Anesthesia E-ssential

AANA Anesthesia E-ssential, November 7, 2019
National CRNA Week

Vital Signs

Rule Change by the Centers for Medicare & Medicaid Services Recognizes CRNAs' Expert Care

The American Association of Nurse Anesthetists (AANA) commends the Centers for Medicare & Medicaid Services’ (CMS) for recognizing a Certified Registered Nurse Anesthetist’s (CRNA) ability to perform pre-anesthetic assessments in Ambulatory Surgical Centers as part of the final rule made Nov. 1 on the Physician Fee Schedule.

The final rule also includes a provision that finalizes broad modifications to CMS’ documentation policy for evaluation and management services so that CRNAs, along with other APRNs, physicians, and physician assistants, can review and verify, rather than re-document notes in a patient’s medical record. The preamble related to this provision of the rule recognizes Medicare Part B payment to CRNAs for evaluation and management services as defined by a state’s scope of practice. The policy changes implement key provisions of President Trump’s executive order on reducing regulatory burden in Medicare.

Read the AANA press release.
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The Joint Commission Issues Safety Advisory on Preventing Maternal Death from Hemorrhage

Annually, approximately 700 women in the U.S. die from pregnancy-related complications. The most frequent cause of severe and preventable maternal morbidity and preventable maternal mortality is obstetric hemorrhage. Addressing rising maternal hemorrhage rates, The Joint Commission released the Quick Safety advisory, Proactive prevention of maternal death from maternal hemorrhage.

This advisory reviews a new accreditation standard, effective July 1, 2020, targeted at maternal hemorrhage complications, and recommends strategies to reduce these complications, including implementing a standard, comprehensive obstetric safety bundle based on evidence-based practices.

This bundle on obstetric hemorrhage, developed by the Council on Patient Safety in Women’s Health Care, on which the AANA serves, is organized into four action domains: Readiness, Recognition, Response, and Reporting/Systems Learning. All members of the healthcare team, including CRNAs, must maintain situational awareness regarding this important issue. For more information about the Council on Patient Safety in Women’s Health Care’s patient safety bundles, visit

Read The Joint Commission’s Quick Safety advisory and the complete list of action items at The Joint Commission website.

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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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Hot Topics

New! AANA-Approved Addiction Treatment Programs

See for more information on the AANA’s treatment recommendations specific to anesthesia professionals with substance use disorder and our growing list of AANA-approved Addiction Treatment Programs which meet this criteria. Remember, help is available through the AANA Peer Assistance Helpline (800-654-5167), which offers 24/7 live confidential support and resources for concerns related to alcohol or other drugs for CRNAs/SRNAs.
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Do You Have What It Takes to Succeed as an Independent Anesthesia Provider?

If you want to go out on your own, but don’t know the business side of anesthesia, here’s your chance to learn from Juan Quintana and Larry Hornsby, former AANA presidents who both have launched multimillion-dollar anesthesia group practices. They’re hosting this 8-week university-level course exclusively to AANA members online! They’ll engage with you each week to cover topics such as billing and reimbursement, negotiations, contracts and proposals, differences in practice models, and more.

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

Reserve Your Seat Today!
Spring 2020 Session

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New! Five Things You Need to Know About CRNA Malpractice Insurance

Malpractice insurance can be complicated. Gain a basic understanding of CRNA Malpractice Insurance with AANA Insurance Services’ new Five Things You Need to Know resource. Learn more.
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National CRNA Week 2020 Store is Now Open

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 Brett Fadgen Proving He Can Do Anything

Brett Fadgen, MSN, CRNA, is a nurse anesthetist at the University of Pittsburgh Medical Center (UPMC). Fadgen "is like any other nurse anesthetist at UPMC, except that he's part of a 12-person team that's credentialed to work at any UPMC facility on any given day—and was born without a right arm," says the UPMC blog, Inside Life Changing Medicine.

"Over the course of his career, he’s been a firefighter, a paramedic, a rescue specialist, and a flight nurse with STAT MedEvac — and still he wanted more. So, he applied to the nurse anesthesia program at the University of Pittsburgh.

"In the first simulation workshop, students were to perform endotracheal intubation. Brett did not pass at first. His results were the same as his classmates’, but he hadn’t used the standard technique. “I have to learn how to do things differently. I didn’t like to label myself with the term ‘disability’ because I viewed it as saying I was disabled.”" Learn more.
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NewsMaker: SRNA Kendall Vincelette Is Going it Alone

She doesn't have a coach, a physical therapist, a mental coach or nutritionist. Heck, Kendall Vincellette, RN, doesn't even follow a specific nutrition plan. Yet, according to the website, the full-time grad student studying nursing anesthesia at the Minneapolis School of Anesthesia, is currently sitting 11th in the world after three weeks of the CrossFit Games Open. Learn more.
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NewsMaker: Tampa Nurses Turn Excess Supplies Into Sleeping Bags for Homeless

According to Bay News 9 in Tampa, Fla., a group of nurses at Tampa General Hospital found a creative way to put surgical wrap to use so it wouldn't be thrown away. They're using it to make sleeping bags for the homeless. "Every single tray of surgical instruments comes to the operating room in these sterilized wrappers, and if we're just throwing them away, why not put it to a better cause?" said Nicole Hubbard, chief CRNA. Learn more
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Meetings and Workshops

This Weekend: AANA Leadership Summit - Empower the Leader Within

Class A CE Credits: 15.75
When: November 8-10, 2019
Location: Naples Grande Beach Resort, Naples, Fla.

The AANA Leadership Summit is designed to meet the needs of all CRNAs — state association leaders, chief CRNAs and administrators, practice owners and managers, facility leaders, and aspiring leaders. This educational event will include an afternoon of tracks focused on federal political directors, practice and facility leadership (including state reimbursement specialists), president-elect and government relations. Of course, as with all AANA activities, students are welcome and encouraged to join the learning.

View Details.
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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

Course Expiration Date Extended: AANA Journal Supplement: Improve Patient Safety! Recognizing and Preventing Residual Neuromuscular Blockade

The course expiration date for the AANA Journal Supplement, "Improve Patient Safety! Recognizing and Preventing Residual Neuromuscular Blockade (RNMB)," has been extended to January 30, 2020. Learn ways to maintain vigilance for RNMB in all patients through the use of subjective PNS monitoring of the ulnar nerve or objective monitoring to monitor NMB; the incorporation of NMB reversal agents according to the current evidence; and collaboration with other team members to promote safe, patient-centered care. Earn 1.0 Class A Credit. Supported by an education grant provided by Merck & Co., Inc.
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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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CRNA Jobs: Locum Tenens and Permanent Placement Opportunities Across the Country

United Anesthesia – Various Locations. United Anesthesia has been a leading CRNA and Anesthesiologist Locum Tenens and Permanent Placement firm in the country for 40 years. By specializing in only anesthesia placement, we can partner with you to find the ideal situation to suit your strengths, your priorities, your dreams. Your dedicated personal coordinator is looking forward to your call! Learn more.
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CRNA: Banner Health, Brush, Colorado

Banner Health, a Top 5 Large Health Network and one of the country’s premier nonprofit health systems, has a premium opportunity for an experienced CRNA to join us at Banner East Morgan County Hospital (BEMCH) in Brush, CO. Situated in the agriculturally rich South Platte River valley, Brush is home to 5,500 people and serves over 28,000, which includes the majority of Morgan County residents. The community thrives on its rural pace and charm and is revered for its “Homegrown Happiness!”

Details of this practice include:
  • CRNA-only practice model.
  • Responsible for performing general, regional, and monitored anesthesia services including Ultrasound-guided block, and OB.
  • 5 years experience preferred.
  • 4 weeks on, 2 weeks off.
BEMCH is a critical access facility providing a full array of healthcare services and features a Level IV Trauma Center, an attached physician's clinic, a visiting specialists' clinic and rehabilitation center offering a complete range of rehab services including warm-water therapy pool. BEMCH programs and services include: Occupational Medicine, General Surgery, Sports Medicine, Community Wellness Services, Sleep Studies and specialized Breast Disease services. Learn more.
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Full-Time CRNA: AMSURG Anesthesia, Santa Fe, New Mexico

Quality Of Life Position! Our AMSURG Santa Fe, NM, GI Center is seeking a team-centric and patient-focused Full-Time CRNA to contract directly with us starting ASAP. The center is open Monday-Friday, no nights, call, or weekends. This is a 1099 position at 230,000-240,000/yr. We do ask you carry malpractice insurance through an A-Rated Carrier.

We launched anesthesia in one room last year and are expanding to the second room.
  • No call, no nights, no weekends.
  • CRNA-only model.
  • EGD and colonoscopy cases.
  • AAACH accredited.
Learn more.
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Full-Time CRNA: AMSURG Anesthesia, Fresno, California

Quality Of Life Position! Our AMSURG Fresno, CA, GI Center is seeking a team-centric and patient-focused Full-Time CRNA to contract directly with us starting January 2020. The center is open Monday-Friday, no nights, call, or weekends. This is a 1099 position at $165/hr with an 8-hour guarantee. We do ask you carry malpractice insurance through an A-Rated Carrier. 

We launched anesthesia in one room last year and are expanding to the second room.
  • No call, no nights, no weekends.
  • CRNA-only model.
  • EGD and colonoscopy cases.
  • AAACH accredited.
Learn more.
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CRNA: Provident Practice Management, Memphis, Tennessee

Memphis, TN: Area’s largest and fastest growing medical and surgical practice seeking a full-time CRNA with excellent surgical and interpersonal skills.

Candidate should be Board certified and willing to work with current clinical staff to manage an already established significant surgical volume. Present practice consists of anterior segment, refractive, glaucoma, oculoplastics and retina subspecialties.

Our six locations in the Metro-Memphis area include a 45,000 sq.ft. main office with a fully equipped and spacious AAAHC-accredited ambulatory surgery center with four operating rooms. We have three more surgery centers, adjacent to other practice locations, to promote greater access to care for the rapidly increasing patient base in our area.

We have a strong patient base, a large referral community and outstanding growth potential. Work with world class physicians and staff as part of an exceptional team. Competitive salary with sign-on bonus and benefits. Four day work week with minimal on-call required. 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.

Cognition Unaffected When Preemies, Neonates Receive Anesthesia

University of Calgary researchers investigated the effect of anesthesia on preterm infants, whose immature stage of brain development may elevate their risk for neurocognitive defects. Led by Joanna Moser, MD, the team analyzed data for 304 very premature babies born between 2006 and 2012. They compared full-scale IQ (FSIQ) scores at age three for 182 children who were exposed to anesthetics, sedatives, and/or opioids in their first 44 weeks of life and for 122 children with no early exposure. After adjusting for confounding patient factors, FSIQ scores in the exposed group were about 2.7 points lower than those in the control group—a result that was considered to be neither statistically nor clinically relevant. Although the results do not definitively establish neurocognitive safety of the medications investigated, they do suggest that administering those anesthetics and sedatives to very premature infants early in life does not produce adverse cognitive outcomes at age three years. "As such, our present study does not support minimizing opioids in the setting of sedation, where pain relief is indicated, nor delaying required surgery for infants because of pharmacologic concerns," Moser concluded. The findings were presented at the 2019 annual meeting of the Canadian Anesthesiologists' Society.

From "Cognition Unaffected When Preemies, Neonates Receive Anesthesia"
Anesthesiology News (11/04/19) Vlessides, Michael

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Difficult Epidural Placement in Obese and Non-Obese Pregnant Women

Pregnant women who are obese are more likely to experience difficult epidural placement during delivery or epidural failure, report researchers in the Netherlands. The team conducted a systematic review and meta-analysis, using a dozen articles that compared these outcomes in patients with body mass index (BMI) of 30 kg/m2 and in those with higher BMI. The odds ratios for obese parturients versus non-obese parturients were 1.82 for epidural failure and 2.21 for multiple attempts at placement, according to the literature. The researchers, who also determined that risk grows with increasing BMI, recommend exploring ultrasound guidance for some expecting mothers with high BMI.

From "Difficult Epidural Placement in Obese and Non-Obese Pregnant Women"
International Journal of Obstetric Anesthesia (Fall 2019) Vol. 40, P. 52 Uyl, N.; de Jonge, E.; Uyl-de Groot, C.; et al.

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Superficial Cervical Block with Liposomal Bupivacaine Provides Effective Analgesia After Thyroid, Parathyroid Surgery

Findings from a retrospective study show that superficial cervical block with liposomal bupivacaine delivers effective pain relief and mitigates opioid demand following neck surgery. The review included 178 patients who received the block for thyroidectomy and/or parathyroidectomy between June 2017 and July 2018 and 83 patients who underwent the same procedure(s) during the same time span but without the block. While pain scores were comparable for all patients, those who did not receive a liposomal bupivacaine block required more frequent administration of intravenous analgesics. More than 70 percent needed opioids in the post-anesthesia care unit, whereas only 38 percent of block recipients required the same. Meanwhile, only 15 percent of the block patients received opioid prescriptions at discharge versus 83 percent of the no-block group. Block patients also were less likely to experience severe pain during their initial postoperative visit, at a rate of just 1 percent compared with just 9.6 percent of their counterparts who did not get the block. Researchers unveiled the study results at the American Thyroid Association's annual meeting.

From "Superficial Cervical Block with Liposomal Bupivacaine Provides Effective Analgesia After Thyroid, Parathyroid Surgery"
Endocrinology Advisor (11/01/19) Akirov, Amit

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Subarachnoid and Epidural Dexmedetomidine for the Prevention of Post-Anesthetic Shivering

A meta-analysis and systematic review conducted in China compared the anti-shivering effect of subarachnoid and epidural dexmedetomidine versus placebo in adult surgical patients. Researchers identified 22 studies with a collective 1,389 participants. The rate of post-anesthesia shivering was 10.3 percent among the dexmedetomidine recipients and nearly double that, at 20.1 percent, among the controls. Based on subgroup analysis, the greatest impact of dexmedetomidine was observed in non-Indian populations, in women undergoing cesarean section, and in patients who were administered the drug via the epidural route versus the subarachnoid route. With subarachnoid administration, meanwhile, the effect was dose-dependent, with better results generated at doses greater than 5 mcg. Subarachnoid and epidural dexmedetomidine reduced the time to block onset and prolonged block duration and analgesia, but its effect on hypotension and sedation remains to be seen. Additionally, the investigators noted that dexmedetomidine increased the incidence of bradycardia and, therefore, may not be the best option for patients with original bradycardia.

From "Subarachnoid and Epidural Dexmedetomidine for the Prevention of Post-Anesthetic Shivering"
Drug Design, Development and Therapy (11/01/19) Vol. 2019, No. 13, P. 3785 Li, Yi-Zheng; Jiang, Yi; Lin, Han; et al.

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Comparative Efficacy of Peripheral Nerve Block Techniques for Post-TKA Analgesia

Researchers were interested in opioid consumption following total knee arthroplasty (TKA) with femoral nerve block (FNB) versus TKA with adductor canal block (ACB). The sample population was made up of 85 patients who were randomly allocated to FNB or ACB for knee replacement taking place between June 2017 and July 2018. The main endpoint was total amount of patient-controlled analgesia (PCA), in the form of intravenous morphine, administered on postoperative day one. Researchers also specified several secondary outcomes—including postoperative pain and mobility metrics such as quadriceps muscle strength, degree of knee extension, and ability to sit up, stand, and walk. Evidence from the trial indicated that the FNB patients had significantly fewer morphine uses and perceived significantly less severe postoperative pain. Patients who received ACB, however, outperformed on many of the mobility parameters. "We believe that additional—particularly high-volume—studies are needed to facilitate a better understanding of the roles of ACB and FNB after [total knee arthroplasty]," said the investigators, who report their findings in Medicine.

From "Comparative Efficacy of Peripheral Nerve Block Techniques for Post-TKA Analgesia"
Clinical Pain Advisor (11/01/19)

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Effects of Continuous Ketamine Infusion on Hemodynamics and Mortality in Critically Ill Children

A study out of Samsung Medical Center in Seoul, South Korea, focused on the use of continuous ketamine infusions in critically ill children. The single-site investigation, which was retrospective by design, looked at hemodynamic and mortality outcomes in 240 pediatric intensive care unit (PICU) patients who used continuous sedation from 2015 to 2017. The review also included another 82 kids who used continuous ketamine over that same period. Researchers discovered that heart rates and respiratory rates decreased 12 hours after ketamine infusion, while blood pressure and vasogenic medications were unchanged. Continuous ketamine also was not a major risk factor for mortality. Based on the evidence, the investigators believe continuous ketamine could be used in the PICU without disrupting hemodynamic stability. More randomized controlled studies about the effects of continuous ketamine infusion on hemodynamic changes, sedation, and mortality are needed, they conclude.

From "Effects of Continuous Ketamine Infusion on Hemodynamics and Mortality in Critically Ill Children"
PLOS ONE (10/18/19) Park, Sojin; Choi, Ah Young; Park, Esther; 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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Park Ridge, IL 60068
Phone: (855) 526-2262 (toll-free)/(847) 692-7050
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Attn: Cathy Hodson
E–ssential Editor
November 7, 2019