Anesthesia E-ssential

AANA Anesthesia E-ssential
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President Weiner Writes Op-Eds on VA Denial of Full Practice Authority

Following reports in mid-October of cancelled or postponed surgeries at the Denver Veterans Affairs Medical Center due to a lack of anesthesia providers, AANA President Bruce Weiner, DNP, MSNA, CRNA, has written op-eds in The Hill and in Becker's Hospital Review outlining the case for full practice authority for CRNAs in the VA.  Read "VA Denial of Full Practice Authority for Nurse Anesthetists Coming Home to Roost" (The Hill, Oct. 19, 2017), and Six Things the VA can do to Ensure Veterans Get the Anesthesia Care they Need (Becker's Hospital Review, Oct. 24, 2017), in their entirety and watch the AANA website, AANA publications, and AANA Connect for further developments on the VA issue.
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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 (Member login and password required.)
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Two CRNAs Inducted as Fellows in the American Academy of Nursing

Ladan Eshkevari, PhD, CRNA, LAc, FAAN, and Susan Perry, PhD, CRNA, ARNP, Col(ret), NC, USAF, FAAN, were among 173 nurse leaders inducted as 2017 fellows in the American Academy of Nursing (AAN) during the Academy’s annual policy conference October 5-7, 2017, in Washington, DC. The AAN is an organization of distinguished nursing leaders who are recognized for their outstanding contributions to the profession through publications, research, awards and honors, professional activities, and community service. Eshkevari and Perry join more than 2,500 other nurse leaders in the academy, representing all 50 states, the District of Columbia, and 29 countries.
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Featured Career Opportunity

Nurse Anesthesia Program Director - The University of Tulsa

The University of Tulsa is seeking applications for a Program Director to launch a Nurse Anesthesia program that leads to a DNP.  The program will launch in Fall 2018.
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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.

Research Finds Decrease in Opioid Use Among Patients Recovering From Hip and Knee Replacement

A focus on multimodal analgesia in recent years has had a significant impact on postoperative opioid use, which declined by a third between 2006 and 2014 in patients recovering from hip and knee arthroplasty. Based on a population of more than 1 million patients, researchers compared the number who received only opioids after replacement surgery with the number who received multimodal therapy—which included opioids as well as up to three other techniques, like peripheral nerve block, nonsteroidal anti-inflammatory drugs, or COX-2 inhibitors. They reported at ANESTHESIOLOGY 2017 that the share prescribed just opioids fell to about 1 in 12 as of 2014 versus 1 in 4 in 2006. "Opioids are powerful pain medications but have many unwanted side effects, including the risk of addiction. This has prompted more interest in offering patients multimodal therapies to manage pain while also reducing the amount of opioids prescribed," remarked Philipp Gerner, a medical student at University of Massachusetts Medical School. "Our research reflects that there has been steady progress over time toward achieving that goal."

From "Research Finds Decrease in Opioid Use Among Patients Recovering From Hip and Knee Replacement" (10/23/2017)

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Fear of Pain After Surgery Can Stoke Anxiety

New research reveals that surgical patients often overestimate the level of postoperative pain they will face, causing them undue anxiety. The study, presented at ANESTHESIOLOGY 2017, asked 223 participants to rate their anticipated postsurgical pain on a scale of 0 to 10. They were then queried about actual pain one hour after the procedure and again the next day. Pain scores in the post-anesthesia care unit (PACU) averaged 2.56, compared with expectations of 4.66. On postoperative day 1, similarly, the average pain score was only 4.30—although patients had expected levels closer to 5.45. The gap between anticipated and actual pain was even more pronounced among the 96 patients who underwent regional anesthesia, researchers at Thomas Jefferson University Hospital in Philadelphia reported. For them, actual pain in the PACU rated just 0.92—far lower than expectations of 4.63; while pain the day after surgery averaged 3.45 compared to an expected level of 5.47. "We believe providers need to do a better job of counseling patients on realistic pain expectations," declared study co-author Jaime Baratta, MD, director of regional anesthesia at the hospital. "This is especially true for patients receiving regional anesthesia who may not fully understand the benefits of nerve blocks and other regional anesthesia procedures aimed at preventing postoperative pain."

From "Fear of Pain After Surgery Can Stoke Anxiety"
PsychCentral (10/23/17) Nauert, Rick

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Adductor Canal Block in Arthroscopic Knee and ACL Surgeries Questioned

Despite strong evidence to support adductor canal block for knee arthroplasty, new findings cast doubt on the benefits of using this technique for ambulatory arthroscopic surgeries of the knee—including ACL reconstruction. The systematic review and meta-analysis was based on 10 randomized controlled studies comparing adductor canal block against either femoral nerve block or placebo in ambulatory settings under multimodal analgesia. Analysis indicated that postoperative pain severity after six hours, the primary outcome, was indeed reduced with adductor canal block—but only by a "marginal" amount, according to Herman Sehmbi, MD, of Western University in Ontario. "This was the first systematic review and meta-analysis to examine arthroscopic knee surgery and the role of the adductor canal block in these settings," he said, and the results pointed to "modest benefits, at best." Based on the findings, which he presented at the 2017 annual meeting of the Canadian Anesthesiologists' Society, Sehmbi says clinicians may want to reevaluate whether the technique is necessary at all in these types of procedures.

From "Adductor Canal Block in Arthroscopic Knee and ACL Surgeries Questioned"
Anesthesiology News (10/20/17) Vlessides, Michael

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Dexamethasone May Be an Effective Adjunct Analgesic for Labor Pain

New research results suggest that intravenous dexamethasone, as an adjunct to epidural analgesia, may provide additional pain relief to women in labor. The trial, reported in the Journal of Clinical Anesthesia, randomized 80 patients to receive either I.V. dexamethasone or normal saline 45 minutes before receiving an epidural with levobupivacaine and fentanyl. The women in the dexamethasone group consumed significantly less of the levobupivacaine/fentanyl combination per hour than those in the control group. Although the reasons behind the analgesic and opioid-sparing effects of dexamethasone during labor are not yet fully understood, investigators suspect that "activation and transcription of genes relevant to inflammation and pain modulation" may play a role.

From "Dexamethasone May Be an Effective Adjunct Analgesic for Labor Pain"
Clinical Pain Advisor (10/19/17) May, Brandon

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First Time Mums With an Epidural Who Lie Down More Likely to Have a Normal Birth

Findings from a U.K. trial offer insight into the best position for first-time mothers who have had a low-dose epidural and have entered the second stage of labor. The investigators posited that placing patients in an upright position would reduce the number of forceps- or vacuum-assisted deliveries, which are more likely with epidurals. The BUMPES study included nearly 3,100 women who were randomly assigned to be upright or lying down in the final stages of labor for their deliveries, which occurred between October 2010 and January 2014. According to the results, which are reported in the BMJ, the rate of spontaneous vaginal births—requiring no medical intervention—was actually higher in the lying down group, at 41.1 percent, than in the upright group, at 35.2 percent. "The study provides evidence that first time mothers with an epidural who lie down on their side during the second stage of labor are more likely to have a spontaneous vaginal birth, with no apparent disadvantages in relation to short or longer term outcomes for mother or baby," commented Prof. Peter Brocklehurst of the University of Birmingham. The research, he added, calls for further investigation to determine the optimal position for women in the second stage of labor who have not received an epidural.

From "First Time Mums With an Epidural Who Lie Down More Likely to Have a Normal Birth"
Medicalxpress (10/18/2017)

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Antihistamine Improves Quality of Sedation During Colonoscopy

New study results demonstrate that supplemental diphenhydramine (Benadryl) enhances the quality of sedation during colonoscopy. Intravenous fentanyl and midazolam were administered to all 119 participants, who were randomly assigned to also receive either diphenhydramine or placebo. Quality of sedation, as measured by nurses and doctors on a scale of 1 to 7, was significantly better in the intervention group than in the control group. Meanwhile, mean pain scores—as rated by the patients themselves on a 10-point scale—were lower with diphenhydramine than placebo. "Our results showed that, though the use of diphenhydramine did not decrease the dose of conventional sedative used, it did improve the quality of sedation as rated by the patient, nurses and the physicians," said primary investigator Salman Nusrat, MD, of Oklahoma Health Sciences Center in Oklahoma City. He acknowledged that additional research is needed given that his sample population was largely limited to white males over the age of 55 years who were chronic opioid users and were having outpatient procedures.

From "Antihistamine Improves Quality of Sedation During Colonoscopy"
MedPage Today (10/17/17) Bachert, Alexandria

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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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