Anesthesia E-ssential

AANA Anesthesia E-ssential, November 21, 2019
National CRNA Week

Vital Signs

FDA Includes AANA Recommendations in New Drug Shortages Report

Recently, the FDA issued a report, “Drug Shortages: Root Causes and Potential Solutions” that attempts to identify root causes and offer recommendations to help prevent and mitigate drug shortages. The recommendations were based on insights received from stakeholders, including AANA’s detailed comment letter (see p. 18 of the report), as well as FDA data analysis and published research. The report identifies three root causes for drug shortages:
  • Lack of incentives for manufacturers to produce less profitable drugs;
  • The market does not recognize and reward manufacturers for “mature quality systems” that focus on continuous improvement and early detection of supply chain issues; and
  • Logistical and regulatory challenges make it difficult for the market to recover from a disruption.
The report also recommends enduring solutions to address drug shortages. These solutions include:
  • Creating a shared understanding of the impact of drug shortages on patients and the contracting practices that may contribute to shortages;
  • Developing a rating system to incentivize drug manufacturers to invest in quality management maturity for their facilities; and
  • Promoting sustainable private sector contracts (e.g., with payers, purchasers, and group purchasing organizations) to make sure there is a reliable supply of medically important drugs.
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PSMF/APSF Patient Safety Curriculum Award Available to CRNAs

Proposals Due: December 31, 2019, 5 p.m. CDT
The Patient Safety Movement Foundation (PSMF) and the Anesthesia Patient Safety Foundation (APSF) are offering an award to an anesthesia professional’s sponsoring institution of up to $100K for a two-year project! The award is being provided for the purpose of modifying the PSMF’s Patient Safety Curriculum to specifically address perioperative patient safety. The awardee will then test the educational efficiency and effectiveness of implementing the modified curriculum in anesthesia training programs across the spectrum of anesthesia professionals.

Submit an application today! Any anesthesia professional who holds a full-time position in a Department of Anesthesiology at a U.S. academic institution and who has a documented interest and aptitude in anesthesia education and patient safety is eligible to apply. Hurry, proposals are due December 31, 2019 at 5 p.m. CDT. Find out more information here.
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House Hearing Offers Opportunity to Promote Elimination of Scope of Practice Barriers

Last week, the House Small Business Committee held a hearing on shortages in the medical workforce. "Upskilling the Medical Workforce: Opportunities in Health Innovation," analyzed ways the healthcare workforce can be trained to leverage these new technologies to lower costs, incentivize start-ups, and provide quality care.

AANA Federal Government Affairs staff saw this as an opportunity and worked with Congressman Kevin Hern (R-OK) to offer a statement promoting the elimination of scope of practice restrictions as a way to address shortages. Rep. Hern went on to ask witnesses whether they believe physician shortages could be addressed by allowing advanced practice registered nurses (APRNs) to practice to the top of their licensure. A majority of the witnesses agreed that all medical professionals should be able to practice to their full scope, with the lone dissenter being an ophthalmologist who avoided the question by discussing the role of artificial intelligence in healthcare innovation.

This exchange is another great example of the momentum building toward our side in Congress and the federal government. AANA Federal Government Affairs will continue to educate members of Congress on the benefits of eliminating these unnecessary restrictions and to work with our champions on promoting the issue to the forefront of discussions on healthcare.
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Attention State Presidents! Nomination Deadline for Daniel D. Vigness Federal Political Director Award is Jan. 15

Deadline: Jan. 15, 2020
Is your state's Federal Political Director (FPD) awesome? Then nominate her or him for the Daniel D. Vigness Federal Political Director Award, which will be presented during the AANA Mid-Year Assembly in April 2020.

Named for the late Dan Vigness, CRNA, of South Dakota, who was also the first recipient of the AANA Federal Political Director of the Year Award in 2001, this honor recognizes a CRNA who has been involved in federal political campaigns, developed close working relationships with federal officials, led successful CRNA advocacy efforts, helped contribute and raise funds for the CRNA-PAC, and helped recruit CRNAs to participate in political campaigns. Learn more and submit a nomination through the AANA website. Deadline is Jan. 15, 2020.
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November 21: Today is the Great American Smokeout

According to the American Cancer Society, sponsor of the Great American Smokeout, smoking remains the single largest preventable cause of death and illness in the world. More than 34 million Americans still smoke cigarettes. Smoking causes an estimated 480,000 deaths every year, or about 1 in 5 deaths.

Start today. One day. Begin your journey to a smoke-free life with one day. Make it today.
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Happy Thanksgiving!

The American Association of Nurse Anesthetists wishes you a Happy Thanksgiving filled with good food, friends, family, gratitude, and a celebratory start to the holiday season! The AANA is thankful for all its members, it is a pleasure to serve you!

The Anesthesia E-ssential will not be published next week due to Thanksgiving, but will return the following week, on December 5.

Happy Thanksgiving
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Hot Topics

Interested in Serving on a FY2021 AANA Committee?

Deadline: April 30, 2020
The online application site for FY2021 AANA Committee members is now open! More information is available on the AANA Committee page of The application deadline is April 30, 2020.
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FY2021 CRNA-PAC Committee - New Application Deadline is now April 30, 2020!

CRNAs and SRNAs interested in serving on the CRNA-PAC Committee beginning in the 2021 AANA 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;
  • Participate 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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Do You Know an Outstanding CRNA? Nominate Your Colleague for an AANA Recognition Award!

Nomination Deadline: March 15, 2020.
Do you work with an outstanding program director, didactic instructor, or clinical instructor? Do you know someone who has spent a lifetime advancing the practice of nurse anesthesia as a practitioner, educator, clinician, or advocate? Consider nominating your colleague for one of the national AANA recognition awards.

Visit Recognition Awards for details on the:
  • Agatha Hodgins Award for Outstanding Accomplishment,
  • Helen Lamb Outstanding Educator Award,
  • Alice Magaw Outstanding Clinical Anesthesia Practitioner Award,
  • Ira P. Gunn Award for Outstanding Professional Advocacy,
  • Clinical Instructor of the Year Award,
  • Didactic Instructor of the Year Award, and
  • Program Director of the Year Award.
Nomination deadline is March 15, 2020.
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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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Ready To Start Your Own Anesthesia Practice?

Learn the business side of anesthesia from two highly successful group practice owners, Juan Quintana and Larry Hornsby. They’re providing an online 8-week seminar with university-level curriculum covering billing and reimbursement, negotiations, contracts and proposals, and differences in practice models.

AANA Membership Exclusive - Earn 16 CE Credits; Next Session starts January 6, 2020.

Seats are filling up!
Spring 2020 Session
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Looking to Pick Up Work Outside of Your Full-time Position?

AANA Insurance Services has malpractice insurance coverage for that! Visit our Policy Options page to learn more about our short term coverage options, including daily, weekly, monthly, and moonlighting coverages. Learn more.
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Get Your CRNA Week Gear On!

Get ready to celebrate! National CRNA Week is right around the corner. You can help educate the general population about the important work that CRNAs do every day. The 2020 theme emphasizes the high level of care that CRNAs give each and every patient – CRNAs: Your Comfort. Your Care. WE ARE THERE.

Share your professional pride with 2020 National CRNA Week themed shirts, hats, travel mugs, and more. Some items (like pens, buttons, and posters) are available to AANA members for just the cost of shipping. HURRY—quantities are limited. Order today!
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SRNAs and CRNA Educators: Sign Up for the Student Mentoring Program at the Assembly of Didactic and Clinical Educators (ADCE)

Student Registered Nurse Anesthetists (SRNAs), are you interested in becoming a nurse anesthesia educator? CRNA didactic educators, are you interested in mentoring students with an interest in education? Sign up for the Student Mentoring Program at the February 2020 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 19, for the mentor/mentee pairs to meet each other. Students are paired with an educator from a program other than their own. Thursday, February 20, 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 Didactic Faculty: 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 9, 2019. Provide your/the student’s name, nurse anesthesia program, email address and phone number.
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NewsMaker: CRNA Capt. Murphy Pays Tribute to America's Veterans, Families

For a Veterans Day commemoration in Grant, Neb., retired Navy Capt. Pam Murphy, MSA, CRNA, offered these words of wisdom: "We gather now to honor all those who have paid the highest price any American can offer to the Nation; to honor those wounded; to the surviving families who lost a loved one and to remember those currently returned to civilian life and those still serving."

According to The Grant Tribune Sentinel, Murphy, though retired from the Navy, works as a CRNA with Perkins County Health Services, and comes from a family rich in military service. She had the honor of receiving her first naval commission and her promotion to captain from her uncle, Rear Admiral Frederick Johnson. Read more.
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NewsMaker: CRNA Mary Williams Receives 2019 Advanced Practice Provider of Year Award

Phoebe Physicians in Albany, Ga., has awarded its 2019 Advanced Practice Provider of Year Award to Mary Williams, CRNA. Williams has been working in healthcare for more than 53 years. She received multiple nominations from colleagues recognizing her dedication to team members and patients. Read more.
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NewsMaker: CRNA Shannon Allen Receives Distinguished Nurse of the Year Award

On Nov. 2, Shannon Allen, DNAP, CRNA, was honored with the Distinguished Nurse of the Year Award from the New Mexico Center for Nursing Excellence. "Shannon's dedication and work are truly helping our community every single day," said Diane Evans-Prior, DNP, RN, and president of the board of directors for the New Mexico Center for Nursing Excellence.

Allen has served Lea County in New Mexico for 31 years. She has dedicated her career to growing the next generation of nursing leaders in the state. She has been a safety advocate in her community, and worked on healthcare issues at the state and federal levels. She is tenacious in her quest to promote CRNA practice and ensure residents have access to high-quality care in every part of rural, underserved New Mexico.

The New Mexico Center for Nursing Excellence recognizes excellence in nursing practice, and honors nurses for their contributions to their organizations, communities and the state of New Mexico. Each year, nurses are awarded in the categories of Excellence in Practice, Excellence in Leadership, and awards of distinction. Since 2005, more than 2,800 nurses throughout the state have been nominated for the awards. For the 2019 awards, 190 nurses were nominated.
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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

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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Don't Forget! Open Enrollment Closes December 15, 2019

Open Enrollment: November 1 - December 15, 2019
Healthcare plans are now available through the Affiliate Health Insurance Exchange (AHIX), including long term major medical, group medical and the Affordable Care Act ("ObamaCare") or ACA. The long-term major medical coverage offers a new three-year rate and plan design guarantee. It covers pre-existing conditions after 1 year, doctor office co-pays, wellness benefits, a prescription discount program, and more. The group medical program covers all preexisting conditions from Day 1, and it offers unlimited lifetime maximums. ACA coverage also offers pre-existing coverage from Day 1 with unlimited lifetime maximums. Learn more.

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CRNA: Quincy Anesthesia Associates, Quincy, Illinois

Quincy Anesthesia Associates is a group that works out of Blessing Hospital in Quincy IL. They are the exclusive providers of anesthesia services in Quincy and they are a private practice group. They have held this contract for about 50 years.

The group works out of two locations—Blessing Hospital has the hospital ORs and a surgical center. The surgical center has 3 rooms staffed daily and the hospital has 10. They just added another room in the main hospital. The hospital has also just announced they will be constructing a brand new surgical center at the main hospital campus. This will make things more convenient for all staff as there will be a Skywalk to go back and forth from the surgical center to the main ORs. This is a State-of-the-Art surgery center of new construction in a $20 million capital improvement. The group is a private practice group partnership and the CRNAs are a valued and integral part of the anesthesia team model.

The CRNAs do Neurosurgery, General Surgery, Urology, Vascular, GI, OB, GYN, Ortho, ENT, Eyes, Podiatry, etc. They have 10 rooms at the hospital and 3 at the surgical center. Everyone is equally rotated. The CRNAs do the inductions. The MDs and CRNAs interview patients. The MD and CRNA discuss the medical plan and execute. Officially, it is a directed practice. This is a team collaborative effort. Someone who works well within a team format works well in this group. There are 4 techs who work with the group and stock carts for the CRNAs.
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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.

Base salary:
  • $190,000 0-3 years experience
  • $205,000 4-6 years experience
  • $220,000 7+ years experience
  • $10,000 sign-on bonus
  • $20,000/year quality bonus potential
  • $6,000 retention bonus
Paid vacation:
  • 5 weeks, year 1
  • 6 weeks, year 2
  • 7 weeks, year 3
  • 8 weeks, year 4+
  • Overtime compensation
  • Relocation assistance
  • Student loan assistance
  • Paid CME days with allowance
  • Full benefits package with retirement plan
  • NBCRNA certification and IL CRNA license required
Enjoy a high level of autonomy operating within an anesthesia care team with anesthesiologists and CRNAs working in collaboration to provide quality care. 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. Learn more.
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CRNAs: Mary Washington Healthcare, Fredericksburg, Virginia

Full-time opportunities for CRNAs (day & night shifts) in both inpatient and outpatient settings.

Mary Washington Healthcare – ranked #2 in the Washington, DC area by U.S. News and World Report, has excellent opportunities for CRNAs to join our experienced team of surgeons who perform everything from complex abdominal surgeries to minor outpatient procedures.

Ideal candidates will have a valid VA Nursing license, valid VA licensure as a Nurse Practitioner in Anesthesia and current certification as a Nurse Anesthetist by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). If pending initial certification, evidence of graduation from an accredited nurse anesthesia program and of eligibility for board exam is required.

Our fast-growing healthcare system provides a level of surgical excellence that is unsurpassed in our region, and we have opportunities at three different locations, including:
  • Magnet-designated Mary Washington Hospital – our Level II Trauma Center, with 15 operating rooms and 1 Cysto room performs Cardiac, Thoracic, General/Vascular, Ortho, Neurology, Plastics, and EENT.
  • Stafford Hospital – our 100-bed community hospital that provides high-quality care from a patient's initial visit through diagnosis, treatment, and post-surgical follow-up.
  • Fredericksburg Ambulatory Surgery Center (FASC) – the only tertiary-level outpatient surgery facility in the region
Learn more.

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CRNA: American Anesthesiology of Virginia/Mednax, Richmond, Virginia

American Anesthesiology of Virginia is seeking CRNAs to join our thriving group practice at Bon Secours Mercy Health in Richmond, VA. The group consists of 25 physicians and over 70 CRNAs who function in a care team model. They provide anesthesia services at two area hospitals, both with high levels of acuity, in over 44,000 cases a year. The case mix includes OB, bariatric, cardiac, thoracic, pediatric, and plastic surgery, as well as spine neurosurgery. The group also manages a busy regional anesthesia practice with an acute pain service.

Highlights of the opportunity include:
  • A very cohesive team environment.
  • The opportunity to administer epidurals and blocks.
  • Call taking positions with flexible scheduling options.
  • Additional compensation for overtime and callback time, with available opportunities for additional call.
  • Full-time (32 hours or more per week) career opportunities are available.
Future graduates, recent graduates and experienced CRNAs are all welcome to apply.

Our clinicians enjoy a competitive compensation package with many locations offering sign-on bonuses, relocation and tuition reimbursement.

Our benefits* include:
  • Health (various options), life, vision, dental and disability insurance.
  • 401(k) with annual matching program.
  • Advanced and continuing medical education.
  • Leadership training and advancement opportunities.
  • Employee stock purchase plan at a 15% discount.
  • Professional liability insurance.
  • Support and payment for mandatory license/s and hospital credentialing.
*These benefits are for full-time employees, employees in other types of employment classifications may be eligible for some of these benefits. Learn more.
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Midwest Academic Setting — Join University of Missouri’s CRNA Team; University of Missouri, Columbia, Missouri

University of Missouri Department of Anesthesiology is seeking additional CRNAs to join their dynamic academic health center in mid-Missouri, home to the only children's hospital and Level I Trauma Center between St. Louis and Kansas City. A tremendous opportunity to join a group of energetic, self-motivated and culturally diverse faculty and staff with a strong commitment to support the growth in surgical volumes and expansion of surgical facilities. Highlights of these important positions with the region's most comprehensive healthcare network include:
  • Enjoy a variety of cases via MU's main hospital, Women's & Children's Hospital, Orthopedic Institute and surgical/endoscopy centers.
  • Variety of shifts available: 8-,10-,12- and 24-hour options available.
  • Only 1-2 weekend call shifts per year (no nights).
  • Mentoring program available to newer graduates and new hires.
  • Impressive collaboration between CRNA and MD staff - offering medical direction vs. supervision.
  • Opportunity to participate in research studies, clinical trials and operational improvement projects.
  • Full benefit package including pension/retirement (including employer contributions) and all insurances and HSA.
  • Competitive salary with paid options for additional shifts or extra call if desired.
  • Benefits also provide a generous PTO plan, including paid holidays.
The University of Missouri is an equal access, equal opportunity, affirmative action employer and is fully committed to achieving the goal of a diverse and inclusive academic community of faculty, staff and students. We seek individuals who are committed to the goal and our core campus values of respect, responsibility, discovery and excellence. 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.

The Effect of Ketamine on Emergence Agitation in Children

A systematic review and meta-analysis delved into the use of ketamine for prevention of emergence agitation in children after an operation or imaging procedures requiring anesthesia. Researchers combed the MEDLINE, EMBASE, and CENTRAL databases through February 2019 for relevant randomized controlled trials. The literature search eventually produced 13 studies with 1,125 patients. Emergence agitation affected 14.7 percent of the children who received ketamine as part of the clinical studies and 33.3 percent of children who received placebo. In addition to a lower rate of emergence agitation, ketamine recipients achieved lower postoperative pain scores and ranked lower on the pediatric anesthesia emergence delirium scale five minutes after the procedure. The studies did not provide results related to ketamine's adverse effects, however, including postoperative nausea and vomiting, desaturation, and laryngospasm. Moreover, the quality of the evidence was low. If nothing else, though, the researchers say their findings demonstrate that ketamine is well-tolerated with no obvious adverse effects across all of the trials analyzed.

From "The Effect of Ketamine on Emergence Agitation in Children"
Pediatric Anesthesia (12/19) Ng, Ka Ting; Sarode, Deep; Lai, Yuen Sin; et al.

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Superior Trunk Block Provides Noninferior Analgesia Compared with Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery

Researchers explored superior trunk block as an alternative to interscalene brachial plexus block, which delivers stellar analgesia after shoulder surgery—but at the risk of hemidiaphragmatic paresis. For the study, they randomly assigned 78 patients to one technique or the other. The primary outcome was pain intensity 24 hours post-surgery. The between-group difference in pain scores on an 11-point numerical scale was 0.1, which met the prespecified limit for noninferiority. In addition to providing comparable postoperative pain relief, patients who received superior trunk block were no less satisfied than those who received interscalene block. Moreover, the incidence of hemidiaphragmatic paresis was reduced to 76.3 percent in the superior trunk block group from 97.5 percent in the interscalene block group.

From "Superior Trunk Block Provides Noninferior Analgesia Compared with Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery"
Anesthesiology (Fall 2019) Vol. 131, No. 6, P. 1316 Kang, Ryung A.; Jeong, Ji Seon; Chin, Ki Jinn; et al.

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Side Effects Mild, Brief with Single Antidepressant Dose of Intravenous Ketamine

Government research shows that a single infusion of ketamine—administered at a low, subanesthetic dose—is not associated with serious or lasting side effects in patients with treatment-resistant depression. Intravenous ketamine increasingly is being used off label in this setting to deliver rapid relief to patients who do not respond to antidepressants; and observers have worried about the potential for adverse events linked to the drug, which has been a popular target for misuse. Scientists with the National Institute of Health (NIH) collected data on side effects from 163 patients with major depressive disorder or bipolar disorder, along with data from 25 healthy controls. Among 120 possible side effects evaluated, 34 were closely linked to the treatment—the most common of which was feeling strange, weird, or bizarre. None of the effects were serious in nature or generated ketamine cravings or created a potential for recreational use three months later. Additionally, most side effects dissipated within one hour of ketamine administration, and none lasted longer than four hours. The researchers, with NIH's National Institute of Mental Health, published their results in the Journal of Affective Disorders.

From "Side Effects Mild, Brief with Single Antidepressant Dose of Intravenous Ketamine"
ScienceDaily (11/18/19)

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Predictors Listed of Prolonged Extubation After General Anesthesia

The variables that contribute to prolonged extubation following general anesthesia are not well understood, a knowledge gap that laid the groundwork for a study of more than 86,100 adults. Researchers from the University of Mississippi Medical Center and Washington University in St. Louis were especially interested in identifying any factors—those related to anesthesia, in particular—that could be modified to reduce risk. The team observed outcomes in first-encounter, presumably low-risk patients who underwent general anesthesia with either an extraglottic airway or tracheal tube from 2010 through 2014. About 90 percent of the sample experienced normal extubation within 15 minutes, about 9.5 percent experienced prolonged extubation within 16 to 60 minutes, and 0.4 percent experienced very prolonged extubation lasting longer than an hour. The investigators documented several independent predictors of prolonged and very prolonged extubation, including intraoperative prone position, use of tracheal tube instead of laryngeal mask airway, nighttime extubations, and receipt of a blood transfusion. Additionally, the study determined that patients who undergo prolonged extubation are much more likely to need immediate reintubation.

From "Predictors Listed of Prolonged Extubation After General Anesthesia"
Anesthesiology News (11/15/19) Vlessides, Michael

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Comparative Efficacy of Epidural Clonidine Versus Epidural Fentanyl for Treating Breakthrough Pain During Labor

A study out of Columbia University Irving Medical Center examined the viability of clonidine for management of breakthrough pain during neuraxial labor analgesia. While administration of additional epidural local anesthetics often can help, clonidine is an alternative in cases where this remedy is inadvisable. The New York researchers conducted a randomized trial to compare the efficacy of clonidine in this setting with that of fentanyl, with each serving as an adjuvant to bupivacaine. Among 98 enrollees, those who received clonidine experienced similar success—defined as a reduction in pain score equivalent to 4/10 within 15 minutes of study drug administration—as those who received fentanyl. Analgesic efficacy and hemodynamic side effects in the mother also were not significantly different between the groups up to two hours after treatment.

From "Comparative Efficacy of Epidural Clonidine Versus Epidural Fentanyl for Treating Breakthrough Pain During Labor"
International Journal of Obstetric Anesthesia (Fall 2019) Lee, Allison; Landau, Ruth; Lavin, Thomas; et al.

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Preprocedural Ultrasound Versus Landmark Techniques for Spinal Anesthesia Performed by Novice Residents in Elderly

A group of 180 older patients participated in an experiment comparing spinal anesthesia success rates using pre-procedural ultrasound-guided (US) approaches versus the conventional landmark-guided technique. While the midline approach is the most common choice overall, the paramedian palpation approach has proven to be more helpful in the older population, whose osteoarthritic changes may challenge the routine process. Pre-procedural US, meanwhile, has been beneficial in guiding spinal anesthesia in patients who are likely to present technical difficulty with traditional handling. With these factors in mind, the researchers randomized study participants equally into three treatment arms. One group of 60 underwent conventional surface landmark-guided midline technique, while another received pre-procedural US-guided midline technique. The third group received pre-procedural paramedian technique. A novice resident initiated the spinal anesthesia in all cases. Based on the incidence of successful first attempts of dural puncture, the median number of attempts, medium number of passes, and time need to perform spinal anesthesia, the pre-procedural US scan did not improve the facility of midline and paramedian spinal anesthesia compared with the traditional midline standard.

From "Preprocedural Ultrasound Versus Landmark Techniques for Spinal Anesthesia Performed by Novice Residents in Elderly"
BMC Anesthesiology (11/11/19) Vol. 19, No. 208 Rizk, Marwan S.; Zeeni, Carine A.; Bouez, Joanna N.; et al.

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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:

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Attn: Cathy Hodson
E–ssential Editor
November 21, 2019
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