Anesthesia E-ssential

AANA Anesthesia E-ssential, October 4, 2018

Vital Signs

American Association of Nurse Anesthetists Applauds Congress for Passage of Comprehensive Opioid Package

Yesterday the U.S. Senate approved a final opioids package that includes a provision allowing CRNAs and other APRNs the ability to prescribe medication-assisted treatments, such as buprenorphine, to treat opioid addiction. The bill was recently passed by the House and now goes to the President for his signature. This is a major victory for CRNAs after months of grassroots and lobbying efforts to ensure this language would remain in the final bill. Read the AANA press release regarding this important legislation.

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Call for Abstracts to be Presented at 2019 AANA Annual Congress

Submission process opens: October 1, 2018
Submission deadline: November 15, 2018

You are invited to submit an abstract for consideration to present at the 2019 AANA Annual Congress on August 9-13, 2019, at the Hyatt Regency Chicago, Chicago, Ill. Present your topic to thousands of CRNAs and SRNAs from across the nation, representing various practice settings and levels of leadership.

Selection Process
The new Abstract ScoreCard platform makes it easier than ever to submit your paper. AANA will accept up to three submissions per presenter with a maximum of two presenters per abstract submitted.

The submission process opened on October 1, 2018, and the deadline for submissions is November 15, 2018, at 11:59 p.m. CT. Please review the submission guidelines before submitting your abstracts.

Submit your abstracts here.

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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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AANA is a Proud Partner in U.S. National Health IT Week

This October, AANA — as a partner in the advancement of health information technology to help improve healthcare — is a proud partner in U.S. National Health IT Week, being held October 8-12, 2018.

Join AANA in support of this nationwide awareness week focused on the value of health IT for the U.S. healthcare system. There is no better time for the health IT community to come together under one umbrella to raise national awareness!

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Hot Topics

Pharm D Solutions, LLC, Issues Voluntary Nationwide Recall of all Sterile Compounded Drugs

Pharm D Solutions, LLC is voluntarily recalling all sterile compounded drug products within expiry due to concerns that practices at the pharmacy have the potential to pose a risk of contamination to products that are intended to be sterile. These concerns arose following a routine inspection of the pharmacy by the U.S. Food and Drug Administration (FDA). The sterile drug products subject to this recall were distributed nationwide and directly to customers and/or medical facilities. Learn more on the FDA’s website.

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The CDC and The Joint Commission Post New Infection Control Resources

The Centers for Disease Control and Prevention (CDC) and The Joint Commission released new infection control resources for podiatry, orthopedic, and pain management settings. These free online resources are part of ADOPT (Adaptation and Dissemination of Outpatient Infection Prevention), which adapt, enhance and disseminate CDC guidance in outpatient settings. The goal is to improve practice and protect patients and staff across diverse outpatient settings and services. The resources include a checklist for other outpatient settings.

The guides cover several topics, including infection prevention and control program and infrastructure, education and training, safe injection practices, medical device reprocessing, and environmental cleaning. The Joint Commission encourages ambulatory health organizations to use the guides, which can be customized for facility-specific plans. Read more.

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Upcoming FDA Adverse Event Reporting Webinar

Join the U.S. Food and Drug Administration (FDA) for a complimentary webinar on Oct. 9 at 1 p.m. ET to learn more about the FDA Adverse Event Reporting System (FAERS) Public Dashboard. AANA members can apply for Class A CE credit for this webinar. Register here.

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International Conference On Opioids (ICOO 2019): Call for Abstracts

The International Conference On Opioids (ICOO 2019) Program Committee is now accepting abstracts for presentations, posters, workshops and Corporate Satellite Symposia to be presented during the 8th Annual ICOO, June 9-11, 2019, in Boston.

Read more.

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NewsMakers: CRNAs Groom and O'Donnell Named 2019 SSH Fellows

Jeff Groom, PhD, CRNA, ARNP, and John O'Donnell, DRPH, MSN, CRNA, have been named 2019 Fellows of the Society of Simulation in Healthcare Academy. They are the first CRNAs named as fellows of the society.

They are two of 11 new fellows in the 2019 class. They will be formally inducted into the SSH Academy on January 26, 2019, at the International Meeting on Simulation in Healthcare (IMSH) in San Antonio.

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NewsMaker: CRNA Jeff Kopecky Shares His Facility is Award Winner

Thanks to Jeff Kopecky, MAE, CRNA, for the news that his facility, Providence Hood River Memorial Hospital, in Hood River, Oregon, has received the 2018 American Heart Association Stroke Readiness Silver Plus Award, the Practice Greenhealth Environmental Excellence Award 2018, baby-friendly certification from World Health Organization in 2016, and was ranked the No. 1 hospital for safety in Oregon by Consumer Reports in 2015. Read more.

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NewsMaker: CRNA Operates Prep School for Future Military

Arnold T. Stocker, DNP, CRNA, EMTP, LTC, USAF, a CRNA in Florida, has served more than 40 years in the military, and operates a preparatory school, South Florida Tactical Athletes, for youth wishing to join the coveted special operations forces in the U.S. military.

Read more.

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NewsMaker: CRNA Jill Stulce Emphasizes Science in Nurse Anesthesia Program

Jill Stulce, PhD, CRNA, is the program administrator of Webster University's nurse anesthesia program. In an interview with a local TV station, Stulce describes how Webster's environment is conducive to educating and training scientists. 

Read more.

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NewsMaker: CRNA Retires After 55 Years at Charles George VA Medical Center

Mickey Donathan, BSN, CRNA, has retired after 55 years at the Charles George VA Medical Center in Asheville, N.C.

"When someone is sick, when someone wants vacation, she'll give up her off time to work," says Susan Bazemore, chief of anesthesia at the VAMC.

Calculating conservatively, Bazemore and Donathan estimate Donathan has handled 500 patients a year, just at the VA, meaning she's anesthetized about 8,500 veterans over the years.

Read more.

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AANA Member Benefits

CRNA Financial Planning, 100 px
Learn How to Structure Your Business to Reduce Taxes

As a freelancer, you’re both a CRNA and a business owner, which means you have a lot more responsibilities. A few wrong mistakes could mean losing money or facing tax penalties. You don’t want to wind up paying more than you ‘should’ in federal income taxes, nor do you want to be hit with an unpleasant surprise when it comes time to file your taxes.

When tax season comes around, some CRNA business owners and self-employed professionals are shocked to see their tax bill. While there’s no avoiding taxes, there are legal ways to structure your business and your salary to reduce taxes.
One such opportunity is reducing FICA self-employment taxes for S corporations. Learn more.

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Nationwide: Best Times to Buy

Different products follow different cycles of pricing, depending on everything from holidays to weather to annual trade shows. Check out our month-by-month suggestions for the best deals and steals.

Nationwide Purchasing

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Certified Registered Nurse Anesthetist: Memorial Medical Center – Springfield, IL, United States

Our CRNAs administer general, regional, and MAC anesthesia to patients of all ages and any ASA status. The CRNAs work in a collaborative team environment with 60 CRNAs, 23 Anesthesiologists and 12 Anesthesia Techs to assist with room turnover. The CRNAs serve as Clinical Instructors for SIUE and Millikin/Decatur Nurse Anesthesia programs.

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CRNA: Orlando Health / Arnold Palmer Hospital for Children – Orlando, FL, United States

Stable group with 9 doctors and 12 CRNAs seeking 1 to 2 CRNAs for a full-time salaried position; guaranteed 40 hours per week. Attractive schedule, minimal weekends and shared holidays. Providing Anesthesia for Level 1 Pediatric Trauma Center, Level III NICU, outpatient surgeries, Radiology and GI Services. No call, competitive salary and benefits.

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Nurse Anesthetist: VCU Health – Richmond, VA, United States

VCU Health System's ANES – Anesthesiology is seeking a Full-time Anesthetist to provide anesthesia services at VCU Medical Center for all age groups. Our CRNAs have the opportunity to precept and mentor Nurse Anesthesia students enrolled in VCU School of Nurse Anesthesia.

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BANNER UNIVERSITY MEDICAL GROUP (BUMG) is seeking a CRNA to join our team at Banner University Medical Center – Tucson (BUMC-T). You’ll be involved in clinical management of patients, performance of therapeutic and diagnostic procedures, interpretation of diagnostic tests, prescribing medications, patient education, consultation, and research.

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Certified Registered Nurse Anesthetist (CRNA): University of Maryland Medical System – Baltimore, MD, United States

As a CRNA at UMMC, you’ll be joining a team of Pioneers in Care. You’ll get to experience the most challenging cases, in a highly collaborative environment using the most innovative equipment and technology. We are changing the face of medicine, literally.

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Certified Registered Nurse Anesthetist: SANFORD HEALTH – Fargo, ND, United States


Sanford Health Fargo Anesthesia Department is currently seeking Certified Registered Nurse Anesthetists (CRNA) to join its current group of 21 anesthesiologists and 72 CRNAs.

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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!

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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.

Patient-Controlled Versus Clinician-Controlled Sedation with Propofol

Researchers launched a systematic review and meta-analysis to compare patient-controlled sedation (PCS) with propofol against clinician-controlled sedation (CCS) with propofol in therapeutic and diagnostic settings. After searching the literature through October 2017, the team from the anesthesiology division at Geneva University Hospital identified 13 relevant studies with about 1,100 participants collectively. Compared with CCS, the Swiss investigators found no higher risk of oxygen desaturation with PCS, nor did patient control influence the amount of propofol administered or the level of satisfaction experienced by the patient or the clinician. PCS did, however, appear to lower the risk of oversedation as well the risk for rescue intervention due to sedation-associated adverse events. Although promising, the quality of the evidence was considered low. The researchers conclude that high-quality trials are needed to better evaluate the risks and benefits of PCS.

From "Patient-Controlled Versus Clinician-Controlled Sedation with Propofol"
Anesthesia & Analgesia (10/18) Vol. 127, No. 4, P. 873 Kreienbühl, Lukas; Elia, Nadia; Pfeil-Beun, Elvire; et al.

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National Survey Finds No Clear Consensus on Patient Selection Criteria for ASCs

Appropriate and uniform standards for patient selection are largely missing in U.S. ambulatory surgery centers (ASCs), according to a nationwide poll of anesthesia providers. Based on about 1,200 responses, researchers from the University of Nebraska Medical Center determined that almost 45 percent of survey participants work at ASCs that accept patients with chronic obstructive pulmonary disease (COPD) on home oxygen. The vast majority also admit patients with body mass index above 35 (94 percent) as well as those with coronary artery disease or insulin-dependent diabetes (more than 90 percent for each). Meanwhile, 20 percent of anesthesia providers say their ACS has no defined policy on whether or not to service pregnant women or patients with congestive heart failure. The study's authors say the findings underscore the need for consensus on evidence-based inclusion and exclusion criteria at ACS facilities. "Due to advances in both surgical and anesthetic techniques ... we are seeing an ever-increasing number of cases being done in the outpatient setting," said researcher Nicholas Heiser, MD. "Simultaneously, the general population is increasingly obese, elderly, among other trends that lead to an increase in patient comorbidities. Anesthesiologists will be tasked with being the gatekeepers with respect to determining who is and who is not safe for outpatient surgery."

From "National Survey Finds No Clear Consensus on Patient Selection Criteria for ASCs"
Anesthesiology News (10/02/18) Raj, Ajai

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Greater Occipital Nerve Block Potentially Effective for Acute Migraines

In a small study, greater occipital nerve block (GONB) offered some relief to acute migraine patients who sought emergency care after first-line metoclopramide failed to improve their symptoms. A total of 13 participants were randomly assigned to GONB, which entailed an intradermal injection of 3 mL of bupivacaine 0.5% adjacent to the greater occipital nerve bilaterally. The 15 patients who underwent "sham" treatment, by comparison, received an injection of 0.5 mL of bupivacaine 0.5% into the posterior scalp overlying the greater occipital nerve bilaterally. The primary endpoint was headache intensity one half-hour after treatment. The sham patients were no better after 30 minutes, but 31 percent of the GONB patients were headache-free. The moderate relief came at a cost for a few patients who developed shingles; but otherwise patients reported only slight effect, such as injection-site pain.

From "Greater Occipital Nerve Block Potentially Effective for Acute Migraines"
Neurology Advisor (09/27/18)

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Minimal Effective Weight-Based Dosing of Ondansetron to Reduce Hypotension in Cesarean Section Under Spinal Anesthesia

Researchers wondered if they could pinpoint the optimal amount of ondansetron needed, based on patient weight, to reduce hypotension following spinal anesthesia for cesarean section. Their prospective study involved more than 200 expecting women, who were randomly assigned to normal saline, 0.05 mg/kg of ondansetron, or 0.1 mg/kg of ondansetron. Treatment was delivered intravenously five minutes prior to anesthesia induction; and patients were subsequently monitored for a number of outcomes. Amount of blood loss, overall heart rate, and ephedrine requirements were comparable between all three treatment arms. Hypotension rates also were not markedly different, affecting 81.9 percent of the control group, 84.5 percent of the low-dose ondansetron group, and 73.6 percent of the higher-dose patients. Based on the results, the investigators concluded that ondansetron at doses of 0.05 or 0.1 mg/kg did not prevent hypotension in patients undergoing C-section.

From "Minimal Effective Weight-Based Dosing of Ondansetron to Reduce Hypotension in Cesarean Section Under Spinal Anesthesia"
Medscape (09/26/18)

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Liposomal Bupivacaine Did Not Improve Pain, Function in Patients with Distal Radius Fractures

Based on study findings, supplementing supraclavicular nerve block does not reduce pain or improve function in patients suffering from distal radius fractures. Researchers worked with a sample population of 46 patients who received supraclavicular nerve block for open reduction and volar plating, with or without liposomal bupivacaine. A comparison of VAS pain score and Quick-DASH function score at 18 hours, 72 hours, one week, and two weeks post-procedure revealed no meaningful differences at any of those intervals between participants who received liposomal bupivacaine and participants who did not. Although increased postoperative pain and poorer function were associated with pain catastrophizing scores, researcher Yen Hsun Chen, MD, says these scores were not influenced by the additional of liposomal bupivacaine. "We did not see a rebound pain phenomenon in our cohorts, even in patients who only received a block," according to Chen, who presented the research at the American Society for Surgery of the Hand annual meeting in Boston.

From "Liposomal Bupivacaine Did Not Improve Pain, Function in Patients with Distal Radius Fractures"
Healio (09/25/2018) Tingle, Casey

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Results From the SOLVE-TAVI Trial Reported

Evidence points to local anesthesia as a feasible alternative for transcatheter aortic valve replacement (TAVR) patients with intermediate to high surgical risk. Results from the SOLVE-TAVI clinical study, the first randomized trial to compare general and local anesthesia in this setting, were recently unveiled at the Transcatheter Cardiovascular Therapeutics symposium. Registry data have suggested benefits from using local over general anesthesia, but until now there have been no adequately powered randomized trials to support that premise. SOLVE-TAVI involved 447 patients with severe symptomatic aortic stenosis who underwent one technique or the other. A composite of all-cause mortality, stroke, myocardial infarction, infection requiring antibiotics, and acute kidney injury at 30 days affected 27 percent of the local anesthesia patients and 25.5 percent of the general anesthesia patients. Duration of procedure, valve-related outcomes, and clinical results also were similar between the groups. "The SOLVE-TAVI trial is the first adequately powered randomized trial comparing local versus general anesthesia in patients with symptomatic aortic valve stenosis undergoing TAVR," notes Holger Thiele, MD, director of the Heart Center Leipzig—University Hospital in Germany. "Results indicate that local anesthesia is both safe and effective and may be a good option for those patients undergoing TAVR with an intermediate or high surgical risk."

From "Results From the SOLVE-TAVI Trial Reported"
Medicalxpress (09/24/2018)

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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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October 4, 2018