Anesthesia E-ssential

AANA Anesthesia E-ssential, October 18, 2018

Vital Signs

Johnson & Johnson Launches Nurses Innovate QuickFire Challenge

To help inspire nurses to showcase their innovative ideas, Johnson & Johnson Nursing has announced the Nurses Innovate QuickFire Challenge. This initiative supports nurse innovators who have ideas that can profoundly change lives.

Between October 1, 2018, and February 1, 2019, Johnson & Johnson is inviting practicing and retired nurses around the U.S. to submit ideas for new devices, health technologies, protocols or treatment approaches that have the power to profoundly affect patient care and improve health. The innovators with the best ideas will receive up to $100,000 in grants and access to mentoring and coaching from Johnson & Johnson, via JLABS.

Solutions will be evaluated by a panel of reviewers and judges on their ability to meet the following criteria:
  • Uniqueness of the idea
  • Potential impact on human health
  • Feasibility of the idea
  • Thoroughness of approach
  • Identification of key resources and plan to further idea
Johnson & Johnson is working with Maria Menounos to build awareness of this initiative, and the tremendous value that nurses bring to changing patient health.

Learn more.
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Integrating a Nurse Practitioner ERAS Coordinator

The latest story from the Enhanced Recovery Shared-Interest Group (SIG) details the role of Kelsey Terrones, CRNP, a nurse practitioner, working as the enhanced recovery coordinator at the Greater Baltimore Medical Center. Her key responsibilities include providing education pre-operatively, rounding on patients post-operatively, collecting data pertaining to adherence and evaluating patient outcomes. Learn more.
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Nominations for 2018 AANA Elections Due Dec. 1

Nominations for AANA elected offices and consent forms from nominees are due in the AANA office by Dec. 1, 2018.

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 2019, 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 from Regions 1, 4 and 5 to serve a two-year term, and one member for the Resolutions Committee.

Members also are 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. (Member login required.)

For information regarding the electoral process, please visit (Member login required.)
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2019 National CRNA Week Items Available Nov. 1

Mark your calendar! If the presale at the AANA 2018 Annual Congress is any indication, these hot items will go quickly. Don't miss your chance to order posters, men's and women's performance shirts, ball caps, travel mugs, pens, buttons, and coffee mugs. Share your professional pride and promote the nurse anesthesia profession. Promotional items are available online beginning November 1.

National CRNA Week will be held January 20-26, 2019.

Want event and promotional ideas? Take a look at some of the many ways our members have put CRNAs in the spotlight during National CRNA Week.

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Hot Topics

Answers to Your Frequently Asked Malpractice Insurance Questions

Whether you have a question regarding your current coverage or would like to learn more about the coverage options AANA Insurance Services offers, our Insurance FAQs page (Member login required) has you covered.

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Physician Compare Preview and Public Reporting Webcast – Oct. 30, 2018

CMS will present a webcast on Oct. 30, 2018, about the 2017 Quality Payment Program (QPP) performance information that will be published on Physician Compare. Providers will have a 30-day period to review the information on their public profile before it is published for consumers. Register for the event through the Medicare Learning Network.
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MIPS Eligibility Status at TIN Level-QPP Participation Status Tool Available

Providers in group practices can now check Merit-based Incentive Payment System (MIPS) eligibility for all the clinicians in their practices. The Quality Payment Program (QPP) website displays information on the eligibility status of every clinician associated with the Taxpayer Identification Number (TIN) by their National Provider Identifier (NPI). To access the eligibility status of each clinician associated with the TIN, you will need to log into the CMS Quality Payment Program website with your Enterprise Identity Data Management (EIDM) credentials. See Participating in the Quality Payment Program – Year 2 for more information.
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Data submission schedule for CY2018 MIPS Performance Data

The Merit-based Incentive Payment System (MIPS) data submission period for CY2018 data begins on January 2, 2019 and ends April 2, 2019. Providers who report via claims and the CMS Web Interface can submit data from January 22, 2019 until March 22. 2019. See the How to Submit 2018 Data guide for more details.
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AANA Seeks to Record CRNA Service in Vietnam

For most veterans of the Vietnam War who returned home alive to the United States, life would never be the same. They had seen the atrocities of war, had lost comrades and friends, and in some cases, had been on the receiving end of jeers, spitting and violence as they returned home. For some, there was great psychological turmoil to reconcile. For others, physical wounds required care and healing. And still others were fortunate to escape the ravages of war's mental, emotional or physical aftermath.

The American Association of Nurse Anesthetists (AANA) seeks to record the histories of our Certified Registered Nurse Anesthetists (CRNAs) who served in Vietnam. AANA hopes to share these experiences with our membership, legislators and the general public as a means of enlightening, healing, and reaching back into history so that the many accomplishments and sacrifices of CRNAs, soldiers, brothers, sisters, friends and loved ones, are not forgotten. See submission guidelines:
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CRNA - Full time: Mercy Health Defiance Hospital

Mercy Health Defiance Hospital is looking for an exceptional CRNA to join the team. Why choose Mercy Health? We know that the expert, compassionate care patients receive starts with you, and we want you to feel your efforts are valued and supported with professional and personal growth. Learn more.
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Hospital-employed CRNA Opportunity: Carle Physician Group

Carle Physician Group is seeking an additional CRNA to join our team of 50 CRNAs at our main campus in Urbana, Illinois. Learn more.
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Northshore CRNA: Zephyr

Looking for a part-time / PRN CRNA for an office-based anesthesia position at a Northshore facility. Learn more
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CRNA (Nurse Anesthetist): OhioHealth

The certified registered nurse anesthetist (CRNA) works under the supervision of a physician anesthesiologist who is a member of the Medical Staff with privileges to provide anesthesia services. Except for emergencies, all anesthetic delivered is done so under the supervision of the attending anesthesiologist. Learn more.
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Check out the new AANA Career Center, CRNA Careers! Whether you’re a seasoned CRNA or just getting started, the new Career Center can connect you to the best opportunities.

Plus, there are robust search tools to help narrow your search, as well as tips for resume writing and salary negotiating. Add your resume and know that you can remain anonymous if you choose. Take advantage today!

Visit 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.

77 Percent of Surgical Patients Expect Opioids, Survey Finds

Media focus on the opioid crisis has not diminished the desire and expectation for postoperative painkillers, according to a patient survey conducted at Thomas Jefferson University Hospital in Philadelphia. The responses were culled from 503 adults planning to have joint replacement; back or abdominal surgery; or ear, nose, and throat operations—all of whom said they expected to receive some type of pain medication after their procedure. Respectively, 37 percent and 18 percent of the survey-takers figured they would receive acetaminophen or a nonsteroidal anti-inflammatory drug. More than three-quarters of poll participants, however, believed they would be treated postoperatively with opioids, which were overwhelmingly perceived to be the optimal pain management approach after surgery—even by those who did not expect to receive them. Despite patients' expectations, research indicates that "opioids aren't necessarily more effective," Thomas Jefferson anesthesia resident Nirmal Shah, DO, said in a press release. "Clearly, we need to provide more education to bridge that gap and help patients understand that there are many options for pain relief after surgery, including other pain medications such as acetaminophen and ibuprofen."

From "77 Percent of Surgical Patients Expect Opioids, Survey Finds"
Becker's Hospital Review (10/16/18) Cook, Harrison

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Both Midazolam and Music Effective as Pre–Nerve Block Anxiolytics

Both midazolam and music are effective means of curbing anxiety in patients who receive single-shot peripheral nerve blocks ahead of ambulatory surgery, according to preliminary research findings. About 100 participants in the University of Pennsylvania study were randomized to listen to specific instrumental music selections through noise-canceling headphones or to receive intravenous midazolam. Investigators subsequently compared differences in preoperative anxiety scores between the two groups. Based on the State-Trait Anxiety Inventory tool, patients in the music group scored 3.3 while patients in the midazolam group scored 3.1. Although the nonpharmaocologic approach worked as well as the pharmacological strategy, the investigators noted that patients given midazolam had better communication with the attending physician and were more satisfied with the overall experience than the patients in the music group.

From "Both Midazolam and Music Effective as Pre–Nerve Block Anxiolytics"
Anesthesiology News (10/14/18) Vlessides, Michael

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Does Perioperative Intravenous Dextrose Reduce Postoperative Nausea and Vomiting?

Researchers performed a systematic review and meta-analysis in hopes of better understanding whether perioperative dextrose-containing fluid avoids postoperative nausea and vomiting (PONV), which is often triggered by general anesthesia. The team from South Korea examined data from seven randomized controlled trials comparing the effect of dextrose-containing fluid vs. non-dextrose-containing fluid on PONV following surgery under general anesthesia. The evidence did not suggest any overall benefit from intravenous administration of dextrose-containing fluid as it pertained to PONV risk in the first 24 postoperative hours, except in the case of patients having laparoscopic cholecystectomy. However, dextrose-containing fluid did appear to curtail the need for antiemetics during that same time frame.

From "Does Perioperative Intravenous Dextrose Reduce Postoperative Nausea and Vomiting?"
Therapeutics and Clinical Risk Management (10/15/18) Vol. 2018, No. 14, P. 2003 Kim, Seung Hyun; Kim, Do-Hyeong; Kim, Eungjin; et al.

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Dorsal Root Ganglion Neurostimulation May Aid Patients with Chronic Back Pain

Dorsal root ganglion (DRG) neurostimulation therapy delivers effective pain relief and improves function in patients with chronic lower extremity and back pain, researchers report. Based out of Chicago's Rush University Medical Center, the team tracked outcomes over 1 to 18 months in 67 patients who received a permanent DRG stimulator implant. On a scale of 1 to 10, pain scores fell to 5 at the end of their longest follow-up periods from 8 at baseline; while Oswestry Disability Index levels came down to 23 percent at follow-up from 33 percent at the start of the study. Additionally, there was a meaningful 70 percent shift in patient global impression of change. "People in our study who had DRG stimulation reported significant improvement in pain even after a year, which is notable," said lead author Robert McCarthy, PharmD. "For most, DRG stimulation improved their quality of life."

From "Dorsal Root Ganglion Neurostimulation May Aid Patients with Chronic Back Pain"
Healio (10/15/2018)

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FDA Panel Delivers Mixed Views for Two New Opioids

Two new opioid drug candidates went before a Food and Drug Administration committee last week, with one getting a nod from the panel and the other falling just shy of approval. The Anesthetic and Analgesic Drug Products Advisory Committee declined to recommend oliceridine, an opioid injection for management of moderate to severe acute pain in adult patients. The first in a new class of µ-opioid receptor ligands that selectively activate the G-protein pathway, which is associated with pain relief, the novel agent aims to provide analgesia just as fast as morphine but with accelerated onset, reduced respiratory depression, less sedation, and fewer gastrointestinal effects. However, committee chair Raeford Brown Jr., MD, of the University of Kentucky, Lexington, said that study results were disappointing. "The problem with this drug is that it's not a substantial improvement over what we have now," he said. While committee members voted down oliceridine, they did favor a sufentanil tablet designed for rapid pain relief. The synthetic opioid, which is as much as 10 times more potent than fentanyl, is already available for I.V. and epidural anesthesia and analgesia under the care of an anesthesia provider; but the new sublingual preparation was envisioned as an option for people who cannot swallow oral medications and/or lack access to I.V. opioids. If approved, it will be the first sufentanil analgesic for sublingual use—although it still will be not be available in the home or retail pharmacy settings. Despite winning over the committee, the drug is not without its critics—including Brown, who argues that sufentanil should be reserved for use in the operating room, "where there are airway management experts available."

From "FDA Panel Delivers Mixed Views for Two New Opioids"
Medscape (10/15/18) Anderson, Pauline

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Study: Only 59 Percent of Young Adults Undergoing Surgery Are Fluid Responsive

A small study of young adult surgical patients has shown that more than 40 percent were not fluid responsive before and after anesthesia induction. Researchers led by Andrew Stasic, MD, of Indiana University, documented cardiac output, stroke volume (SV), and fluid volume responsiveness at both intervals. The patients, all between the ages of 18 and 30 years, were considered fluid responsive if a passive leg raise increased SV by more than 10 percent. Prior to induction, the investigators found, only 13 of the 22 study participants achieved this target; and the return to a steady-state level of anesthesia ahead of the surgery did not change that. The remaining patients were not fluid responsive or were non-preload dependent and, therefore, potentially at greater risk for fluid mismanagement and ensuing complications.

From "Study: Only 59 Percent of Young Adults Undergoing Surgery Are Fluid Responsive" (10/16/2018)

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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.

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Attn: Cathy Hodson
E–ssential Editor
October 18, 2018
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