Anesthesia E-ssential

AANA Anesthesia E-ssential, September 26, 2019
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New: Five Things You Need to Know About CRNA Malpractice Insurance

Malpractice insurance can be complicated. Gain a basic understanding of CRNA Malpractice Insurance with AANA Insurance Service’s new Five Things You Need to Know resource. Learn more.
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Employers – When You Get Compensation Right, You Attract and Retain the Best CRNA Talent

How are your benefits and compensation packages stacking up against other programs and facilities? With the official 2019 Compensation and Benefits Report, review salary and benefit trends across the U.S., so you can remain competitive and compensate your staff fairly:
  • 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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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: CRNA Volunteers in Bahamas After Hurricane, Urges Others Not to Forget

After Hurricane Dorian, Mayo Clinic nurse anesthetist Michele Woodrum, MSN, CRNA, ARNP, helped set up a makeshift health clinic in the devastated community of Hope Town, on Elbow Cay in the Bahamas. She gave tetanus vaccinations, dealt with coughs and colds, treated cuts, a dog bite, and heat exhaustion.

"I don't know if people understand what's going on right now," she told First Coast News in Jacksonville, Fla. "It's a crisis, an international crisis, and people have very short attention spans. This is going to be going on a long time. People are going to be rebuilding, physically and emotionally, for a long time." Learn more.
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NewsMaker: Maine Association of Nurse Anesthetists Holds "Swing for Success" Golf Tournament to Benefit Those in Opioid Recovery

The Maine Association of Nurse Anesthetists, Rocky Knoll Golf Course, and Healthy Acadia partnered recently to host the second annual, "Swing for Success" golf tournament. Proceeds from the event will build the Downeast Recovery Support Fund, which assists those in recovery from opioids and other substances. 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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Graduate Faculty – Doctor of Nursing Practice Degree Program with Nurse Anesthesia Track (CRNA): Marian University, Indianapolis, Indiana

Marian University seeks a highly motivated, energetic, doctoral program enrolled or doctoral-prepared Certified Registered Nurse Anesthetist (CRNA) Graduate Faculty to assist in developing and teaching assigned courses in the Nurse Anesthesia Doctor of Nursing Practice (DNP) graduate program. Additionally, this position will advise/mentor program students, serve as a primary advisor on DNP scholarly projects, and work collaboratively with the graduate nursing faculty/Marian University faculty and staff. Candidates who do not currently possess a doctoral degree but are experientially qualified and enrolled in a doctoral program with an expected degree completion within 12-18 months of application may be considered for this position.

Essential Duties and Responsibilities:
  • Designs and delivers course material based on the graduate philosophy, course description, course outcomes, and program outcomes.
  • Translates learning material to online, hybrid, and synchronized classes.
  • Evaluates student work and clinical performance based on outcome rubrics/clinical evaluations.
  • Monitors and evaluates student e-portfolios.
  • Advises/Mentors assigned program students.
  • Serves as an advisor for students' DNP Scholarly Projects.
  • Engages in clinical practice to maintain professional skills and serve as a model/resource for faculty and students.
  • Participates in student recruitment, student selection, and public relations.
  • Other duties as assigned.
Learn more.
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Midwestern Academic Setting – Join CRNA Team: University of Missouri, Columbia, Missouri

University of Missouri Department of Anesthesiology is seeking additional CRNAs to join their dynamic academic health center in mid-Missouri, home to the only children's hospital and Level I Trauma Center between St. Louis and Kansas City. A tremendous opportunity to join a group of energetic, self-motivated and culturally diverse faculty and staff with a strong commitment to support the growth in surgical volumes and expansion of surgical facilities. Highlights of these important positions with the region's most comprehensive healthcare network include:
  • Enjoy a variety of cases via MU's main hospital, Women's & Children's Hospital, Orthopedic Institute and surgical/endoscopy centers.
  • Variety of shifts available: 8-,10-,12- and 24-hour options available
  • Only 1-2 weekend call shifts per year (no nights).
  • Mentoring program available to newer graduates and new hires.
  • Impressive collaboration between CRNA and MD staff - offering medical direction vs. supervision.
  • Opportunity to participate in research studies, clinical trials and operational improvement projects.
  • Full benefit package, including pension/retirement (including employer contributions) and all insurances and HSA.
  • Competitive salary with paid options for additional shifts or extra call if desired.
  • Benefits also provide a generous PTO plan, including paid holidays.
Learn more.
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CRNA: Atlanta Women’s Center, Atlanta, Georgia

Outpatient Independent Contractor CRNA – TUES thru SAT – NO NIGHTS – NO HOLIDAYS – NO CALL.

Atlanta Women’s Center, a state-licensed ambulatory surgical center located in the Buckhead neighborhood of Atlanta seeks an experienced CRNA as Independent Contractor to deliver IV sedation.

AWC has delivered excellence in abortion and reproductive healthcare for over 40 years, always at the forefront of best practices in our field. Our team members are committed to advocating and caring for patients seeking legal, safe, compassionate abortion care, in addition to assistance for adoption services and prenatal care.

AWC is committed to continuous improvement and we believe that all people must have access to high quality, compassionate and respectful reproductive healthcare. AWC is an active member of the Abortion Care Network and accredited by the National Abortion Federation and Georgia Department of Health. Learn more.
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Certified Registered Nurse Anesthetist: McLeod Health, Dillon, South Carolina

As part of McLeod Health, the region's largest healthcare network, McLeod Health Dillon, a 79-bed, acute care facility, provides a variety of services to not only the city of Dillon but also its neighboring counties in both South and North Carolina. Some of these services include: cardiac, women's, surgical and orthopedic. Each member of McLeod Health Dillon provides patient-centered care with compassion and understanding.

Department Highlights
  • Four ORs which include general surgery, endoscopy and OB/GYN.
  • Currently averages around 180 cases per month.
  • Offers a culture of patient safety and a teamwork environment.
  • Autonomy.
  • Flexible hours - some days you are able to go home early but receive a full day's pay due to the low number of scheduled cases that day.
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.

Palonosetron Versus Ondansetron for PONV After Total Abdominal Hysterectomy Under Spinal Anesthesia with Intrathecal Morphine

Because palonosetron prevents postoperative nausea and vomiting (PONV) after general anesthesia, researchers wondered if it produces the same effect under neuraxial anesthesia. A team in Brazil designed a prospective trial and enrolled women having total abdominal hysterectomy (TAH) under spinal anesthesia with intrathecal morphine—an anesthetic agent that is highly effective in this setting but also strongly associated with PONV. Participants, all of whom were considered at high risk for the complication, were randomly assigned to receive either palonosetron or ondansetron. In addition, all received care that included spinal anesthesia with intrathecal morphine and dexamethasone. The results, published in BMC Anesthesiology, showed no between-group difference in the rate of early- or late-onset nausea or early-onset vomiting. However, the overall incidence of PONV was lower in the palonosetron group, at 42.9% versus 52.9% in the ondansetron group. Moreover, the rate of late-onset vomiting was significantly lower with palonosetron.

From "Palonosetron Versus Ondansetron for PONV After Total Abdominal Hysterectomy Under Spinal Anesthesia with Intrathecal Morphine"
Medscape (09/20/19)

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Examining the Effect of Ketamine Infusion on Opioid Consumption After Chest Trauma

Researchers are playing down the benefit of ketamine infusion therapy as an opioid-sparing pain regimen for rib fracture caused by blunt chest trauma. Their study involved 376 patients admitted to a level one trauma center with rib fracture. All were treated with opioids, and 14 received ketamine infusion as well. The ketamine recipients consumed a median 124.5 oral morphine equivalents (OMEs), compared with 30 OMEs for the opioid-only group. The difference was not considered significantly significant, however, owing to the small sample size of ketamine users. While ketamine infusion may not lower opioid demand in this setting, the investigators say it may have other value and that more research is warranted to explore this possibility. “By avoiding respiratory and cardiovascular compromise, ketamine may be a safer alternative treatment modality compared [with] opioids in managing pain associated with rib fractures secondary to blunt force traumatic injury,” according to the researchers, who presented the findings at PAINWeek 2019 this month in Las Vegas.

From "Examining the Effect of Ketamine Infusion on Opioid Consumption After Chest Trauma"
Clinical Pain Advisor (09/12/19) Dellabella, Hannah

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TAP Block Not Superior in Children Undergoing Hydrocelectomy or Hernia Repair

Researchers compared the efficacy of two approaches to managing postoperative pain following pediatric hydrocelectomy and/or hernia repair. The small pilot study included 47 patients between the ages of five and 13 years, who all received standard intraoperative anesthetic care. According to randomized assignment, however, an anesthesia provider administered preoperative transverse abdominis plane (TAP) block to 23 of the children and the surgeon administered intraoperative intravenous local infiltration, also known as field block, to the other 24. The study's primary specified outcomes—including postoperative opioid consumption, time to first rescue medication, average pain scores, and parental satisfaction—were not meaningfully different from one treatment arm to the next. “This was a negative result, which I think is valuable to publish,” said Joshua Hozella, MD, an anesthesia provider at Beaumont Health in Royal Oak, Mich. “It's important to find out whether doing an intervention is useful or worth the risks, and in our case ... we determined that it wasn't.” He added that the absence of TAP block superiority in this setting should be confirmed in larger trials.

From "TAP Block Not Superior in Children Undergoing Hydrocelectomy or Hernia Repair"
General Surgery News (09/15/19) Doyle, Chase

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Sub-Hypnotic Propofol Attenuates Intrathecal Morphine-Induced PONV and Pruritus in Parturients Undergoing C-Section

A prospective, single-site study evaluated whether a single sub-hypnotic dose of propofol could prevent postoperative nausea and vomiting (PONV) in women undergoing elective cesarean section. The trial included 345 women, divided randomly and equally into three treatment arms. The rate of PONV was not significantly different between patients who received propofol or metoclopramide as an antiemetic, at 8.7 percent and 7 percent, respectively. Both also were superior to saline which, as a placebo, generated a PONV incidence rate of 93.9 percent. There was a significant difference between the propofol and metoclopramide groups, meanwhile, in terms of postoperative pruritus—which affected 85.2 percent of the controls and 87 percent of the metoclopramide recipients but only 2.6 percent of the propofol recipients.

From "Sub-Hypnotic Propofol Attenuates Intrathecal Morphine-Induced PONV and Pruritus in Parturients Undergoing C-Section"
BMC Anesthesiology (09/14/19) Vol. 19, No. 177 Kampo, Sylvanus; Afful, Alfred Parker; Mohammed, Shiraj; et al.

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Rotator Cuff Repair Surgery: PROSPECT Guidelines for Postoperative Pain Management

For the first time, there are formal guidelines in place to inform pain-relief strategies following rotator cuff repair. The recommendations come courtesy of the procedure-specific postoperative pain management working group (PROSPECT), which published them in Anesthesia. Among the key take-aways, the document lists interscalene brachial plexus blockade as the preferred regional analgesic technique for rotator cuff repair surgery, with suprascapular nerve block to be used as an alternative. Additionally, a single dose of intravenous dexamethasone should be used to prolong the analgesic duration of interscalene brachial plexus block, curtail analgesic use, and introduce anti-emetic relief. Systemic analgesia, according to the PROSPECT collaborators, should include preoperative or intraoperative paracetamol and non-steroidal anti-inflammatory drugs, which should continue to be administered after surgery. Opioids, they say, should only be used as rescue analgesia as needed in the postoperative period.

From "Rotator Cuff Repair Surgery: PROSPECT Guidelines for Postoperative Pain Management"
Specialty Medical Dialogues (09/23/19) Sarkar, Deepanjana

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National Drug Shortage Affects TKA Practice Standards and Outcomes

A nationwide shortage of hyperbaric bupivacaine last year triggered changes in clinical practice, concludes a study that reflects the experience of one California institution. The team from VA Palo Alto Health Care System compared data from 55 total knee replacements performed before the supply squeeze and 54 of the surgeries done while it was in full swing. What they discovered, according to one of the primary investigators, Edward Mariano, MD, was that "behavior does change [and] that you have to adapt. You have to change your practice." The investigators found that 80 percent of the procedures conducted before the shortage incorporated spinal anesthesia, but that share fell to 68 percent once hyperbaric bupivacaine became scarce. The most common substitute for the first-line choice of anesthetic was isobaric bupivacaine. Meanwhile, clinicians also relied more on intrathecal adjuvants—including fentanyl and epinephrine—after the hyperbaric bupivacaine supply dried up. The researchers also counted more cases of nausea and vomiting and other minor adverse events in the post-anesthesia care unit during the shortage. The biggest take-away from the study, Mariano says, was that the lack of hyperbaric bupivacaine had many unintended effects on routine clinical practice and that secondary options did not necessarily deliver optimal care. Going forward, he says, the aim is to improve communication so that everyone can be as informed—and, thus, as prepared—as possible about potential shortages.

From "National Drug Shortage Affects TKA Practice Standards and Outcomes"
Anesthesiology News (09/23/19) DePeau-Wilson, Michael

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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
September 26, 2019