AANA Anesthesia E-ssential
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Your Membership Matters: Renew Today!
Grace Period Expires October 31

Support your profession, your state and national associations, and fellow CRNAs around the country, and avoid an interruption in your member benefits. If you haven't already done so, renew your membership for fiscal year 2017 by Oct. 31, so you don't incur an administrative fee or miss out on your member benefits. It’s not too late!
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Hot Topics

Life Support Credit Limit

With the implementation of the National Board of Certification and Recertification for Nurse Anesthetists' (NBCRNA's) Continued Professional Certification (CPC) Program, the NBCRNA has instituted a limit of 20 credits for life support courses (any combination of Class A and Class B credits) per four-year CPC cycle, which includes both provider and instructor courses. In an effort to assist CRNAs keep track of their life support credits, the AANA is working to enhance the CPC transcript to include a breakout of life support credits. Email continuingeducation@aana.com with any questions.
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PANA Takes CRNA Message to NPR

The Pennsylvania Association of Nurse Anesthetists (PANA) has begun a radio campaign on National Public Radio (NPR) that will inform listeners about the role that Certified Registered Nurse Anesthetists (CRNAs) play in anesthesia care and America’s health system as a whole.

“As part of our continuing efforts to ensure that Pennsylvania residents understand the role and value of CRNAs in the delivery of anesthesia care, PANA is working with several NPR affiliates across the state to help spread the word,” said Matt McCoy, chairman of PANA's Communications Committee. “This is a great time for nurse anesthesia information to air on NPR due to it being a presidential election year, more listeners are tuning in for news.

A total of 340 radio spots will air beginning Saturday, Oct. 1, through early November on various radio stations throughout Pennsylvania. The stations are as follows:
  • WESA 90.5 FM in Pittsburgh
  • WITF 89.5 FM in Harrisburg
  • WHYY 90.9 FM in Philadelphia
  • WVIA 89.9 FM in Scranton/Wilkes-Barre
The timing of this campaign ties in with PANA’s Fall Symposium, which is being held Oct. 21-23 at the Omni Bedford Springs Resort and Spa. If you reside in one of Pennsylvania’s largest metropolitan markets, please tune in.
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Accreditation of New Post-Graduate CRNA Fellowships

The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is pleased to announce that accreditation has been awarded to two post-graduate CRNA fellowships.

Middle Tennessee School of Anesthesia and American Association of Nurse Anesthetists Acute Surgical Pain Management Fellowship, Madison, TN. Accreditation is effective Sept. 2, 2016, and has been awarded for a period of five years, through September 2021.

Omni Anesthesia Fellowship Program for Trauma and Critical Care Nurse Anesthesia, Fresno, CA. Accreditation is effective Sept. 2, 2016, and has been awarded for a period of five years, through September 2021.
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CRNA Volunteers Needed for Nurse Anesthesia Faculty in Liberia

Seed Global Health and the Global Health Service Partnership are seeking CRNAs to serve as visiting faculty and strengthen their existing nurse anesthesia training program. Applications close November 25, 2016 for July 2017 departure. More information, including benefits, can be found by contacting info@seedglobalhealth.org​.
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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 October 1, 2016, to January 31, 2017.) You'll find savings and plenty of 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 AHIX.com or call 888.624.5870.
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Nominations for 2017 AANA Elections Due December 1

Nominations for AANA elected offices and consent forms from nominees are due in the AANA office by Dec. 1, 2016.

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 from their region. In 2017, directors from Regions 1, 4, and 5 are eligible for election. Finally, state associations may nominate one member from their region for the AANA Nominating Committee 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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New Programs Seeking Accreditation to Be Reviewed in 2017

Capability review for accreditation of two proposed programs is in progress. The programs are listed below as a public notification for purposes of third-party notification.

Emory University Doctor of Nursing Practice Nurse Anesthesia Program. Atlanta, GA. Tentative date of onsite review: January 2017.

The University of Tulsa Nurse Anesthesia Program. Tulsa, OK. Tentative date of onsite review: Spring 2017.

Please direct all comments to the Executive Director, Council on Accreditation of Nurse Anesthesia Educational Programs (COA). Anyone interested in commenting should obtain the written procedures by contacting the COA at 222 S. Prospect Ave., Park Ridge, Illinois 60068. Third parties wishing to present an oral or written statement must notify the COA by March 1, 2017. The COA’s scheduled meeting where an accreditation decision will be made is May 2017.
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Open Sessions at COA Meetings

The business portion of Council on Accreditation of Nurse Anesthesia Educational Programs (COA) meeting is open to the public. The meetings are open to program representatives and others who are interested in observing the proceedings, however, the meeting will be closed to observers while the COA deliberates on accreditation decisions.

  • October 19-21
  • January 18-20
  • May 17-19
  • October 18-20
The meetings are held at the AANA Headquarters, 222 S. Prospect Avenue, Park Ridge, IL 60068. Please notify the COA of your proposed attendance. Call the COA office (847-655-1161) for further information, specific times, and directions.
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Meetings and Workshops

ASF Registration Now Open

Attention nurse anesthesia educators: Register now for the Assembly of School Faculty, Feb. 23-25, in Fort Lauderdale, Fla. The ASF is the only forum that brings all nurse anesthesia educational programs together to discuss and define the future of the profession.
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Registration Open Now for Fall Leadership Academy

Learn to lead at any level, in all practice settings, at the Fall Leadership Academy, Nov. 11-13, 2016, in Rosemont, Ill. Featuring more than 20 expert speakers and five educational tracks, Fall Leadership Academy is designed to expand your leadership skills as well as your network of colleagues.
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Foundation and Research

Research Grants Application Deadline - November 1

Research Grants for FY17 are due Nov. 1, 2016, and/or May 1, 2017. Applications are available at AANA Foundation. If you have any questions, please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com.
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AANA Foundation Kicks Off Rise Above Campaign

AANA Foundation Board Chair Wilma Gillis, BSN, CRNA, APNP, launched the public phase of the campaign to RISE Above at the AANA 2016 Nurse Anesthesia Annual Congress. She announced:

"We are kicking off a three-year RISE Above Campaign to create a pipeline to fund additional research. We WILL raise $1 million over 3 years... My vision is that...all CRNAs will hear of this opportunity and be driven to join us to RISE Above and support our wonderful profession... Please consider giving at least $1,000 over the next three years."

RISE Above campaign funds will be focused on major, large-scale research studies to validate and strengthen the nurse anesthesia profession and advance patient safety. Ultimately, the research will educate the spectrum of healthcare stakeholders about the value and quality that CRNAs bring to their patients. Without this research, proving the value of CRNAs is difficult.

To learn more and support the campaign, visit: crnasriseabove.org.
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AANA Foundation State Advocates Needed

The AANA Foundation is looking for State Advocates in 16 states. Click here to view the current list of State Advocates and the states with Advocate vacancies. To learn more about the program or volunteer, contact Luanne Irvin at lirvin@aana.com or (847) 655-1173.

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Visit www.crnacareers.com to view or place job postings
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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.

Waste Anesthetic Gases Survey Finds Gaps in Protection

Hospitals and outpatient surgical centers must do more to protect workers from exposure to waste anesthetic gases, finds a new study from the National Institute for Occupational Safety and Health (NIOSH). The conclusion is based on the 2011 NIOSH Health and Safety Practices Survey of Healthcare Workers, which was completed by nearly 3,000 anesthesia providers who had administered inhaled anesthetics the week before filling out the questionnaire. While the results reflected near-universal use of anesthesia machines fitted with scavenging systems, takeup of other recommended practices was uneven. The responses indicated that 18 percent of poll-takers were never trained to safely handle anesthetic gases; 5 percent did not consistently check anesthesia equipment for leaks; and 17 percent used open, rather than closed, systems to fill anesthesia vaporizers. Anesthesia providers also practiced different behaviors based on patient age. More than a third, for example, initiated anesthetic gas flow before a mask was applied to a child while 14 percent did the same for adults; and 17 percent used high-flow anesthesia only for pediatric patients while 6 percent did so only for adult charges. "Employers need to ensure that anesthesia care providers are initially and periodically trained; safe-handling procedures reflecting recommended practices are in place and support for their implementation is understood; anesthesia machines with scavenging systems are used; and medical surveillance, exposure monitoring, and other administrative controls are in place," NIOSH wrote in its report.

From "Waste Anesthetic Gases Survey Finds Gaps in Protection"
Occupational Health & Safety (10/12/16)

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Spinal Anesthesia Favored Anesthetic in Hip Fracture Repair

In the ongoing discussion about optimal anesthetic approach for hip fracture repair, a new analysis leans toward spinal anesthesia. Researchers led by Duke University associate anesthesiology professor Jeff Gadsden, MD, reviewed the anesthetic records of nearly 3,000 patients who had the surgery between 2005 and 2012. The primary outcome was hypotension—which is associated with a higher risk of morbid postoperative events in the elderly, who are prone to hip fracture. While the investigators had theorized that continuous spinal anesthesia would produce the lowest rates of hypotension, they were surprised to discover that single-injection spinal anesthesia had a comparable effect. Both, meanwhile, worked better than general anesthesia (GA) to avoid hypotension. The complication developed in just 71 percent of patients who received single-shot spinal anesthesia and only 74 percent of those who received continuous spinal anesthesia, compared to 86 percent of the surgical patients who underwent GA. Gadsden acknowledged the potential for selection bias but said a randomized controlled trial could help identify and address any flaws in study design.

From "Spinal Anesthesia Favored Anesthetic in Hip Fracture Repair"
Anesthesiology News (10/11/16) Vlessides, Michael

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Naldemine May Improve Opioid-Induced Constipation in Patients With Cancer

Researchers in Japan have demonstrated promising results using naldemedine to treat opioid-induced constipation (OIC) in cancer patients. The Phase III trial participants, who experienced five or fewer spontaneous bowel movements during a two-week qualification period, were randomized to receive the opioid receptor antagonist or placebo. Followup after two weeks revealed that naldemedine worked faster than placebo, taking less time to achieve the first spontaneous bowel movement after the first dose. Not only did the drug improve OIC within a short time frame, according to investigators, but it was well tolerated in the study population. Although diarrhea was a common side effect, most cases were mild in nature and all patients recovered. The findings were reported at the recent European Society for Medical Oncology 2016 Congress.

From "Naldemine May Improve Opioid-Induced Constipation in Patients With Cancer"
Oncology Nurse Advisor (10/11/16) Hoffman, Jason

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Methadone Provides Pain Relief for Kids With Sickle Cell

Combining methadone with standard opioid therapy can mitigate pain from sickle cell disease, new research suggests. The study, reported online in Pediatric Blood & Cancer, involved 24 children and 23 adults who were admitted to the hospital for severe pain tied to the condition. Half underwent usual care with morphine, while the remainder received a single, low dose of methadone; and all were able to control the amount of medication administered. The methadone patients rated their pain lower and better than those who did not receive the drug, which is commonly used to treat surgery and cancer pain as well as opioid addiction. The researchers noted that methadone works differently than morphine and remains in the system longer, which could explain its ability to better alleviate pain in kids with sickle cell disease. At the same time, the low dose given in the study may be the reason the benefit seen with children was not replicated in the adults. It also is possible that adults have built up tolerance to pain medications, making them less effective, the investigators surmised.

From "Methadone Provides Pain Relief for Kids With Sickle Cell"
Medical Xpress (10/10/16) Martin, Judy

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Similar Results at 2 Years Seen With Standard vs Subscapular-Sparing Shoulder Arthroplasty

Use of standard and subscapular-sparing techniques for shoulder surgery yielded similar results at followup two years later, according to a prospective investigation. The 107 study participants were randomized to one approach or the other; but researchers observed no statistically significant differences over time between the two groups—which experienced similar levels of pain, motion with flexion and external rotation, and postoperative complications. First author Young W. Kwon, MD, reported the findings at the recent American Shoulder and Elbow Surgeons Annual Meeting.

From "Similar Results at 2 Years Seen With Standard vs Subscapular-Sparing Shoulder Arthroplasty"
Healio (10/09/2016) Tingle, Casey

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Similar Change in Pain Scores Seen With Single vs Continuous Nerve Blocks for Extremity Fractures

Research demonstrates that single nerve block and continuous nerve block provide comparable pain control after surgery to repair distal radius or ankle fractures. The study compared postoperative pain scores and opioid consumption at 8, 12, 24, 48, and 72 hours in 90 patients who received either an infraclavicular block for distal radius fracture or popliteal-sciatic block for ankle fracture. Although pain scores and opioid demand were generally greater for the ankle group, investigators found no statistically meaningful difference between the two sets of patients in terms of change in pain scores over time or average number of pain pills taken. "[Regional] anesthesia works equally well in both upper and lower extremities postoperative fracture care in the form of either a continuous nerve infusion or single nerve block," summarized lead researcher Abhishek Ganta, MD, who presented the findings at the annual meeting of the Orthopaedic Trauma Association earlier this month.

From "Similar Change in Pain Scores Seen With Single vs Continuous Nerve Blocks for Extremity Fractures"
Healio (10/07/2016) Jaramillo, Monica

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Shoulder Surgery: Liposomal Bupivacaine Extends Analgesia for Brachial Plexus Blocks

Patients having shoulder surgery typically undergo multimodal analgesia that includes a single-injection interscalene brachial plexus block. However, because analgesia is limited to 12 to 14 hours with the single shot, more extensive operations may require a catheter—which takes skill to insert and, even so, may become dislocated. As another alternative, researchers in Belgium explored using liposomal bupivacaine to prolong anesthesia without catheters. They randomized 50 patients to receive either interscalene brachial plexus block with 15 mL of bupivacaine or a combination of bupivacaine and liposomal bupivacaine. "We found that the addition of liposomal bupivacaine resulted in lower pain thresholds up to seven days postoperatively," said lead investigator Catherine Vandepitte, MD, adding that additional study is warranted. The research was presented at the 2016 Networking World Anesthesia Convention.

From "Shoulder Surgery: Liposomal Bupivacaine Extends Analgesia for Brachial Plexus Blocks"
Anesthesiology News (10/06/16)

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Antihypertensive Class Linked to Reduced Joint Pain, Opioid Use in Osteoarthritis

U.K. researchers have demonstrated pain-related benefits for arthritic patients who take beta-blockers. The team from the University of Nottingham used data from the GOAL study to compare extent of large-joint pain in patients taking beta-adrenergic blockers versus those taking other antihypertensive agents. The analysis included 873 patients with symptomatic hip and/or knee osteoarthritis who were taking at least one prescription medication. A correlation was drawn between use of beta-adrenergic blockers and lower pain scores, a relationship that was not documented with the use of alpha blockers or any other class of antihypertensive drug. Beta blockers also translated to a drop in opioid consumption and analgesic use in general. The results are published in Arthritis Care & Research.

From "Antihypertensive Class Linked to Reduced Joint Pain, Opioid Use in Osteoarthritis"
Monthly Prescribing Reference (10/16) Han, Da Hee

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Abuse-Deterrent Hydrocodone ER Safe, Effective in Back Pain

New trial data on the safety and efficacy of abuse-deterrent hydrocodone extended-release (ER) was disclosed at the 2016 annual meeting of the Academy of Integrative Pain Management, formerly known as the American Academy of Pain Management. After Phase III randomized testing demonstrated that the new formulation outperformed placebo in soothing chronic low back pain, the study was extended study for another six months. The additional research effort involved a share of the original study participants; those who initially had been assigned to take hydrocodone ER remained on the same analgesic dose unless adjustments were needed, while those previously taking placebo were titrated to an analgesic dose. The extension study, ultimately completed by 136 participants, determined that most patients maintained analgesic benefit, with just 4 percent of them raising the dosage. The extra research also enhanced the safety profile of hydrocodone ER, showing that common adverse events like constipation and nausea were mild to moderate in severity. Additionally, the researchers found that the rate of drug diversion associated with the new formulation was a low 3 percent.

From "Abuse-Deterrent Hydrocodone ER Safe, Effective in Back Pain"
Medscape (10/04/16) Anderson, Pauline

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Massage Therapy May Be Beneficial for Surgical Pain

According to a systematic review and meta-analysis of 16 published randomized controlled trials, massage therapy tops other active treatments in calming the pain and anxiety of patients just before surgery or during recovery. Most of the research centered on the effect of massage on pain, sleep, stress, mood, and health-based quality-of-life outcomes compared to control techniques like usual care, standard analgesia, relaxation, rest, and no treatment. "The promising results warrant the investment of both time and resources into addressing recommendations offered in this report to guide future research and ultimately offer massage therapy as a beneficial tool for surgical patients experiencing pain," the study authors, hailing from the Alexandria, Va.-based Samueli Institute, wrote in Pain Medicine. They noted that tougher reporting requirements are warranted, as are niche-specific guidelines ensuring that dosing, timing, massage pressure, and provider qualifications and credentialing are appropriate for surgical patients in the hospital setting.

From "Massage Therapy May Be Beneficial for Surgical Pain"
Clinical Advisor (10/03/2016) Stong, Colby

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How Does Anesthetic Affect Spinal Lumbar Fusion Urinary Retention?

Surgical anesthesia can influence postoperative urinary retention (POUR) following single-level lumbar fusion, researchers have determined. Among 205 patients examined for POUR after undergoing such a procedure between 2009 and 2013, 17 percent experienced the complication. POUR affected patients who received phenylephrine and neostigmine, particularly at higher doses. "This finding suggests that there may be modifiable anesthetic risk factors to prevent the development of POUR in patients undergoing lumbar spine surgery," the investigators reported in Spine. Additional studies, they suggested, could enhance care and reduce health care costs.

From "How Does Anesthetic Affect Spinal Lumbar Fusion Urinary Retention?"
Becker's Spine Review (09/29/16) Dyrda, Laura

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100 Million Prescription Opioids Go Unused Each Year Following Wisdom Teeth Removal, Study Estimates

New research from the University of Pennsylvania addresses the prescription drugs that are left over after surgical tooth extraction. According to the report, more than one-half of the opioids prescribed to patients following the dental procedure were left unused. "Results of our study show within five days of surgery, most patients are experiencing relatively little pain, and yet, most still had well over half of their opioid prescription left," said Elliot V. Hersh, DMD, MS, PhD, a professor in the department of Oral & Maxillofacial Surgery and Pharmacology at Penn Dental Medicine, and a co-author on the study. "Research shows that prescription-strength NSAIDs, like ibuprofen, combined with acetaminophen, can offer more effective pain relief and fewer adverse effects than opioid-containing medications." Lead author Brandon C. Maughan, MD, an emergency physician and health services researcher at The Lewin Group, who conducted the study while serving as a Robert Wood Johnson Foundation Clinical Scholar at the Perelman School of Medicine at the University of Pennsylvania, added that "when translated to the broad U.S. population, our findings suggest that more than 100 million opioid pills prescribed to patients following surgical removal of impacted wisdom teeth are not used, leaving the door open for possible abuse or misuse by patients, or their friends or family." The research, published in Drug and Alcohol Dependence, suggests that having prescription disposal kiosks in pharmacies as well as small financial incentives could increase correct disposal of opioids by more than 20 percent.

From "100 Million Prescription Opioids Go Unused Each Year Following Wisdom Teeth Removal, Study Estimates"
Science Daily (09/22/2016)

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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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October 14, 2016
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