Anesthesia E-ssential

AANA Anesthesia E-ssential, October 3, 2019

Vital Signs

AANA Recommends Inclusion of Strategic Consideration of the Role of Anesthesia in Enhanced Recovery After Surgery Protocol as an Innovative Healthcare Delivery Model

In a Sept. 25 regulatory comment letter, the AANA advised CMS that CRNA services are crucial to the successful development and implementation of the use of techniques such as anesthesia Enhanced Recovery After Surgery (ERAS®) programs. As CRNAs administer more than 49 million anesthetics each year in the United States, the AANA said, CRNAs play an integral role in these episodes of care in inpatient and outpatient settings. The letter also noted that proper anesthesia services management can make a tremendous difference in terms of improving patient flow, patient safety, and ultimately in cost savings. The comments came in response to the Medicare Hospital Outpatient Prospective Payment (HOPPS) and Ambulatory Surgical Center Payment Systems CY 2020 proposed rule.

The AANA also made the following recommendations regarding the Medicare program:
  • Support CMS proposal that hospitals make public the list of their standard charges and request inclusion of anesthesia care as ancillary services in a shoppable service situation;
  • CMS can address underlying causes of surprise billing by issuing a proposed rule on provider non-discrimination and by promoting adequate provider networks in health plans. The AANA also recommended that the agency work with healthcare stakeholders in developing guidance to educate consumers on questions to ask their insurance companies to help avoid surprise billing;
  • Use of non-opioid alternatives, such as multimodal pain management and Enhanced Recovery After Surgery (ERAS) protocols, do lead to a decrease in prescription opioid use and addiction;
  • Include in the final rule further guidance on the proposal for a prior authorization process for certain outpatient services;
  • Support for the creation of an anesthesia-specific survey that will collect information on relevant anesthesia quality measures, including the modification of Consumer Assessment of Health Care Providers and Systems Surgical Care Survery (S-CAHPS) to accurately reflect the role of CRNAs.
Medicare is slated to review the AANA's comments alongside other public comments and render a final rule in November that takes effect January 2020.
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Hot Topics

CRNAs/SRNAs - Do You Know How Much You Should be Getting Paid?

Whether you’re comparing offers, negotiating your salary, or conducting research on the profession’s outlook, stay up to date on the latest CRNA compensation, salary, and benefits trends! With the official 2019 Compensation and Benefits Report, you can better understand what your full compensation package should entail:
  • 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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Are You Paying Too Little for Your Malpractice Insurance?

Like most things in life, you get what you pay for. While items such as cars and microwaves can be replaced when flaws become evident, the same cannot be said for malpractice insurance. By the time you discover a flaw with your malpractice insurance coverage, it’s already too late. To better understand the pitfalls of paying too little for malpractice insurance, visit Will Your Assets Be Protected?
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Call for Abstracts: Share Your Professional Knowledge by Presenting at AANA 2020 Annual Congress in San Diego

AANA Members are invited to submit an abstract for consideration to present at the AANA 2020 Annual Congress, in sunny San Diego, Calif., the biggest event in nurse anesthesia. Present your topics to thousands of CRNAs and SRNAs from all over the nation - from various practice settings and levels of leadership.

For more information on how to submit an abstract, abstract submission guidelines and a template of the grading rubric, please visit the abstract page. Abstract submissions will close on Thursday, October 17, 2019, at 11:59 p.m. CST. 
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NewsMaker: Illinois CRNA Jennifer Banek To Run for Lake County Coroner

Jennifer Banek, MSN, CRNA, said she decided to run as a candidate for Lake County coroner in the Democratic primary election next year because she believes her skill sets in both medicine and community involvement make her a good fit for the position.

“As a captain in the Army Reserve, a [library district] trustee, and a volunteer for many community and professional organizations, I am passionate about serving,” Banek said. “The coroner position brings together my medical training and interest in serving our community.” Learn more.
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NewsMaker: CRNA Kaitlyn Brown Profiled as Thriving Nurse Anesthetist

Southeast Missouri State University alumna, Kaitlyn Brown, DNP, CRNA, of Jackson, Mo., graduated from Southeast in 2013 with a Bachelor of Science in nursing. She continued her education at Southern Illinois University-Edwardsville, where last May she completed a doctorate of nursing practice in nurse anesthesia.

"I chose nursing because I realized that I wouldn’t get as much one-on-one time with patients if I chose to be a physician like I originally intended. I knew there would be lots of advanced nursing options for me if I decided to pursue an advanced education and become more specialized," said Brown. Learn more.
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Meetings and Workshops

Spinal Epidural with Obstetric Essentials Workshop

When: October 24-26, 2019
Location: AANA National Headquarters, Park Ridge, Ill.

Presentations include:
  • Normal and abnormal physiology of pregnancy.
  • Pharmacology
  • Analgesia/anesthesia techniques.
  • Formal presentations.
  • Clinical applications of spinal and epidural anesthesia procedures.
  • Introduction to the application of ultrasound using live models.
View Workshop Program.
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Leadership Summit: Empower the Leader Within

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 2020: Wine, Spa Treatments, and the Latest in Nurse Anesthesia Education

When: February 19-22, 2020
Location: Château Élan Winery and Resort, Braselton, Ga.

Mark your calendar to join us next year in Braselton, Ga., at the Château Élan Winery & Resort, February 19-22, 2020. Château Élan Winery & Resort is located approximately 45 minutes from the Hartsfield-Jackson Airport. Transportation will be provided for AANA attendees, from the airport to the resort.

Save the Date.

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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

Improving Your Options With A Guide to Student Loan Refinancing

For years student loan borrowers have felt stuck, with limited options to improve student loan interest rates or repayment terms. Now those days are gone. As more students turn to federal and private loans to help finance their undergraduate and graduate education, additional options for repaying those loans are available. Learn more.

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CRNA Jobs: Locum Tenens and Permanent Placement Opportunities Across the Country

United Anesthesia – Various Locations. United Anesthesia has been a leading CRNA and Anesthesiologist Locum Tenens and Permanent Placement firm in the country for 40 years. By specializing in only anesthesia placement, we can partner with you to find the ideal situation to suit your strengths, your priorities, your dreams. Your dedicated personal coordinator is looking forward to your call! Learn more.
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CRNA: Banner Health, Ogallala, Nebraska

Nebraska isn't for everyone, but if you enjoy unique adventures, beautiful scenery, calm pace of life, and a solid compensation package, this opportunity is just right for YOU!

Banner Health is one of the largest non-profit healthcare systems in the country with twenty-eight hospitals, six long-term care centers and an array of other services, including family clinics, home care services and home medical equipment, in six Western states.

We have an excellent opportunity for a dynamic CRNA to join our highly trained team!
  • CRNA-only practice model
  • Responsible for performing general, regional, and monitored anesthesia services including Ultrasound-guided block, and OB
  • Experience preferred
  • One week on, one week off, one week call
Ogallala Community Hospital (OCH) is an 18-bed critical access hospital committed to meeting the healthcare needs of western Nebraska and was one of four Banner Health facilities named HealthStrong™ Top 100 Critical Access Hospitals scoring best among critical access hospitals on the iVantage Health Analytics’ Hospital Strength Index™. The Hospital Strength Index is a comprehensive rating of critical access hospitals, and results recognize the Top 100 Critical Access Hospitals that provide a safety net to communities across rural America. Service area 15,653. Learn more.
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CRNA: St. Joseph’s Medical Center/Steward Healthcare, Houston, Texas

St. Joseph's Medical Center is seeking a full-time CRNA to do a variety of cases including but not limited to Vascular, Neuro, OB and Peds. This is an employment position reporting to the Anesthesia Medical Director and Chief CRNA. St. Joseph's Medical Center in Houston Texas, is a general acute care, level III trauma hospital. It has 400 beds, 17 main ORs, 3 endoscopy suites, 5 Women's ORs and a 12 bed labor and delivery floor.

Incoming CRNA will be expected to develop a comprehensive, patient-centered Anesthesia assessment. CRNA will coordinate care in an Anesthesia Care Team model according to policy and procedures of the department. CRNA will administer appropriate anesthetic agents and monitor each patient's response / progress with accurate documentation. CRNA will provide and evaluate post anesthesia care. Learn more.
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CRNA: Freeman Health System, Joplin, Missouri

As the only locally owned, not-for-profit health system in the area, Freeman focuses on meeting the health and wellness needs of those we serve as well as the needs of our employees.

Freeman in Joplin, Missouri, is a 460-bed, three-hospital system providing comprehensive healthcare services to an area that includes more than 450,000 from Missouri, Arkansas, Oklahoma, and Kansas.

Freeman Health System includes Freeman Hospital West, Freeman Hospital East, Freeman Neosho Hospital and Ozark Center – the area’s largest provider of behavioral health services – as well as two urgent care clinics, dozens of physician clinics and a variety of specialty services.

With their expertise and skills, Freeman CRNAs deliver direct anesthesia care to our patients. We need your knowledge of a wide variety of anesthetics and procedures including Spinal, IV Regional, and other Regional techniques.

As we continue to grow, we need dedicated, skillful, compassionate employees. Are you interested in helping us provide the best care to our community? 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.

Neuraxial Labor Analgesia Is Associated with a Reduced Risk of Maternal Depression at 2 Years After Childbirth

Because severe pain during labor is implicated in the development of postpartum depression, researchers questioned whether neuraxial analgesia for childbirth lowers that risk. About 600 nulliparous women participated in the prospective, longitudinal study, which was carried out at multiple hospitals in China. All of the patients had singlet pregnancies and were planning to deliver vaginally. Nearly three-quarters of the women received neuraxial analgesia during labor, 7.3 percent of whom presented with depression two years after childbirth. The mothers who did not receive neuraxial labor analgesia, meanwhile, were almost twice as likely to suffer the condition, at a rate of 13.6 percent. After adjusting for confounding factors, the investigators confirmed that use of neuraxial analgesia during labor was associated with a markedly lower risk of two-year maternal depression.

From "Neuraxial Labor Analgesia Is Associated with a Reduced Risk of Maternal Depression at 2 Years After Childbirth"
European Journal of Anaesthesiology (10/01/2019) Vol. 36, No. 10, P. 745 Liu, Zhi-Hua; He, Shu-Ting; Deng, Chun-Mei; et al.

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Patients' Expectations of Their Anesthesiologists

Most surgical patients have high expectations of their anesthesia provider, according to 170 survey responses collected by researchers at Penn State Health Milton S. Hershey Medical Center. Patients attending the facility's pre-anesthesia clinic answered a questionnaire before their clinic interview. The focus for that intervention centered on the respondent's perceptions of the role of the anesthesia provider as well as his or her expectations of the anesthesia experience and the anesthesia provider. Poll participants were asked to complete another survey on the first day after their procedure—this one asking about the perioperative experience and whether it met their expectations. It also inquired about overall satisfaction with the quality of anesthesia care. According to the results, greater than 75 percent of respondents had high expectations of their provider. The level of satisfaction with the experience, meanwhile, was highest among poll participants who felt that their expectations were met and among those who believed the anesthesia provider prepared them for what to expect afterwards. To improve satisfaction scores, the investigators say anesthesia providers must educate patients about what they do, set realistic expectations about what takes place after the operation, and make care decisions with input from the patient.

From "Patients' Expectations of Their Anesthesiologists"
American Journal of Managed Care (10/01/2019) Vol. 25, No. 10 Lin, Charlie; Prozesky, Jansie; Martin, Donald E.; et al.

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Anesthesia Type Is Not Associated with Postoperative Complications in the Care of Patients with Lower Extremity Traumatic Fractures

A retrospective study out of Brigham and Women's Hospital in Boston compared outcomes in patients undergoing surgery for lower-extremity traumatic fractures, based on the type of anesthesia used. In a cohort of 3,254 patients who underwent the procedure between 2011 and 2016, only a fraction received regional anesthesia/neuraxial anesthesia (RA/NA)—usually spinal anesthesia—as the primary anesthetic. The overwhelming majority, meanwhile, had general anesthesia. Analysis found no between-group difference in 30-day mortality, the primary endpoint. Secondary outcomes—including number of complications, length of stay, days from operation to discharge, and unplanned readmission—also were similar, regardless of anesthetic selection. Although traumatic lower-extremity fractures are very common and RA/NA could be useful in this setting, the rate of take-up is disproportionately low. The study authors suspect patient and provider preferences could be at play and that the urgent nature of these surgeries could influence their decisions.

From "Anesthesia Type Is Not Associated with Postoperative Complications in the Care of Patients with Lower Extremity Traumatic Fractures"
Anesthesia & Analgesia (10/19) Vol. 129, No. 4 Brovman, Ethan Y.; Wallace, Frances C.; Weaver, Michael J.; et al.

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The Effect of the Use of Pre-emptive Oral Pregabalin on the Postoperative Spinal Analgesia in Patients Presented for Orthopedic Surgeries

Preoperative oral pregabalin has potential clinical value in the setting of orthopedic surgery, researchers in Egypt report. The team from the University of Tanta recruited 60 adults for their randomized study. All of the patients underwent surgical repair of a femoral fracture under spinal anesthesia; however, some received pregabalin an hour before the operation while others received only a placebo. The investigators looked for differences between the two treatment arms for a number of endpoints. Analysis of the results favored the use of oral pregabalin—which reduced pain scores, prolonged the duration of postoperative analgesia, curtailed morphine consumption, and improved sleep during the first night following surgery. Oral pregabalin also stretched out the time required to regression of spinal block to L2 and extended the duration of motor block, with no change in the onset of sensory or motor block.

From "The Effect of the Use of Pre-emptive Oral Pregabalin on the Postoperative Spinal Analgesia in Patients Presented for Orthopedic Surgeries"
Journal of Pain Research (09/19) Vol. 12, P. 2807 Omara, Amany F.; Ahmed, Sameh A.; Abusabaa, Motaz M.A.

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Intravenous Lidocaine Can Treat Acute Pain

Early evidence shows that intravenous lidocaine can be used to calm acute pain in emergency room visitors, avoiding the use of opioid analgesics. Alternatives may be necessary in situations where a patient does not respond to opioids, the drugs cause problematic adverse effects (AEs), or they are otherwise inappropriate. A case series, for example, revealed I.V. lidocaine to be effective for emergency patients seeking attention for renal colic resistant to treatment with opioids and nonsteroidal anti-inflammatory drugs. Meanwhile, a randomized study found that I.V. lidocaine reduced pain scores more than I.V. morphine and as much as I.V. fentanyl in this patient population. The lidocaine approach has also been used effectively for cancer or perioperative pain, refractory headache, and trauma. The research suggests that lidocaine can be infused slowly via pump to minimize the likelihood of AEs such as dizziness, numbness, and metallic taste. Should they occur anyway, experts say, these side effects typically can be quickly reversed or will resolve on their own because of the short half-life that lidocaine has.

From "Intravenous Lidocaine Can Treat Acute Pain"
Pharmacy Times (09/26/19) Tran, Tran H.; Sin, Billy

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The Relationship Between Obstructive Sleep Apnea and Postoperative Delirium and Pain

Washington University School of Medicine, in St. Louis, spearheaded a study on the possible correlation between obstructive sleep apnea (OSA) and postoperative delirium and acute postoperative pain severity. The retrospective investigation included 1,441 patients, 307 of whom presented with postoperative delirium. High risk for OSA—as defined by a prior diagnosis or a match to more than four factors on the STOP-BANG screening tool—was associated with delirium in unadjusted analysis. However, after adjusting for pre-specified variables, the association was no longer statistically significant, nor was a significant relationship observed between high risk for OSA and postoperative pain severity.

From "The Relationship Between Obstructive Sleep Apnea and Postoperative Delirium and Pain"
Anaesthesia (09/18/19) Strutz, P.K.; Kronzer, V.; Tzeng, W.; et al.

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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.

If you are interested in advertising in Anesthesia E-ssential contact HealthCom Media at 215-489-7000.

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

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Phone: (855) 526-2262 (toll-free)/(847) 692-7050
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Attn: Cathy Hodson
E–ssential Editor
October 3, 2019
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