Anesthesia E-ssential

AANA Anesthesia E-ssential, October 31, 2019

Vital Signs

House Passes Title VIII Nursing Workforce Reauthorization

On Monday, the House of Representatives passed H.R. 728, Title VIII Nursing Workforce Reauthorization! This important bill reauthorizes critical nursing programs, including the Nurse Anesthetist Traineeship. Congress hasn’t passed a five-year reauthorization for Title VIII programs since 2010 and the Senate is planning to mark up the bill later this week. We remain hopeful that the reauthorization will be sent to the President’s desk in the coming months. A big thank you goes to Nursing Caucus Co-Chair Rep. Dave Joyce for his work leading the bill and getting it across the finish line in the House.
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AANA Releases Pivotal Study on Safety, Cost-Effectiveness of Anesthesia Delivery

The American Association of Nurse Anesthetists (AANA) released a new study that suggests politics and professional interests are the main drivers of anesthesia policy in the United States.

In their study, “Advocacy, Research, and Anesthesia Practice Models: Key Studies of Safety and Cost-Effectiveness” first published in Policy, Politics & Nursing Practice, researchers contend that while data shows low risk of death and complications associated with anesthesia, there is debate among professional societies and policymakers about which anesthesia professionals deliver safer care. Learn more.
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Hot Topics

Looking to Pick Up Work Outside of Your Full-time Position?

AANA Insurance Services has malpractice insurance coverage for that! Visit our Policy Options page to learn more about our short term coverage options, including daily, weekly, monthly, and moonlighting coverages. Learn more.
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2020 National CRNA Week Merchandise Available Beginning November 1

 "Your Comfort, Your Care, WE ARE THERE!" Join your fellow CRNAs and SRNAs to revel in the week that celebrates you and the profession of nurse anesthesia. Merchandise for the 2020 National CRNA Week (January 19-25, 2020) will be available beginning Friday, November 1. With the holidays fast approaching, get your supplies and public relations materials early!

National CRNA Week: January 19-25, 2020
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Seeking Candidates: Delegate to Education Committee

The AANA Education Committee is seeking candidates to serve a two-year term as a Delegate. The deadline for receiving completed candidate packets is January 6, 2020. The election will be held, and the winner announced, at the Assembly of Didactic and Clinical Educators (formerly called Assembly of School Faculty) meeting in February 2020.

Delegates must be CRNAs who spend at least 50% of their time in the didactic and/or clinical instruction of nurse anesthesia students at the time of application. During their tenure on the committee, they must:
  • Be continuously involved in the didactic and/or clinical instruction of nurse anesthesia students.
  • Attend the February Assembly of Didactic and Clinical Educators and Nurse Anesthesia Annual Congress during both years of their term.
  • Attend Education Committee meetings and conference calls for the two-year term which begins immediately following the AANA Annual Congress in the year elected.
The candidate information packet is available on the AANA website under CE & Education, Opportunities for Educators. Questions? Contact the Education department at 847-655-1161 or
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NewsMaker: CRNA Shaw-Ekerson Runs for Montesano, Wash., School Board

Priscilla Shaw-Ekerson, DNAP, CRNA, is running for the Montesano, Wash., school board's District 5 director. In a Q&A interview in The Vidette, Shaw-Ekerson says she is the best candidate due to her leadership roles in the U.S. Army, including as program director for the U.S. Army Graduate Program in Anesthesia Nusing Phase II at Madigan Army Medical Center. "Through the various positions I held and through my own college education, I have extensive experience in both education, research, leadership and management," she said. "I work very well in diverse settings where a team aproach is necessary and will be a strong advocate for them all." Learn more.
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NewsMaker: CRNA Chapman Markle is Breaking Records in Ultramarathons

Pamela Chapman Markle, CRNA, is 64 years old and runs anywhere between 80-100 miles each week, and she loves it. In an interview in the Houston Chronicle, Chapman Markle says, "I have run nine ultramarathons since January 2019, and I have more to complete this year." Ultramarathon races range from 50-200 miles, with some lasting for an undetermined distance requiring more than 24-48 hours. She is breaking race records in her age division and earning recognition, including running one of the fastest times of 21 hours and 29 minutes in her age group at a 100-mile road race in Florida. Learn more.
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NewsMaker: CRNA Bueno Administers CPR, Saves Runner

As reported on, Jesus "Jesse" Bueno, MSN, CRNA, APNP, was running in a 10-mile race in Minneapolis/St. Paul, Minn., earlier this month when the young man running in front of him collapsed, having experienced ventricular tachycardia. "He just collapsed," said Bueno. "He basically fell straight down." In an ironic twist, the young man, Tyler Moon, had had "Jesus Saves" printed on his racing bib. Bueno and his colleague began CPR on Moon. After the paramedics arrived, Bueno continued to help and put the defibrillator patches on Moon so they could shock his heart back to a regular rhythm. Moon was taken to a local hospital and Bueno finished the race. Learn more.
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Meetings and Workshops

Considering Your Own Anesthesia Practice?

Learn the business side of anesthesia from two highly successful group practice owners, Juan Quintana and Larry Hornsby. They’re providing an online eight-week seminar with university-level curriculum covering billing and reimbursement, negotiations, contracts and proposals, and differences in practice models.

AANA Membership Exclusive - Earn 16 CE Credits - Next Session starts January 6, 2020

Get more details here!
Spring 2020 Session
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Next Weekend: 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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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 28 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 Ultra Sound 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: UCHealth Memorial Hospital, Colorado Springs, Colorado

At UCHealth, our mission is simple – to improve lives. That starts with you. We help you live your passion for providing personalized, evidence-based patient care at the highest level.

UCHealth has an excellent opportunity for a Certified Registered Nurse Anesthetist (CRNA) to work for UCHealth Anesthesiology-Memorial Central.
  • Schedule is 10s or 12s covering one weekend per month.
  • Work with a collaborative team of anesthesiologist and CRNA/AAs.
  • Enjoy complex cases at a level one trauma center.
Learn more.
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CRNA: Southern Ohio Medical Center, Portsmouth, Ohio

Southern Ohio Medical Center is looking for CRNAs to join our growing, hospital employed Anesthesia team!
  • Competitive base salary!
  • Up to $80k student loan reimbursement.
  • $30k sign-on bonus.
  • Up to 30% of base salary paid in performance bonus.
  • CME - $5,000 and 5 days.
  • 232 hours of PTO (includes holiday, sick).
  • Pay for call program.
  • $10k moving allowance.
Monday - Friday 7:00 a.m.-3:30 p.m. (may stay past 3:30 depending on surgery add-on cases). Weekday and weekend call is 1:7. First call post day off.
Case mix includes: General Surgery, OB/Maternity, Thoracic, Vascular, ENT, Ophthalmology, Ortho, Peds - mostly ENT. CRNAs occasionally assist in cardiac, but MDA is the primary provider.

SOMC is a 248-bed, not-for-profit community hospital in Portsmouth, OH. We are Joint Commission accredited and have achieved Magnet status for nursing. Our service patient population is 250,000. We have been ranked by FORTUNE 100 magazine as one of the best places to work for the last 11 years, also ranking as the #1 employer in the state of Ohio. We attribute much of this to the culture of SOMC. If you want to practice in one of the most challenging and rewarding environments in the country, this may be the place for you. Learn more.
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Associate Director: TCU/School of Nurse Anesthesia, Fort 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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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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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.

The Antipsychotic Amisulpride Proves Effective as Rescue Treatment for PONV

New findings favor the use of intravenous amisulpride, an antipsychotic, in surgical patients who experience postoperative nausea and vomiting (PONV) even after receiving preventive treatment. The study included 230 patients who were given a single dose of 10 mg of IV amisulpride after PONV prophylaxis failed and 235 patients who, under the same circumstances, received only placebo. The primary outcome was complete response, as defined by no vomiting or retching and no antiemetic rescue medication during the first 24 hours after dosing. A total of 41 percent of the amisulpride recipients met this endpoint, while the same was true for just 28.5 percent of the controls. In addition to exposure to volatile anesthetics, nitrous oxide, and postoperative opioids, risk of PONV is elevated by a host of factors including female gender, history of PONV, age younger than 50 years, prolonged surgery, and certain types of surgery. Even so, the researchers determined that patients in the amisulpride group lasted longer before treatment failure than did placebo recipients, regardless of how many baseline risk factors they had. One of the study's primary limitations, however, is that it compared amisulpride with placebo instead of existing dopamine antagonists.

From "The Antipsychotic Amisulpride Proves Effective as Rescue Treatment for PONV"
Anesthesiology News (10/28/19) Kronemyer, Bob

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Recurrence of Breast Cancer After Regional or General Anesthesia

Researchers explored the role that anesthesia care after breast cancer surgery might play in disease recurrence. The multinational study involved more than 2,000 women undergoing potentially curative primary breast cancer resection. Roughly half of the participants were randomly allocated to receive regional anesthesia-analgesia with paravertebral blocks and propofol. The remaining patients were assigned to general anesthesia using sevoflurane—a volatile anesthetic—plus opioid analgesia. Because both volatile anesthetics and opioid analgesia weaken the body's defense against recurrence during cancer surgery—and because regional anesthesia-analgesia mitigates those factors—the team was prepared for better outcomes with the paravertebral block/propofol approach. After a median 36 months, however, the recurrence rate was 10 percent in both treatment arms. There also was no between-group difference in incisional pain, the secondary endpoint, at six and 12 months. Based on the findings of the study, which was terminated after reaching a prespecified futility boundary, the researchers concluded that regional and general anesthesia are both viable choices for breast cancer resection with respect to risk of disease recurrence and management of persistent incisional pain.

From "Recurrence of Breast Cancer After Regional or General Anesthesia"
The Lancet (10/20/19) Sessler, Daniel I.; Pei, Lijian; Huang, Yuguang; et al.

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Lack of Association Between Intraoperative Handoff of Care and Postoperative Complications

Significant covariates must be considered in order to fully comprehend the impact of intraoperative anesthesia handoffs on adverse patient outcomes, a retrospective study out of Atlanta's Emory University School of Medicine has found. Combing through data from the American College of Surgeons National Surgical Quality Improvement Project, the researchers focused on 12,111 cases performed at two hospitals under the same healthcare system. Specifically, they documented the presence of anesthesia handoffs—which occurred in 2,586 cases—as well as patient age, gender, body mass index, case length, surgical case complexity, surgery start time, and American Society of Anesthesiologists Physical Status classification. When analyzed as a single variable—case timing and prolonged case duration, in particular—handoffs correlated with higher rates of adverse outcomes. When confounding variables were factored in, however, the statistical significance was lost.

From "Lack of Association Between Intraoperative Handoff of Care and Postoperative Complications"
BMC Anesthesiology (10/15/19) Vol. 19 O'Reilly-Shah, Vikas N.; Melanson, Victoria G.; Sullivan, Cinnamon L.; et al.

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Lower Readmission Rates After TKA Associated with IV Acetaminophen

Hospital readmission is less likely in knee replacement patients who are given acetaminophen intravenously (IV APAP) rather than through the oral route, researchers report. The finding is based on results from 190,692 individuals who received the drug to manage pain after total knee arthroplasty (TKA). The all-cause readmission rate within 30 days post-discharge was 0.04 percent for patients treated with IV acetaminophen versus 0.14 percent for those treated with an oral formulation. When compared with previously published reports on 30-day readmission rates and risk prediction tools for TKA, the study authors calculated the potential for $160 million in potential cost savings on a nationwide basis. "These findings suggest that IV APAP may be used by orthopedic surgeons aiming to control costs while managing postoperative pain,” they wrote in the Journal of Knee Surgery.

From "Lower Readmission Rates After TKA Associated with IV Acetaminophen"
Healio (10/27/2019) Tingle, Casey

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Study: One-Third of Children Having Tonsillectomies Benefited From Opioid-Free Surgery and Recovery

Although opioids are a popular pain-relief choice after pediatric tonsillectomy, new evidence reveals that many children do not require narcotic analgesics for the procedure. The research was conducted at Montefiore Medical Center in New York City, where investigators reviewed surgical records for 323 children who received either opioids or acetaminophen and/or ibuprofen for pain management along with dexamethasone and dexmedetomidine. For 32 percent of the patients, the experience was completed with zero exposure to opioids, while about a third of the patients in each group required no additional pain medication in the post-anesthesia care unit (PACU) before being discharged. The researchers noted that 40 percent of the children did not receive intraoperative opioids, and most (73 percent) patients in that category also did not take them for postoperative pain. Length of stay in the PACU and rate of other complications were comparable, meanwhile, regardless of pain relief. "We believe this research is important because it has the potential to offer ... a safe and effective regimen for tonsillectomy that is opioid-free and potentially reduces risks associated with opioid use," said study lead author Glenn Mann, MD.

From "Study: One-Third of Children Having Tonsillectomies Benefited From Opioid-Free Surgery and Recovery"
News-Medical (10/21/19)

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Oliceridine Study Finds Reduced Risk for Opioid-Induced Respiratory Depression

Researchers report that, aside from being a fast-acting and effective analgesic after colorectal surgery, oliceridine also appears to reduce risk for opioid-induced respiratory depression (OIRD). The investigational opioid was at the center of a secondary study analysis of 115 patients undergoing the procedure—none of whom required naloxone, boding well for oliceridine's safety profile. In addition, researchers announced at the 2019 Annual Congress of the American Society for Enhanced Recovery, the rates of hypoxia or bradypnea were lower than what the literature suggests they should have been. While the findings are encouraging, the study authors emphasize that oliceridine should be limited to a multimodal analgesia role, using the lowest effective dose. Moreover, large-scale research is warranted to confirm the results.

From "Oliceridine Study Finds Reduced Risk for Opioid-Induced Respiratory Depression"
Anesthesiology News (10/27/19) Kronemyer, Bob

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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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Attn: Cathy Hodson
E–ssential Editor
October 31, 2019