study involved 37 patients undergoing gynecologic procedures, with some receiving intravenous paracetamol and others receiving placebo after a general anesthetic. The rate of postoperative shivering was considerably higher among the placebo-takers, at 73.7 percent, than the paracetamol patients, at 22.2 percent. The severity of the shivering was also reduced in women in the paracetamol group. Although hard evidence is lacking, postoperative shivering may be the result of the body cooling down. In addition to the pain and discomfort it can trigger, primary investigator Takahiro Tadokoro, MD, said the complication "can also put strain on the cardiovascular system, therefore, we need to prevent it, especially in patients with cardiopulmonary risk. We believe our findings can be widely applicable, as acetaminophen [paracetamol] is a relatively safe drug and commonly used."

From "Paracetamol May Help Reduce Post-Operative Shivering"
Nursing Times (United Kingdom) (10/25/17) Ford, Steve

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Opioid-Free Anesthesia Reduces Postoperative Nausea, Study Finds

Opioids are usually among the drugs that surgical patients receive for general anesthesia, but new research finds that using other pain medications not only is safe but curbs postoperative nausea. In a study conducted at Select Physicians Surgery Center in Tampa, Fla., more than 1,000 patients having head and neck operations underwent general anesthesia without opioids. Alternatives including magnesium, sub-anesthetic ketamine, lidocaine, and ketorolac were administered instead. Compared with typical postoperative nausea rates ranging from 50 percent to 80 percent, the complication affected study participants at a rate of just 11 percent. Moreover, 64 percent of the patients needed no pain medication in the post-anesthesia care unit. "Opioids crept into general anesthesia over the years because they don't cause problems with the cardiovascular system, but our research suggests we can use alternatives safely and effectively," noted lead author David Samuels, MD. The findings were presented at ANESTHESIOLOGY 2017.

From "Opioid-Free Anesthesia Reduces Postoperative Nausea, Study Finds" (10/24/2017)

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Postpartum Depression: Scientists Find Seasons, Labor Pain Affect Mother's Risk

Researchers have unveiled some newly discovered factors—from decisions about anesthesia to the time of year of delivery—that are now linked with postpartum depression (PPD). Choosing to forgo an epidural, for example, appears to increase the risk of developing the mental health disorder. "Women who did not have anesthesia may have been at an increased risk for PPD because the pain associated with labor may have been traumatizing to the women during delivery," according to a statement from the American Society of Anesthesiologists, whose 2017 annual meeting included a presentation on the findings. "Or, it's possible those who declined anesthesia just happened to have intrinsic characteristics that made them more vulnerable to experiencing PPD." Previous research has theorized that undergoing labor without adequate relief could cause pain severe enough to result in psychological damage. PPD also is more likely, according to the latest data, to affect women who have their babies in the fall or summer months or who have higher body mass. Mothers who are white or who carry their babies for a longer period, meanwhile, are at less risk for PPD. The new evidence is based on a study of medical records from more than 20,000 women who gave birth between June 2015 and August 2017—about 4 percent of whom developed PPD.

From "Postpartum Depression: Scientists Find Seasons, Labor Pain Affect Mother's Risk"
International Business Times (10/23/17) Glowatz, Elana

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Migraine Pain Could Be Eased With Ketamine, Study Finds

Researchers in Philadelphia believe that ketamine, a powerful anesthetic also being explored as a treatment for depression, additionally could help migraine sufferers. The team conducted a retrospective study of 61 patients whose migraine was difficult to treat, who had stopped responding to existing therapies, or both. All were administered ketamine infusions for three to seven days, with nearly 75 percent of them reporting a drop in pain intensity following the treatment. The average migraine pain score was 3.4 on a scale of 1 to 10 after the infusions—down from 7.5 at baseline—and the lowest pain scores were reported on the fourth day. Any adverse effects that befell patients were classified as mild. Although no firm conclusions can be drawn due to the retrospective nature of the study, the investigators are optimistic. "Ketamine may hold promise as a treatment for migraine headaches in patients who have failed other treatments," said Eric Schwenk, MD, director of orthopedic anesthesia at Thomas Jefferson University Hospital. "Our study focused only on short-term relief, but it is encouraging that this treatment might have the potential to help patients long-term."

From "Migraine Pain Could Be Eased With Ketamine, Study Finds"
Medical News Today (10/22/17) Whiteman, Honor

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Low-Dose Perineural Dexamethasone Prolongs Effects of Brachial Plexus Nerve Block

A retrospective study involving more than 1,000 patients undergoing ropivacaine brachial plexus nerve block with ropivacaine investigated whether adding perineural dexamethasone would make the analgesia last longer. A total of 537 patients received perineural dexamethasone at a very low dose of less than 2 mg, while 393 received a low dose ranging from 2 to 4 mg. A control group of 97 patients, meanwhile, underwent the block with no dexamethasone at all. "Very low and low doses of perineural dexamethasone are associated with prolonged interscalene and supraclavicular brachial plexus block duration compared with ropivacaine alone," the investigators determined, noting that block duration was extended by a mean 5.9 hours with low-dose dexamethasone and by a mean 4.9 hours with very low-dose dexamethasone. Female gender, older age, and higher dose of local anesthetic were factors that correlated with longer duration of analgesia, they reported in Pain Medicine.

From "Low-Dose Perineural Dexamethasone Prolongs Effects of Brachial Plexus Nerve Block"
Clinical Pain Advisor (10/20/17) Martin, Jessica

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

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

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November 2, 2017
Quicken Loans AANA Group Disability