Anesthesia E-ssential

AANA Anesthesia E-ssential, September 6, 2018

Vital Signs

AANA Board of Directors Withdraws Amendment 7 to AANA Bylaws (Article XI Resolutions)

Dear Colleagues,

On September 4, the AANA Board of Directors met via conference call and unanimously voted to withdraw proposed Amendment 7 to the AANA Bylaws (Article XI Resolutions).

I want to assure you that Amendment 7 was never intended to silence the voice of AANA members in the governance of our association. The AANA always has been, and always will be, a member-driven organization. In fact, it is our bylaws that define a resolution as "a written 'main motion' (submitted in advance of the annual Business Meeting) which contains serious subject matter potentially having significant impact on the business of the association." Clearly, the members' intent has always been to have an active voice and drive important issues impacting the profession.

The intent of the amendment was simply to bring Article XI Resolutions in line with the AANA Articles of Incorporation and Illinois state law; a recommendation by our new parliamentarian and co-author of Robert's Rules of Order, Newly Revised, Thomas J. Balch. The Board decided that changing the language in Article XI could have a negative impact on efforts to increase member engagement and participation in the AANA by creating the perception that the amendment was meant to stifle the voice of our members. So much good work has been done by the Board, member task forces, committees, and staff to enhance engagement, participation and communication, that damaging this forward progress due to ongoing debate over Amendment 7 was deemed counterproductive. The considerable, ongoing, and often emotional feedback of the membership via social media and other communication was particularly impactful on the Board's decision-making. Finally, prior to the Board's conference call, the extensive research that had been undertaken by the Bylaws Committee, Resolutions Committee, and AANA parliamentarian and legal counsel which helped frame the development of Amendment 7 in the first place, was reconsidered.

Most likely the inconsistency between bylaws, Articles of Incorporation, and Illinois state law will need to be addressed at some point in the future. Before that time comes, this Board has elected to begin a process that will include member input in the development of bylaw language moving forward. For now, however, as your president I accept full responsibility for the current Board's decision to approve this amendment; for failing to anticipate the possible perceptions of our members; and for not fully appreciating the importance that our members place on the ideology of resolutions to our organization.

In other words, the membership has made itself heard, and the Board has taken the members' concerns to heart. Throughout the year, including in relation to Amendment 7, our work and our decisions have been based only on what we believe to be in the best interests of the collective membership. While some members may not agree with some of our decisions, in our hearts and minds the choices we've made have been based on data as well as feedback, comments, and recommendations from members and staff. Our decision to withdraw Amendment 7 is consistent with that.

I have been honored to serve with a Board comprised of an amazing group of individuals who have worked hard to return the AANA to its "why," are being responsive to member needs, and shoring up our foundation as a member-driven, member service-oriented association where CRNAs feel valued. We have done some remarkable things to reach these milestones, such as initiating a cultural assessment of our organization; amending the CEO Succession Plan and Conflict of Interest Policy; addressing member engagement, recruitment, and retention; developing tools and resources to position our members for new reimbursement models that will impact practice; providing new resources to address the AA issue; initiating a leadership workshop to improve the governance competencies of our members; providing additional funding to support state associations fighting legislative and regulatory battles; developing a new strategic plan that looks ahead 10 years and will make this organization the transformative leader in healthcare; implementing strategies to optimize workforce; and using new and innovative communication channels to connect with the AANA membership. We have sought feedback from the members and considered their ideas, questions, comments, and concerns, often leading to the Board taking bold and sometimes scary steps to move our association forward.

Based on the information provided to the Board, I once again want to assure you that our decision to bring Amendment 7 to the membership was well intentioned. Never did we perceive that our fellow members would see this action as an attempt to silence their voices, especially with so many channels for direct communication available to allow members to be heard by the Board without waiting until Annual Congress. While the member dialog has been essential, impactful, and maybe even cathartic, I apologize for this misstep and the consternation it has caused.

I look forward to seeing you at the Annual Congress in Boston.


Bruce Weiner, DNP, MSNA, CRNA
AANA President
Share Facebook  LinkedIn  Twitter 

Hot Topics

The Joint Commission Explains Standards Development and Survey Process

Have you ever wondered how The Joint Commission develops its accreditation standards or plans and executes the survey and accreditation decision for your facility? Summaries recently released by The Joint Commission answer those questions. These overviews highlight key points, including that standards:
  • Are only developed if they relate to patient safety or quality of care,
  • Have a positive impact on health outcomes,
  • Meet or surpass law and regulation, and
  • Can be accurately and readily measured.
Goals of the survey process include evaluating the organization using standards and elements of performance, and providing education and “good practice” guidance to help staff continually improve the organization’s performance.
Share Facebook  LinkedIn  Twitter 

Product Theater: Mock Malpractice Deposition Presented by AANA Insurance Services and MedPro

Most CRNAs have not witnessed or been involved in a deposition. Get a feel for the unpredictability, intensity, and stress associated with being deposed.

Angela L. Carr, JD, an experienced trial attorney and civil litigator, specializing in professional liability defense, general liability, and employment law, will depose a member of MedPro Groups’ CRNA Advisory Board. “The deposition is an integral part of any malpractice suit,” said John Fetcho, CPCU, ARM, Director of AANA Insurance Services. “We want attendees to recognize its importance and understand the benefit of having your own legal representation.”

This session will take place at the AANA Product Theater on Sunday, Sept. 23rd from 5-6 p.m., with a question and answer period to follow.
Share Facebook  LinkedIn  Twitter 

NewsMaker: CRNA Stephen Klinkhammer Receives Recognition Award

Earlier this year, Mayo Clinic School of Health Sciences alumnus Stephen Klinkhammer, DNP, CRNA, received the school's Recognition of Outstanding Contribution Award at the alumni association's annual dinner and program in Rochester, Minnesota.

Klinkhammer was recognized for his work with veterans, in particular those who served in Vietnam. He has organized fundraisers, founded a veterans group, created a veteran's memorial in a local park, and was involved in creating a Wisconsin Vietnam Veterans memorial parade float, among many other activities and efforts.

"We need to remember the sacrifices of service members in the past and today," says Klinkhammer. "I hope everyone respects that and finds ways to support veterans in our communities."

Read more.
Share Facebook  LinkedIn  Twitter 

NewsMakers: CRNAs Prepare to Hike Mount Kilamanjaro

CRNAs Kristin Waters, Lindsey Diaz, and Julie Canada, will hike Mount Kilamanjaro, a dormant volcano in Tanzania, September 6-22.

They, along with anesthesiologist Georgina Kesterson, will only spend eight days on the mountain, with a day of traveling to and from it. 

Acclimating to the altitude is one of the hardest parts of the hike because it's one of the main things that can send hikers back down the mountain.

Read more.

Share Facebook  LinkedIn  Twitter 



Share Facebook   LinkedIn   Twitter  

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.

New Technique for Tarsal Tunnel Nerve Block Offers Potential for Better Ultrasound Visibility

Stanford University researchers have found a way to circumvent positioning challenges associated with tarsal tunnel nerve block, which delivers effective analgesia when these obstacles are overcome. Until now, the technique required patients with tarsal tunnel syndrome to lie prone or to rotate externally at the hip to expose the inner ankle—often a problem with individuals who are morbidly obese or who suffer from cerebral palsy, for example. Under the new approach, developed by Scott Priztlaff, MD, and Einar Ottestad, MD, patients are instead placed on their backs with the leg neutral. The needle is then introduced to the nerve from the opposite side of the ankle. This takes great skill on the part of the clinician, warn the colleagues, who do not recommend it for novices. There is a risk of injuring the sural nerve and, like with conventional tarsal tunnel blocks, the tibial nerve. However, the new technique, when done properly, offers a host of advantages: enhanced patient comfort levels, excellent ultrasound views, and no additional investment of time or equipment. "We're increasingly doing these procedures on patients who are sicker, more debilitated and heavier," Priztlaff notes, "and I think that's the utility of this approach." He and Ottestad have not yet undertaken a formal study of the alternative method.

From "New Technique for Tarsal Tunnel Nerve Block Offers Potential for Better Ultrasound Visibility"
Pain Medicine News (09/03/18) Vlessides, Michael

Share Facebook  LinkedIn  Twitter 

A Simulation Study to Evaluate Improvements in Anesthesia Work Environment Contamination After Implementation of an Infection Prevention Bundle

A study out of Seattle's Virginia Mason Medical Center demonstrates the value of an infection prevention bundle to mitigate microbiological contamination of the anesthesia work environment (AWE). Tainted equipment and areas represent a potential source of health care-associated infections; but a study involving anesthesia providers tested preventative tactics such as double gloving before intubation, performing hand hygiene before any contact with the anesthesia cart, and keeping all airway equipment in a single designated space. Each of the 25 participants completed two general anesthesia scenarios in a simulated operating room—one with the infection prevention protocol and one without—using a manikin. Investigators tracked AWE after each scenario with an ultraviolet light, reviewed recordings to determine the number and duration of glove removal and hand hygiene events, and recruited blinded observers to rate the images for the presence or absence of fluorescent tracers. The intervention was found to reduce AWE scores by 27 percent, although some sites—such as laryngoscope handles—were universally contaminated despite prevention efforts. Survey results from the anesthesia providers who took part in the experiment indicated that they assigned significant value to the simulations and felt likely to adjust their clinical behavior as a result. The researchers conclude that linking hand hygiene to specific high-impact tasks is an effective approach to controlling AWE that can be put in place quickly without compromising timely patient care.

From "A Simulation Study to Evaluate Improvements in Anesthesia Work Environment Contamination After Implementation of an Infection Prevention Bundle"
Anesthesia & Analgesia (09/18) Vol. 127, No. 3, P. 662 Porteous, Grete H.; Bean, Helen A.; Woodward, Crystal M.; et al.

Share Facebook  LinkedIn  Twitter 

Effectiveness of Lumbar Facet Joint Blocks and Predictive Value Before Radiofrequency Denervation

While there is an established practice of administering facet blocks before radiofrequency ablation, its value as a prognostic tool has not been demonstrated. With facet interventions increasingly being challenged, researchers recruited 229 participants for a randomized trial. The goal was to better understand the efficacy of intraarticular and medial branch facet blocks and their ability to predict radiofrequency ablation outcomes. Patients were randomly assigned to one of the two techniques, or to saline. After one month, anyone with at least a 2-point drop in average pain score and a satisfaction score of 3 or higher on a 5-point scale were followed up to six months. Meanwhile, all saline recipients underwent radiofrequency ablation, along with any patients in the intraarticular and medial branch block groups who experienced a positive diagnostic block but a negative outcome, for a total of 135 patients. The primary outcome for the second phase of the study was average pain score three months post-ablation. The mean reduction in average pain score at one month was not statistically significant between treatment arms, suggesting that facet blocks do not have therapeutic value. However, the share of positive blocks was more than double among the facet block patients than what was observed among those who received control blocks with saline. According to the investigators, that finding suggests that facet blocks may be useful in predicting radiofrequency ablation outcomes.

From "Effectiveness of Lumbar Facet Joint Blocks and Predictive Value Before Radiofrequency Denervation"
Anesthesiology (Summer 2018) Vol. 129, No. 9, P. 517 Cohen, Steven P.; Doshi, Tina L.; Constantinescu, Octav C.; et al.

Share Facebook  LinkedIn  Twitter 

Adjunctive Methadone Use May Reduce Post-Spinal Fusion Opioid Requirements in Pediatric Patients

Intraoperative administration of remifentanil is associated with risk of hyperalgesia, but new evidence indicates that adding methadone could have positive implications for adolescents undergoing spinal fusion. The study involved 60 teenage scoliosis patients randomized to one of three treatment groups: desflurane plus remifentanil, remifentanil plus methadone, and remifentanil plus magnesium. The specified co-outcomes were opioid demand and postoperative pain scores. The opioid requirement was significantly lower in the methadone adjunct patients compared with the desflurane adjunct group, but pain scores between the two sets of participants were comparable. "Given the potential for hyperalgesia with the intraoperative use of remifentanil, the adjunctive use of methadone may be warranted in this patient population," according to the researchers, who report their results in the Journal of Anesthesia.

From "Adjunctive Methadone Use May Reduce Post-Spinal Fusion Opioid Requirements in Pediatric Patients"
Clinical Pain Advisor (08/31/18) Dellabella, Hannah

Share Facebook  LinkedIn  Twitter 

The Impact of Fluoroscopic Confirmation of Thoracic Imaging on Accuracy of Thoracic Epidural Catheter Placement on Postoperative Pain Control

Using contrast-enhancing fluoroscopy could improve the success rate for thoracic epidural anesthesia (TEA) catheter placement after surgery, researchers in Chicago report. The team from the University of Illinois and Advocate Illinois Masonic Medical Center worked with a sample population of 25 patients scheduled to undergo thoracic or upper abdominal procedures. As part of the open-label, prospective investigation, catheters were placed using a thoracic paramedian epidural approach and contrast solution was injected to show the location of the catheter tip in the epidural space. Among the 25 participants, only three catheters were not identified as being in the epidural space. On average, the difference between clinical and radiological assessments of catheter tips was 1.5 vertebral levels; and slightly more than half of the catheters were more than one vertebral level away from clinically assessed level. Placement location had no meaningful impact on pain scores up to 48 hours postoperatively, meanwhile; and correct catheter placement was associated with less opioid consumption, but not statistically significantly so.

From "The Impact of Fluoroscopic Confirmation of Thoracic Imaging on Accuracy of Thoracic Epidural Catheter Placement on Postoperative Pain Control"
Local and Regional Anesthesia (08/18) Vol. 11, P. 49 Aijaz, Tabish; Candido, Kenneth D.; Anantamongkol, Utchariya; et al.

Share Facebook  LinkedIn  Twitter 

Infant Analgesia with a Combination of Breast Milk, Glucose, or Maternal Holding

A team of researchers in Italy studied four kinds of nonpharmacological analgesia in 80 neonates undergoing heel stick. The babies, born to term and healthy, were randomized into four treatment groups. Twenty each were assigned to receive an oral glucose solution on a changing table, expressed breast milk on a changing table, a glucose solution while being cradled by the mother, or actual breastfeeding by the mother. Investigators analyzed the infants' pain expression as well as cortical activation in parietal, temporal, and frontal cortices. No cortical activation occurred during heel stick in babies who were given oral glucose while lying on a changing table or while being held in their mothers' arms. There was localized bilateral activation of somatosensory and motor cortices in babies who took expressed breast milk. Meanwhile, extensive bilateral activation of somatomotor, somatosensory, and right parietal cortices was observed in the newborns who were breastfed. Pain expression was reduced when neonates were held by their mothers. The study results indicate that oral glucose appears to block or weaken cortical pain processing. However, the greatest analgesic benefit appears to be derived from having women hold their babies while breastfeeding them or giving them oral glucose.

From "Infant Analgesia with a Combination of Breast Milk, Glucose, or Maternal Holding"
Pediatrics (08/28/18) Bembich, Stefano; Cont, Gabriele; Causin, Enrica; et al.

Share Facebook  LinkedIn  Twitter 

Abstract News © Copyright 2018 INFORMATION, INC.
Powered by Information, Inc.

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:

222 S. Prospect Avenue
Park Ridge, IL 60068
Phone: (855) 526-2262 (toll-free)/(847) 692-7050
Fax: (847) 692-6968

Attn: Cathy Hodson
E–ssential Editor
September 6, 2018
Earn Your DNAP