Anesthesia E-ssential

AANA Anesthesia E-ssential, September 19, 2019
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CRNAdvocacy Alert: Tell CMS You Support its Proposal to Allow CRNAs to Perform the Pre-anesthetic Assessment in ASCs

The Centers for Medicare & Medicaid Services (CMS) recently published a preview of its 2020 Physician Fee Schedule proposed rules. We are pleased to report that, at the AANA's request, CMS included a proposal that would allow CRNAs to provide the pre-anesthetic evaluation in Ambulatory Surgery Centers (ASCs) as part of the Conditions for Coverage (CfC).

The Medicare ASC CfCs are federal regulations with which ASCs must comply in order to participate in Medicare. Currently, the ASC CfCs require a physician to examine the patient immediately before surgery to evaluate the risk of anesthesia and the procedure to be performed, precluding CRNAs from performing the pre-anesthetic evaluation.

This can be a major victory for CRNAs and our patients, but we need your help to get it across the finish line. The proposed rule is open for comments until Sept. 27, 2019. And you can guarantee that thousands of our colleagues at the American Society of Anesthesiologists (ASA) will be submitting comments opposing this important proposal which, in its words, "could compromise patient safety."

We urge every AANA member to submit a comment to CMS supporting its proposal to allow CRNAs to perform the pre-anesthetic evaluation in ASCs.

Please follow the instructions below to submit your comment TODAY!
1. Log into the CRNA-PAC website with your AANA username and password.

2. You will be directed to a sample comment letter. Please personalize this letter so that it is not seen by CMS as a "form" letter. We strongly suggest that you include the type of facility in which you practice.

3. Click "send letter" to have your letter posted to the comment site. Please note that all comments are public.

If you have any questions, please don't hesitate to contact AANA Federal Government Affairs at or 202-484-8400
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Hot Topics

NINR Reopens Search for Director

After facing backlash from nurses over the appointment of a dentist, Lawrence Tabak, DDS, PhD, to lead the National Institute of Nursing Research (NINR), the federal research institute announced Sept. 16 that Dr. Tabak is out as interim director and the search is on for a new director. Let’s put a CRNA in this position! Applications are due by Nov. 18.
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The Dangers of E-Cigarettes

JUUL, e-cigs, vapes – these are some of the many names that electronic nicotine delivery systems (e-cigarettes) go by. A common misconception about e-cigarettes are that they are safe, where in fact they still contain toxic chemicals. From 2011 to 2017, there has been over a 10% increase of use by high-schoolers and an alarming rate of increase by middle school students and young adults. Much is still not known on the dangers of e-cigarettes. As stated by the truth initiative’s most recent campaign, “Don’t use humans as test subjects.” Visit the AANA page Be Healthy: Stop Smoking for tips to quit the habit once and for all.
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Podcast: Understanding Malpractice Insurance Options with John Fetcho

From policy type and limits of liability to cost and choosing the right company, there are many things to consider when purchasing malpractice insurance coverage. John Fetcho, director of AANA Insurance Services, will help you better understand malpractice insurance as it relates to CRNAs and clear up any misconceptions. Listen now.
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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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Meetings and Workshops

AANA Meetings: Refresh Your Knowledge and Make New Connections

Connect with your peers at a live nurse anesthesia learning experience. Earn Class A CE credits, build your support network, and meet AANA leaders.

Ultrasound-Guided Peripheral Nerve Blocks
September 21 - 22, 2019 AANA National Headquarters, Park Ridge, Ill.

Spinal Epidural with Obstetric Essentials Workshop
October 24 - 26, 2019 AANA National Headquarters, Park Ridge, Ill.

AANA Leadership Summit: Empower the Leader Within
November 8 - 10, 2019 Naples Grande Beach Resort, Naples, Fla.

To view all upcoming live events, visit
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CRNA in New London, CT

Lawrence Memorial Hospital/Envision Physician Services — New London, CT
Envision Physician Services has an exciting new opportunity for qualified CRNAs to join our team in New London, CT! This is a full time opportunity to join the well-established group of 11 physicians and over 20 CRNAs.  We will also consider part time candidates who will commit to 24 hours per week.  The practice covers Lawrence Memorial Hospital in New London as well as 2 surgery centers in the region. The New London area is located on the coast in Southeastern Connecticut and is centrally located between Boston and New York City. 
Opportunity Highlights:
  • $25,000 start date bonus!
  • Very Flexible scheduling/variety of shifts; day and night shifts available
  • Excellent compensation and bonus structure with additional call pay
  • Generous PTO and true work/life balance
  • Robust benefits package including medical, dental, vision, and 401k (effective day one!)
  • 100% paid malpractice insurance with tail coverage
  • SRNAs Receive Monthly Stipend (Learn more about our Earn While You Learn Program!
Learn more.
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CRNA in Tucson, AZ

Banner University Medical Center — Tucson, AZ

BANNER UNIVERSITY MEDICAL GROUP (BUMG) is seeking a CRNA to join our team at Banner University Medical Center – Tucson. BUMC-T values patient-centered care and health care innovation. We were named a U.S. News and World Report Best Hospital and ranked No. 3 Hospital in Arizona. Tucson, located in the Sonoran Desert surrounded by multiple mountain ranges, is a very friendly Southwestern town where you’ll have access to a multitude of yearlong outdoor activity options, from cycling to boating to golf, to simply sitting and enjoying some of Mother Nature’s most astounding creations. With resources and lifestyle opportunities like these, what you envision for your professional career and personal life environment can become your reality.

Details and requirements include:
  • Current Board, CPR, BLS, and ACLS certifications
  • Current Arizona License
  • Critical Care training and experience
  • Responsible for performing general, regional, and monitored anesthesia services across a broad scope of the health continuum in a Directed Program
  • Some weekends may be required
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Certified Registered Nurse Anesthetist in Springfield, IL

Memorial Health System  — Springfield, IL

Status: Full-Time, Hospital employed

Schedule: Convenient flexible schedule with 8, 10 and 12 hour shift options available

Basic Functions:
This position embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision and values. 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 50 CRNAs, 21 Anesthesiologists and 12 Anesthesia Techs to assist with room turnover and stocking. The CRNAs serve as Clinical Instructors for SIUE and Millikin/Decatur Nurse Anesthesia programs.

Due to our continued growth, Memorial Medical Center has multiple needs for Certified Registered Nurse Anesthetists.  Positions are available full time in the Main OR, CVOR or as a split 50/50 between Main OR and CVOR.

Learn more.
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CRNA in Fredericksburg, VA

Mary Washington Healthcare — Fredericksburg, VA

CRNAs-Sign-On Bonus $15,000

New Grads Welcome

Full-time opportunities for CRNAs (day & night shifts) in both inpatient and outpatient settings.

Mary Washington Healthcare – ranked #2 in the Washington, DC area by U.S. News and World Report, has excellent opportunities for CRNAs to join our experienced team of surgeons who perform everything from complex abdominal surgeries to minor outpatient procedures.
Ideal candidates will have a valid VA Nursing license, valid VA licensure as a Nurse Practitioner in Anesthesia and current certification as a Nurse Anesthetist by the National Board of Certification and Recertification (NBCRNA). If pending initial certification, evidence of graduation from an accredited nurse anesthesia program and of eligibility for board exam is required.

Our fast-growing healthcare system provides a level of surgical excellence that is unsurpassed in our region, and we have opportunities at three different locations, including: 
  • Magnet-designated Mary Washington Hospital – our Level II Trauma Center, with 15 operating rooms and 1 Cysto room performs Cardiac, Thoracic, General/Vascular, Ortho, Neurology, Plastics, and EENT.
  • Stafford Hospital – our 100-bed community hospital that provides high-quality care from a patient's initial visit through diagnosis, treatment, and post-surgical follow-up.
  • Fredericksburg Ambulatory Surgery Center (FASC) – the only tertiary-level outpatient surgery facility in the region
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Certified Registered Nurse Anesthetist in Allentown, PA

Lehigh Valley Health Network  — Allentown, PA

A Certified Registered Nurse Anesthetist (CRNA) is an advanced practice registered nurse (APRN) who practices both autonomously and in collaboration with a variety of health providers on the interprofessional team to deliver high-quality, holistic, evidence-based anesthesia and pain care services. The CRNA cares for patients at all acuity levels across the lifespan in a variety of settings for procedures including, but not limited to, surgical, obstetrical, diagnostic, therapeutic, and pain management. 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.

Association Between Post–Dural Puncture Headache After Neuraxial Anesthesia in Childbirth and Intracranial Subdural Hematoma

Women who undergo neuraxial anesthesia for childbirth often develop post-dural puncture headache, which researchers suspected might elevate their risk for intracranial subdural hematoma. Using hospital discharge data, they designed a large cohort study around women who gave birth in the United States from 2010 to 2016. After excluding repeat deliveries, deliveries lacking two months of follow-up data, and deliveries where the mother received diagnostic lumbar puncture, the investigators were left with a sample population of 22.1 million patients and deliveries. Post-dural puncture headache occurred within two months postpartum in 68,374 women, for an overall rate of 309 per 100,000 deliveries. Subdural hematoma was documented 342 times, for an overall rate of 1.5 per 100,000 women; but the incidence increased to 147 per 100,000 patients when looking at only those who experienced post-dural puncture headache. The researchers believe the finding, which supports the theory that post-dural puncture headache after childbirth increases the odds for intracranial subdural hematoma, warrants further investigation.

From "Association Between Post–Dural Puncture Headache After Neuraxial Anesthesia in Childbirth and Intracranial Subdural Hematoma"
JAMA Neurology (09/19) Moore, Albert R.; Wieczorek, Paul M.; Carvalho, Jose C.A.; et al.

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Anesthetic Drug Sevoflurane Improves Sepsis Outcomes, Animal Study Reveals

The medical community currently lacks a standardized protocol for anesthetizing patients with sepsis before they undergo surgery or imaging procedures. However, according to new research, the particular agent used for general anesthesia may influence survival outcomes in this patient population. To explore further, the researchers induced sepsis in three separate groups of mice, giving them one of two inhaled anesthetics or no anesthetic at all. They observed better survival rates and other favorable outcomes in the mice that received sevoflurane. Isoflurane administration, however, was associated with poorer sepsis outcomes compared to receiving no anesthetic. "With the prevalence of sepsis on the rise and the mortality rates of severe sepsis already extremely high, it is crucial that our findings are validated in a human model," said Koichi Yuki, MD, an associate professor of anesthesia at Boston Children's Hospital. "We are hopeful that one day, the findings from this study will improve the outcomes of patients with sepsis." The study appears in The FASEB Journal.

From "Anesthetic Drug Sevoflurane Improves Sepsis Outcomes, Animal Study Reveals"
Medical Xpress (09/12/19)

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Single-Shot and Continuous Fascia Iliaca Blocks Similar for Geriatric Hip Fracture

Single-shot and continuous fascia iliaca blocks deliver a comparable level of pain relief to older patients suffering from hip fractures, researchers report. The team from Cedars-Sinai Medical Center in Los Angeles analyzed outcomes in 263 patients who presented to the facility with hip fracture between March 2017 and January 2018. While men and women treated with a single-shot block experienced similar pain scores, levels of narcotic consumption, time to ambulation, hospital length of stay, and opioid-related complications as those treated with continuous block via catheter, the investigators were surprised by the single-shot performance. "We expected that patients treated with a nerve catheter would have less pain requirements," explained co-primary investigator Carol Lin, MD. "But we actually found that a single-shot versus a continuous catheter failed to show much of a difference with patients." Going forward, she said, it would be easier to take the single-shot approach, given that catheters require much more sophisticated resources.

From "Single-Shot and Continuous Fascia Iliaca Blocks Similar for Geriatric Hip Fracture"
Anesthesiology News (09/13/19) Kronemyer, Bob

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Does Intravenous Acetaminophen Reduce Perioperative Opioid Use in Pediatric Tonsillectomy?

Researchers explored intravenous acetaminophen as an opioid-sparing adjuvant during pediatric tonsillectomy. The retrospective study considered 166 patients, aged one to 16 years old, at a single children's hospital. A total of 74 youngsters received intraoperative I.V. acetaminophen during tonsillectomy and 92 did not. Morphine demand was lower, both perioperatively and in the post-anesthesia care unit, for the intervention group. The finding indicates the I.V. acetaminophen can reduce the amount of opioid needed to achieve optimal pain relief after tonsillectomy. However, taking that approach could slightly prolong time to discharge readiness as well as increase the risk for postoperative vomiting.

From "Does Intravenous Acetaminophen Reduce Perioperative Opioid Use in Pediatric Tonsillectomy?"
American Journal of Otolaryngology (09/19) Chisholm, Allison G.; Sathyamoorthy, Madhankumar; Seals, Samantha R.; et al.

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A Randomized Controlled Trial Comparing Early Versus Late Oral Feeding After Cesarean Section Under Regional Anesthesia

Allowing patients to eat sooner than later after cesarean section with regional anesthesia is both medically and mentally beneficial, according to new evidence. The study took place in Thailand and included 69 women who were randomly allocated to Early Oral Feeding (EOF) plus 67 others who were designated to Late Oral Feeding (LOF). Patients in the EOF group began to sip water six to eight hours after surgery, while patients in the LOF group waited until after 12 hours had passed. All were then placed on a stepping diet as tolerated. The women who received EOF experienced an earlier return of bowel movement and also expressed greater satisfaction with postoperative consumption than their counterparts in the LOF group. With no between-group difference in gastrointestinal complications, the study results support EOF for women who undergo uncomplicated C-section under regional anesthesia.

From "A Randomized Controlled Trial Comparing Early Versus Late Oral Feeding After Cesarean Section Under Regional Anesthesia"
International Journal of Women's Health (09/19) Vol. 11, P. 519 Mawson, Apinun Luksanachinda; Bumrungphuet, Sommart; Manonai, Jittima

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Potential of Immersive VR to Provide Long-Term Analgesia in Chronic Pain Examined

Immersive virtual reality (VR) could provide durable relief for chronic pain, Canadian researchers speculate. The technique previously has shown efficacy during treatment, with the effect dissipating once the intervention has ended. With that in mind, the investigators have recruited 47 adults with chronic pain for a randomized, longitudinal study. Some participants were assigned to receive immersive VR using a stereoscopic headset, three times a week for at least 30 minutes. The others were exposed to a two-dimensional computer screen, during sessions of the same duration. All were asked to describe and rate their pain levels at baseline as well as before and after each intervention. That data is now being processed, with no association documented between VR and major adverse events thus far. "While the results of this research study are not yet available, the design of the study itself addresses crucial aspects of the viability of VR interventions for chronic pain patients," said the researchers, who outlined the study at PAINWeek 2019 this month in Las Vegas.

From "Potential of Immersive VR to Provide Long-Term Analgesia in Chronic Pain Examined"
Clinical Pain Advisor (09/12/19) May, Brandon

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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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Attn: Cathy Hodson
E–ssential Editor
September 19, 2019
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