Anesthesia E-ssential

AANA Anesthesia E-ssential, October 24, 2019

Vital Signs

AANA FY2020 Nominating Committee Vacancies Resolved

We are pleased to report that the following members have agreed to fill the vacancies for Regions 3 and 6 on the FY2020 Nominating Committee:
  • Region 3 – Margaret Ohryn, MBA, MS, CRNA (Mich.)
  • Region 6 – Michelle Hayes Duell, DNP, MSN, CRNA (Md.)
LTC Peter Strube, DNAP, CRNA, MSNA, AP (Region 3) and Jeffrey Molter, MBA, MSN, CRNA (Region 6) have both resigned from the FY2020 Nominating Committee, effective September of this year. Per the AANA Bylaws, it is the duty of the current Nominating Committee to elect a member from each of the vacant regions to resolve the vacancies.

Ms. Ohryn and Dr. Hayes Duell will serve for the remainder of the two-year term through August 2020. Please join us in congratulating them as well as thanking them for their service to the AANA and its members.
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Hot Topics

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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Employers – When You Get Compensation Right, You Attract and Retain the Best CRNA Talent

How are your benefits and compensation packages stacking up against other programs and facilities? With the official 2019 Compensation and Benefits Report, review salary and benefit trends across the U.S., so you can remain competitive and compensate your staff fairly:
  • Review compensation by location, years in practice, and employment status.
  • Compare benefits by region and employment arrangements.
  • Evaluate time-off and retirement benefits.
  • And more!
AANA members receive 50% off! Order your copy of the report today!
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NewsMaker: CRNA Wallena Gould to Serve on AAN Diversity and Inclusivity Committee

Wallena Gould, EdD, CRNA, FAAN, has accepted a position on the American Academy of Nursing's (AAN) Diversity and Inclusivity Committee. The purpose of this committee is to recommend strategies and goals for increasing diversity and inclusivity within the Academy and its leadership bodies. Members of the committee serve a two-year term with the opportunity to be reappointed by the board of directors for one additional term.

Dr. Gould is a pioneer in the diversity and inclusion efforts for nurse anesthesia, and has long championed diverse student registered nurse anesthetists in their journey toward a career in nurse anesthesia.
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Vietnam Voices: Robert C. Engel

"The weather was noticeably hotter and more humid than I was used to, and there was a huge black market in electric fans. Once the monsoons started, it rained (poured) all day, every day, for months. We had rigged electricity into our metal lockers and kept a light bulb burning 24/7 to keep the mold down," writes Robert C. Engel, MBA, CRNA, about his experiences as a nurse anesthetist in Vietnam. Read more
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Meetings and Workshops

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

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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New Benefits Kick Off AHIX Open Enrollment

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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Certified Registered Nurse Anesthetist: Lehigh Valley Health Network, Allentown, Pennsylvania

The Lehigh Valley Health Network is looking for a CRNA who can:
  • Evaluate the patient's medical and surgical history and physiologic status.
  • Can develop an anesthesia plan of care.
  • Can provide all types of general anesthesia, monitored anesthesia care and regional anesthesia techniques, including epidural analgesia for labor.
  • Can provide all types of anesthesia for patients ranging from neonate to elderly adult and for all ASA classifications and emergencies.
The right candidate must have graduated from an accredited school of nurse anesthesia, hold certification by the NBCRNA, hold a master's degree in nursing or nurse anesthesia, and a doctorate in nursing practice (DNP) or a doctorate of nurse anesthesia practice (DNAP). New graduates are encouraged to apply. $20K sign-on bonus. Learn more.
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Certified Registered Nurse Anesthetist: Merritt Hawkins, Cincinnati, Ohio

The largest independent anesthesia group in the Cincinnati region—with more than 140,000 cases per year in all specialties—is seeking a qualified CRNA to join its team.
  • Benefit from competitive compensation—base salary plus bonus potential.
  • Opportunity with an autonomous practice with anesthesiologist supervision—rotating call and no call.
  • Enjoy a flexible schedule and the option to choose from 4 Major Hospital locations with 20+ ancillary facilities in the greater Cincinnati area.
  • Receive a generous 10% profit-sharing retirement contribution.
With 8 Fortune 500 companies and a metro population of more than 2 million, Cincinnati, Ohio, is filled with tremendous opportunities for families and individuals alike. Whether you are seeking urban downtown living or a more suburban family-friendly community, our city accommodates all lifestyle desires. Learn more.
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Simulation Coordinator-DNP Advisor: Fairfield University & Bridgeport Hospital, Bridgeport/Fairfield, Connecticut

The Fairfield University & Bridgeport Hospital Nurse Anesthesia Program, located in Fairfield, Connecticut, is seeking a doctorally prepared, innovative leader to serve as the program’s Simulation Coordinator/DNP Advisor with a rank of Assistant Professor within the Fairfield University Egan School of Nursing & Health Studies. The Simulation Coordinator works with the program director and assistant program director to plan, implement and evaluate the program’s simulation curriculum and serves an active role in programmatic change. In addition, he/she will serve as advisor for the development, implementation, evaluation and dissemination of doctoral projects. Learn more.
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Certified Registered Nurse Anesthetist: North Mississippi Medical Center, Tupelo, Mississippi

  • Performs and documents a pre-admission assessment and evaluation.
  • Request consultations and diagnosis testing.
  • Develops and implements a plan of care.
  • Selects, orders, and administers anesthesia based on procedure.
  • Determines anesthetic technique to be used: general, local, intravenous sedation, etc.
  • Monitors patient during the procedure and recovery process for any adverse effects.
  • Document medical conditions to be aware of for anesthesia.
  • Update patient documentation regarding anesthesia accurately and timely.
  • Obtains informed consent for anesthesia.
  • Provides post-anesthesia follow-up evaluation and care related to anesthesia side effects or complications. Learn more.
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Associate Director: TCU/School of Nurse Anesthesia, Ft. Worth, Texas

Texas Christian University, Harris College of Nursing and Health Sciences, seeks an Associate Director of the School of Nurse Anesthesia (professional practice faculty, assistant/associate professor). The associate director assists the director of the school of nurse anesthesia with oversight of the daily operations of the school.

EXTRAORDINARY OPPORTUNITY – The associate director will collaborate with the director to:
  • Lead a team of expert and dynamic faculty into a new era at a fiscally strong university that is moving forward under a dynamic strategic plan.
  • Lead a highly ranked program (Top 30 by US News and World Report).
  • Lead a pain management program of national distinction (as awarded by AANA).
  • Engage with affiliations with major hospitals in the region and across the country.
  • Actively engage with the newly accredited TCU and UNTHSC School of Medicine for innovative collaborations and learning experiences.
  • Have a vast opportunity for growth and success as an academic leader.
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.

One in Three Pain Patients Suffer Side Effects After Ketamine Infusion Therapy

U.S. pain patients increasingly are turning to ketamine infusions as an alternative to opioid therapy, but new evidence suggests a strong correlation between this treatment path and adverse events. According to the Duke University study, more than a third of the patients who use the potent anesthetic to alleviate acute and chronic pain or depression may experience hallucinations, visual disturbances, or sedation, among other side effects. The researchers examined data for nearly 300 patients who received ketamine infusion therapy as a pain intervention during the first half of 2017. About 35 percent reported significant side effects, with about 20 percent of the cases tied directly to ketamine and about 15 percent linked to the use of ketamine as part of combination therapy. "Although the opioid epidemic has prompted the medical community to thoroughly investigate pain management alternatives, our number one priority is to ensure the safety of patients receiving ketamine," said lead study author Padma Gulur, MD. "More than one in three patients reported significant side effects from ketamine infusions that required ongoing monitoring or resulted in discontinuation of therapy. More research on the impact of ketamine use for pain on the population is needed."

From "One in Three Pain Patients Suffer Side Effects After Ketamine Infusion Therapy"
Medical Xpress (10/21/19)

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Anesthetic Depth and Complications After Major Surgery

Researchers explored the potential association between anesthetic depth and postoperative survival in patients aged 60 years and up. The study population included 6,644 older adults from seven countries, all of whom were at increased risk of complications after major surgery. A total of 3,316 enrollees were randomized to light general anesthesia, with the remaining 3,328 assigned to deep general anesthesia. The main outcome was death for any reason after one year. The all-cause mortality rate at that interval was 6.5 percent in the light sedation recipients and 7.2 percent in the deep sedation recipients, or 212 versus 238 patients. In addition, the findings indicated that mean arterial pressure was higher and volatile anesthetic use was lower in the light sedation group compared with the deep sedation group. The evidence suggests that light general anesthesia does not significantly curtail one-year all-cause mortality after major surgery, nor are grade 3 and 4 adverse events any more frequent with one technique than the other. Rather, the researchers concluded, anesthesia can be safely administered across a wide range of anesthetic depth when titrating volatile anesthetic concentrations using a processed electroencephalographic monitor.

From "Anesthetic Depth and Complications After Major Surgery"
The Lancet (10/20/19) Short, Timothy G.; Campbell, Douglas; Frampton, Christopher; et al.

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Laughing Gas Helpful for Labor Pain, But Epidural Still Top Choice

Study results show that women who use nitrous oxide to manage their labor pain are very satisfied with the technique; however, most eventually ask for an epidural or other relief. Researchers reviewed the medical records of 1,958 women who received the inhaled anesthetic, known as laughing gas, to alleviate labor pain between March 2016 and March 2018. The data demonstrated no harm from nitrous oxide to the newborns, based on their Apgar scores. Moreover, maternal satisfaction with laughing gas rated a mean reading of 7.4 on a scale of 0 to 10. Despite the high level of satisfaction, 68.9 percent of patients who initially opted for it ultimately switched to epidural or another pain management option. "Nitrous oxide is easy for patients to use, relatively inexpensive, and will attract more patients looking for a birthing center, or more homelike type of delivery experience," notes study co-lead Barbara Orlando, MD, of the Icahn School of Medicine at Mount Sinai in New York. "The high patient satisfaction rate and safety profile that we found should motivate other institutions nationwide to offer nitrous oxide as a pain management option to women in labor."

From "Laughing Gas Helpful for Labor Pain, But Epidural Still Top Choice"
Science Codex (10/20/19)

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Colorectal Surgery Patients in ERAS® Program Report Less Pain, Use Fewer Opioids

A reduction in pain and lower opioid consumption are key benefits for colorectal surgery patients who receive enhanced recovery after surgery (ERAS®), a care protocol that aims to quicken the comeback process after an operation. The finding comes from a single-site study that compared outcomes in 66 patients and 181 patients who underwent the procedure before and after, respectively, an ERAS program was put in place. Pain scores immediately after surgery were lower for the ERAS patients, at an average of 5.12 on a scale of 0 to 10 compared with an average of 6.45 for the controls. Patients with ERAS exposure achieved the lower pain scores despite using significantly fewer opioids during the operation, immediately afterwards, and three days later. That was largely because ERAS patients were more likely to receive alternatives, including ketorolac, acetaminophen, gabapentin, and ketamine. It also was because preoperative education helped to prepare them for what to expect, including some pain, after surgery. "Through ERAS, patients are educated regarding the appropriate level of pain to anticipate after surgery and are more willing to accept that some form of postoperative pain is normal and to be expected," explained lead study author Bradley Larson, MD. "Therefore, they are less likely to request additional medication to attempt to fully alleviate their pain, which leads to decreased opioid consumption."

From "Colorectal Surgery Patients in ERAS® Program Report Less Pain, Use Fewer Opioids"
News-Medical (10/20/19)

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Wrong-Side Nerve Blocks and the Use of Checklists

The medical field has embraced the use of checklists as a simple and low-cost approach to avoiding human errors and improving patient safety. Even so, wrong-site surgeries (WSSs)—which, theoretically, are 100 percent preventable and should never occur—persist. This is especially true for wrong-site nerve blocks (WSNBs), the risk for which is elevated by factors such as time pressure or failure to mark or check the site, patient sedation or confusion, and siting the block after anesthesia has been induced. Although no formal checklist has been assembled specifically for regional anesthesia to date, WSS checklists have not have the desired effect. The problem is partially due to differences in checklist implementation at the point of care. Clinicians at one institution, for example, might use a marker to write "yes" on the proper surgical site, for example, while others might write "no" or "wrong side" on the opposing side. In addition to variability, WSNB checklists have a reputation for being difficult to implement and enforce at the point of care. A common theme with WSNBs, for instance, is that a distraction or interruption may temporarily take the anesthesia provider's attention away from a nerve block. Upon return, meanwhile, he or she may not fully recall the laterality from the checklist, leading to a potential case of WSNB. One way to improve the value of checklists in this setting, according to observers, may be to incorporate protocols with extra layers of redundancy—i.e., build a reminder into the action.

From "Wrong-Side Nerve Blocks and the Use of Checklists"
Anesthesiology News (10/19/19) Balocco, Angela Lucia; Kransingh, Samantha; Lopez, Ana; et al.

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Chewing Gum Could Be Answer to Debilitating Post-Op Nausea

A major research effort hopes to prove that chewing a stick of gum can tame postoperative nausea and vomiting (PONV). The research started as a small pilot study and blossomed into the international effort, funded by the Australian and New Zealand College of Anaesthetists, that is currently underway. Preliminary evidence suggests that chewing peppermint gum for about 10 minutes is more effective than anti-nausea medications during recovery. The implications are significant, according to primary investigator Robyn Billing, MD, who ticks off the potential benefits. "We're exploring chewing gum as an alternative treatment that is readily available, cheap, and easy to administer and free of side effects unlike pharmaceuticals," she says. PONV is the No. 1 cause of unplanned hospitalizations after outpatient surgery, potentially affecting tens of millions of patients. Billing adds that chewing gum, if effective, would be especially useful in treating PONV in poorer countries where access to antiemetics is limited.

From "Chewing Gum Could Be Answer to Debilitating Post-Op Nausea"
Scoop (New Zealand) (10/16/19)

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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.

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For more information on AANA and Anesthesia E-ssential, contact:

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Attn: Cathy Hodson
E–ssential Editor
October 24, 2019