Anesthesia E-ssential

AANA Anesthesia E-ssential
CRNA Week 2018

Vital Signs

AANA Board of Directors Approves New Guidelines for Obstetric Anesthesia

The new AANA Practice Guidelines, Analgesia and Anesthesia for the Obstetric Patient, provide guidance for anesthesia professionals to manage the analgesia and anesthesia care of obstetric patients during labor and delivery. Areas of focus include labor analgesia, multimodal pain management, enhanced recovery for cesarean section, crisis management, and many more. Visit the website to read the new guidelines.
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Hot Topics

2016 PQRS Feedback Reports and QRURs Informal Review Requests Deadline is Dec. 1

CRNAs and other eligible professionals may request an Informal Review of their 2016 Physician Quality Reporting System (PQRS) Feedback Reports and/or 2016 Annual Quality and Resource Use Reports (QRURs) if you believe that your payment adjustment status was made in error and have incorrectly been assessed a penalty. The 2016 PQRS Feedback Reports and 2016 Annual QRURs are now available through the Centers for Medicare & Medicaid Services (CMS) Enterprise Portal. CMS will accept a request for a 2016 PQRS informal review and/or a 2018 Value Modifier informal review until Dec. 1, 2017, at 8 p.m. Eastern time.  
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Nominations for AANA Elected Offices and Consent Forms from Nominees Due Dec. 1

Each state association may submit one nominee for president-elect, vice president, and treasurer. In addition, state associations may submit one nominee for a director for their region. In 2018, directors from Regions 2, 3, 6, and 7 are eligible for election. Finally, state associations may nominate one member from their region for the AANA Nominating Committee from Regions 2, 3, 6, and 7 to serve a two-year term and one member for the Resolutions Committee.
Members are also allowed to self-nominate or nominate another member as long as the nominee meets the qualifications for office found in the AANA Bylaws and Standing Rules.
For information regarding the electoral process, please visit the Election Center. (Member login and password required.)
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Call for Candidates: Delegate to Education Committee

The AANA Education Committee is seeking candidates interested in serving on the committee as a delegate. The deadline for receiving completed candidate packets is Jan.15, 2018. The election will be held, and the winner announced, at the Assembly of School Faculty meeting in February 2018.
The candidate information packet is available on the AANA website.
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Fresenius Kabi Issues Recall of Midazolam Injection, USP, 2 mg/2 mL

Fresenius Kabi USA is voluntarily recalling Lot 6400048 of Midazolam Injection, USP, 2 mg/2 mL packaged in a 2 mL prefilled single-use glass syringe. The product, mislabeled as Midazolam Injection, USP, 2 mg/2 mL, contains syringes containing and labeled as Ondansetron Injection, USP, 4 mg/2 mL. The affected Midazolam Injection, lot 6400048, expires July 2018. More information can be found in the recall notice.
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Professional Practice

Joint Commission to Implement New Hospital Pain Assessment and Management Standards

Effective Jan. 1, 2018, The Joint Commission will survey under its new and revised pain assessment and management standards. 
New requirements in the standards include:
  • Identify a leader or leadership team responsible for pain management and safe opioid prescribing
  • Involve patients in developing treatment plans and setting realistic expectations and measurable goals
  • Promote safe opioid use by identifying high-risk patients
  • Monitor high-risk patients
  • Facilitate clinician access to prescription drug monitoring databases
  • Engage in performance improvement activities focusing on pain assessment and management
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The Joint Commission Issues Updated and Expanded Emergency Management Standards

These requirements, which apply to hospitals, critical access hospitals, ambulatory surgery centers, and home health and hospice settings, comport with the Centers for Medicare & Medicaid Services (CMS) final rule on emergency preparedness and apply to facilities accredited under The Joint Commission’s Medicare deemed status programs. The standards, effective Nov. 15, are aimed at meeting the needs of patients and communities during emergency events and throughout recovery and will help organizations plan for disasters and other crises. The rules encompass coordinating with governmental emergency preparedness systems and leadership engagement. The requirements include:
  • Continuity of operations and succession plans
  • Documentation of collaboration with emergency management officials
  • Contact information on volunteers and tribal groups 
  • Annual training of all new/existing staff, contractors, and volunteers
  • Integrated healthcare systems
Read more about these expanded requirements.
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State Government Affairs

Illinois Extends Grandfathering Period for CRNAs Without Graduate Degrees

Illinois has extended the grandfathering period for currently practicing CRNAs who do not have graduate degrees from July 1, 2018, until July 1, 2023. (CRNAs without graduate degrees who are licensed by the deadline will continue to be grandfathered for license renewal in Illinois.) The extension of the grandfathering period is a result of legislation requested by the Illinois Association of Nurse Anesthetists.  
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Meetings and Workshops

Register Now for the Assembly of School Faculty
Feb. 15 - 17, 2018
The Scottsdale Resort at McCormick Ranch

Registration is now open for the only forum that brings all nurse anesthesia educational programs together in one place to discuss and define the future of the profession. If you are passionate about nurse anesthesia education, the Assembly of School Faculty is the must-attend meeting of the year. Find out more, and register now!
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Healthcare Headlines

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

Epidural Steroid Injection Outcomes and Prior Opioid Use

Prior opioid use could factor into how well epidural steroid injections work over time for patients with degenerative spine disease, a retrospective analysis has found. Investigators examined the relationship between pre-injection opioid use and post-injection outcomes in a sample population drawn from a longitudinal registry database. They started with nearly 400 participants undergoing epidural spinal injections, and 276 of them completed the study plus 12-month followup. The results indicated that pre-injection opioid use elevated the risk of disability, as well as arm or leg pain, three months after treatment. By the one-year mark, though, previous opioid use had no bearing on pain scores. Reporting in The Spine Journal, researchers also said that patients could consume up to 55.5 mg/day morphine equivalent before the efficacy of epidural injections might be reduced.

From "Epidural Steroid Injection Outcomes and Prior Opioid Use"
Clinical Pain Advisor (11/01/17) Martin, Jessica

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Extending Adductor Canal Block to 48 Hours Reduces Pain After Total Knee Arthroplasty

Research conducted at the University of Pennsylvania focused on the ideal amount of time that adductor canal blocks, which aid physical therapy and reduce falls after knee replacement, should last following surgery. Based on a randomized study of 160 patients, administering 48-hour blocks was more beneficial than infusions lasting half that time or single-shot injections. Study participants in the 48-hour treatment arm reported better pain control on the second postoperative day than did patients in the other two cohorts. Importantly, as reported at the 2017 annual spring meeting of the American Society of Regional Anesthesia and Pain Medicine, the milder pain scores were achieved without hindering physical therapy outcomes or delaying readiness for discharge.

From "Extending Adductor Canal Block to 48 Hours Reduces Pain After Total Knee Arthroplasty"
Anesthesiology News (11/01/17) Doyle, Chase

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Ice Cube Therapy May Dilute Pain From Local Anesthetic Injections

For patients receiving local anesthetic, the injection itself is often painful; but new research suggests relief may be just an ice cube away. The small Korean study included 50 adults who sought emergency care to treat simple lacerations. A total of 25 patients underwent cryotherapy, with ice applied to the affected area for two minutes prior to a lidocaine injection, while the other 25 did not. Half of the patients in the intervention group ranked their post-injection pain at 2 or below on a scale of 1 to 10. Half of the patients who received usual care, meanwhile, reported pain scores of 5 or above. The researchers concluded that ice cube therapy is a safe, readily available, and effective strategy for lowering perceived pain from local anesthetic injections without increasing wound complications. And unlike other alternatives—such as mixing local anesthetic with sodium bicarbonate, warming lidocaine to near body temperature, and applying eutectic mixture of local anesthetics (EMLA) cream—using ice for analgesia does not require modification of anesthetic administration, demand special equipment, or incur extra costs. The findings are published online in the Emergency Medicine Journal.

From "Ice Cube Therapy May Dilute Pain From Local Anesthetic Injections"
Reuters (11/01/17) Grover, Natalie

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Spinal Anesthesia for Spine Surgery May Improve Outcomes, Cost

Although spine surgery typically is performed under general anesthesia (GA), new research shows that using spinal anesthesia (SA) instead not only improves patient outcomes but saves money, too. The team from Montefiore Medical Center in New York performed a retrospective review of data for 188 patients who underwent lumbar laminectomy or discectomy at their institution between 2012 and 2016 under the care of the same surgeon. The 97 SA patients were in the operating room and post anesthesia care unit for a shorter duration than the 91 GA patients, and they also spent less time under anesthesia. Additionally, SA was associated with a reduction in postoperative pain and opioid requirements compared to GA. Net costs of care were nearly 10 percent lower for SA patients, at about $8,446 versus roughly $9,284 for the GA patients. Ultimately, researcher Matthew Morris said the decision on which technique to use hinges on the comfort level of the surgical team. "If you feel uncomfortable doing (SA), you shouldn't," he advised. "If you feel comfortable doing it, it is absolutely safe and effective and can save on hospital costs."

From "Spinal Anesthesia for Spine Surgery May Improve Outcomes, Cost"
Medscape (10/31/17) Ready, Tinker

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Would a Mother's Voice Help the Effects of Anesthesia in Children?

In South Korea, researchers are preparing for what will be the first randomized controlled trial to study the effect of a mother's voice as her child awakens from anesthesia. The hope is that emergence delirium—which is marked by confusion, hallucinations, and potentially harmful movement—can be reduced in pediatric patients by playing back a recording of their mother speaking during anesthesia recovery. The experiment builds on previous research demonstrating how a mother's voice can activate specific areas of her child's brain and trigger behavioral and neural responses. Through noise-canceling headphones, 33 children aged two to eight years old will hear their mother ask them to wake up, according to study protocol published in Trials. Another 33 children will listen to a similar recording with an unfamiliar voice. Investigators will assign scores to indicators like patient awareness and restlessness, which subsequently will be used in statistical analyses to determine if emergence delirium is significantly different in kids who hear their mom's voice while regaining consciousness after anesthesia compared with kids who hear a stranger's voice. If the hypothesis pans out, they will have identified a low-risk, low-cost strategy for improving patient safety among children and curbing their anxiety during medical procedures.

From "Would a Mother's Voice Help the Effects of Anesthesia in Children?"
Medical News Bulletin (10/27/17) Hall, Courtney

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Haloperidol Plus Conventional Tx Effective for Symptomatic Gastroparesis

Conventional therapy for gastroparesis in the emergency department (ED)—which typically consists of analgesics and antiemetics—works even better if haloperidol is added, new study results suggest. Colleagues at the University of Texas MD Anderson Cancer Center in Houston randomly assigned 33 adult ED patients with known gastroparesis to treatment with either usual care plus 5 mg of haloperidol or usual care plus placebo. They tracked the intensity of their abdominal pain and nausea before therapy and every 15 minutes afterward for one hour. After 60 minutes, researchers documented statistically significant reductions in pain and nausea scores for the 15 patients randomized to haloperidol but not for the 18 participants who received conventional therapy only. The findings, they say, point to a need for larger studies.

From "Haloperidol Plus Conventional Tx Effective for Symptomatic Gastroparesis"
Monthly Prescribing Reference (10/17) Han, Da Hee

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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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