Anesthesia E-ssential

AANA Anesthesia E-ssential
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Coming Soon: New Security Features on

This fall, you'll be able to find all the online resources you need quicker than ever, across all AANA websites—and the first step to enjoying a seamless experience is updating your security settings. 

Soon when you log in to, you’ll be prompted to create a new password and to provide answers to three security questions. Plus, you’ll have the option to opt in to receiving password resets by text once the new site is launched. We can’t wait to unveil the website you’ve been waiting for. Watch your inbox for more details.

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Hot Topics

FDA Alerts not to use Sterile Drug Products from Vital Rx, dba Atlantic Pharmacy and Compounding

The FDA is alerting healthcare professionals not to use drug products intended to be sterile that are produced and distributed nationwide by Vital Rx Inc., dba Atlantic Pharmacy and Compounding, Pompano Beach, Florida, due to lack of sterility assurance. During FDA’s recent inspection of Atlantic Pharmacy, investigators observed insanitary conditions, including poor sterile production practices, which raise concerns about Atlantic Pharmacy’s ability to assure the sterility of the drug products it produces.


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Guest Journal Editorial Champions Why CRNAs Can and Should Help in the Opioid Crisis

With a national epidemic of opioid misuse in the daily headlines, help should come from anywhere possible. CRNAs are the perfect healthcare professional, along with addiction and wellness professionals, to combat this new scourge in the battle against abuse of prescription drugs.

The guest editorial in the August 2017 issue of the AANA Journal briefly covers the history of opioid use and abuse, why CRNAs should become involved and engaged in this battle, and even provides concrete recommendations and actions that CRNAs can take.
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AANA Connect Annual Congress Community Open Now

A new AANA Connect community is available for registered attendees of this year’s Annual Congress. If you’re registered for Annual Congress, you’re automatically a member of this community – no need to enroll. It’s the place to ask questions, network with your peers, and coordinate meeting up with your fellow Connect members. We're excited to see everyone in Seattle next month!

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August 2017 AANA Journal Highlights

Read on for highlights of the August 2017 issue of AANA Journal.

Airway Management in an Infant with Huge Hydrocephalus
By definition, a ‘huge’ hydrocephalus describes a head circumference that exceeds the length of the patient’s body.  In this remarkable case report, the authors describe the anesthetic management of this challenging set of circumstances.
A High-Fidelity Simulation Study of Intraoperative Latent Hazards and Their Impact on Anesthesia Care-Related Handoff
Using a novel research design, the authors explore the complex domain of intraoperative anesthetic handoff communication and how lapses or failures can lead to or exaggerate an adverse outcome.
Comparison of Flow Dynamics of Peripherally and Centrally Inserted Intravenous Catheters Using a Rapid Infusion System (ThermaCor 1200)
The physics and clinical implications of using various catheters (and their insertion sites) on the efficacy of IV rapid infusion technology are explored. This paper helps contribute to our understanding of the limitations of existing systems in the demanding circumstances of fluid resuscitation.
Certified Registered Nurse Anesthetist Working Conditions and Outcomes: A Review of the Literature
Have you wondered how work place environment may influence patient outcome?  The existing literature is reviewed to seek associations and make interesting interpretive conclusions that have relevance to all of us. This article also covers important foundations for how organizational anesthetic care delivery might be better managed.
Creation of a Low-Cost Simulated Trachea for Deliberate Practice of Cricothyrotomy and Retrograde Wire Use
This article describes the use of a low-cost, non-complex teaching aide employed in teaching advanced airway skills (e.g., retrograde intubation) to Ghana trainees, suggesting that the tool may have implications and utility for other technologically impoverished teaching locales.
Investigation of the Anxiolytic and Antidepressant Effects of Eucalyptol (1,8-Cineole), a Compound From Eucalyptus, in the Adult Male Sprague-Dawley Rat
Using an intriguing bench-research design, the authors explore the GABA receptor activity associated with eucalyptol administration (derived from the eucalyptus plant) in a murine model. Such basic science work sets the stage not only for drug drug development, but unraveling the interactivity of a select group of compounds on this frequently targeted, anesthetic-relevant receptor.
Patient Satisfaction With Anesthesia Care: What Do We Know?
This article explores the realm of patient satisfaction through a literature review, drawing important conclusions that focus on reimbursement, provider decision making and how patients perceive their care in the day and age of evidence-based healthcare delivery.
Update on Guidelines for Perioperative Antibiotic Selection and Administration From the Surgical Care Improvement Project (SCIP) and American Society of Health-System Pharmacists
This paper is essential reading for all of us as we are frequently (sometimes routinely) tasked with administering prophylactic antibiotic therapy to the patients we care for.  Implications related to the most successful antibiotic timing and dosing strategies are discussed.
AANA Journal Course: Update for Nurse Anesthetists – Part 3 – A Review of Physiology and Pharmacology Related to Acute Perioperative Pain Management
In this state-of-the-art exploration of perioperative pain control, the 3rd Journal Course thoroughly reviews what we need to do from both basic science and clinical application considerations.
And don’t miss the Journal’s online offerings. This month, in addition to the Guest Editorial "The Opioid Crisis and the Certified Registered Nurse Anesthetists: How Can We Help?" (see above) read the following article of interest online: 
Education News: A CRNA Preceptor Workshop to Increase Preceptor Satisfaction, Confidence, and Comfort: A Quality Improvement Project
The authors describe their experience with a four-hour preceptor workshop to better acquaint and prepare clinicians who work with students in the operating room.  Their focused activity reports substantial gains in measured outcomes as they relate to enhancing the experience for both student and clinician preceptor.
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Get a free ebook edition of
The Painless Guide to Mastering Clinical Acid-Base

During the five-day period of August 23 - August 27, you can get a free copy of the new ebook edition of The Painless Guide to Mastering Clinical Acid-Base by Benjamin Abelow, MD. This highly regarded text is great for both first-time learning and review. Simply search the title or Amazon ID number (B06XRM56TY), or visit Amazon,, and you will find the ebook priced at $0.00 during those five days. Once you "purchase" the book, it will remain permanently in your Amazon library and you'll be able to load it onto any device (phone, tablet, laptop, etc.) that has a Kindle app linked to your account.

Mark your calendar so you don’t miss out on this special offer! 

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Prescription Opioid Analgesics Commonly Unused after Surgery

A large number of deaths in the United States have been caused by opioid misuse. Diversion of unused prescription opioids is a growing patient safety concern. A new systematic review, published in JAMA Surgery, found that opioids prescribed for postoperative pain management often go unused, are not stored in a locked location, and are rarely disposed of in compliance with Food and Drug Administration recommendations. The authors conclude that unused prescription opioids may contribute to an increase in misuse and adverse drug events.  Read more at JAMA.

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to view or place job postings

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Featured Career Opportunity

Full-Time Nurse Anesthesia Faculty -
Quinnipiac University School of Nursing


Quinnipiac University’s School of Nursing is seeking an experienced and dynamic clinical expert in Nurse Anesthesia with a passion for teaching and learning to join our growing and thriving programs! Our School of Nursing serves nearly 1000 graduate and undergraduate students!

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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.

SLU Surgeons Study 'Awake Aneurysm Surgery' for Better Outcomes

Conscious sedation was used successfully during aneurysm surgery to reduce the risk of ischemic harm, according to a study performed at SSM Health Saint Louis University Hospital. The research involved 30 participants having operations for aneurysms that had not erupted. By keeping patients awake and conducting neurological testing throughout the procedure, the hope was to avoid ischemia—a complication that is triggered by lack of blood flow and can impair the neurological system. Indeed, in the case of three patients who presented symptoms of neurological deterioration while in the operating theater, the ability to communicate in "real time" allowed surgeons to make changes mid-surgery to eliminate the potential problems. Although additional research is warranted, primary investigator Saleem Abdulrauf, MD, called the first-of-its-kind study "encouraging."

From "SLU Surgeons Study 'Awake Aneurysm Surgery' for Better Outcomes"
Newswise (08/14/17)

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Ultrasound-Triggered Liposomes for On-Demand, Local Anesthesia

An innovative system developed at Boston Children's Hospital uses ultrasound to noninvasively deliver pain relief to specific anatomical sites. As described in Nature Biomedical Engineering, nerve-blocking agents are placed inside liposomes—tiny artificial sacs whose walls contain small molecules that are sensitive to ultrasound—that are then injected into targeted areas of the body. For up to three days after that, ultrasound can be used to open up the surface of the liposomes, spilling the pain medication into the surrounding tissue. According to co-first author Alina Rwei, the degree of relief can be controlled according to how long and how strong the ultrasound is applied. "We envision that patients could get an injection at the hospital and then bring home a small, portable ultrasound device for triggering the nerve-blocking agent," the graduate researcher explains. "This could allow patients to manage their pain relief at will, noninvasively." Importantly, adds senior author Daniel Kohane, MD, PhD, the system provides effective relief without potentially addictive opioids and short-lasting local anesthetics.

From "Ultrasound-Triggered Liposomes for On-Demand, Local Anesthesia"
Medicalxpress (08/10/2017)

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Study Supports Comprehensive Plan for Managing Difficult Airways in Children

Based on the experience at Baltimore's Johns Hopkins University, mapping out a course of action for managing difficult airway in children before complications arise is effective and valuable. The institution established its Pediatric Difficult Airway Response Team (DART) in 2015, adding a consultation service last year to provide sedation, ventilation, intubation, and extubation plans for patients with potentially difficult airways. By comparing data for 56 patients who required DART and 60 others who were intubated without airway complications, researchers were able to pinpoint medical and physical risk factors for problem airway in the pediatric population. "Unlike in adults, children with difficult airways are often predictable; however, there has been little focus on creating a consultation service to preemptively identify children with potentially difficult airways and describe ventilation and intubation plans prior to these children experiencing respiratory distress," said Johns Hopkins professor and Pediatric DART director Nicholas Dalesio, MD. "The ideal way to alleviate errors and stress during an emergency is to have extensive, well-thought-out plans" that include a multidisciplinary emergency response team of anesthesia providers, surgeons, nurses, and other clinicians; a consultation service; and basic airway education of all practitioners caring for underage patients.

From "Study Supports Comprehensive Plan for Managing Difficult Airways in Children"
Anesthesiology News (08/09/17) Raj, Ajai

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Efficacy of Perineural vs Systemic Dexamethasone to Prolong Analgesia After Peripheral Nerve Block

Swiss and Canadian researchers teamed up to compare the safety and efficacy of perineural dexamethasone versus intravenous or intramuscular administration for the purpose of prolonging analgesia after peripheral nerve block (PNB). The collaborators conducted a systematic review and meta-analysis, based on 11 randomized controlled trials published through January 2017. The findings, culled from 914 adult patients undergoing a variety of operations with PNB, suggested that perineural dexamethasone significantly prolonged analgesia after PNB compared with systemic administration. Duration of analgesia lasted 17 percent—or 3 hours—longer on average when the perineural route was taken, with no additional safety concerns. Subgroup analysis showed analgesia lasting a mean 26.8 hours with bupivacaine as the local anesthetic and perineural dexamethasone as an adjunct. By comparison, analgesia was maintained for 22.1 hours with bupivacaine and systemic dexamethasone—roughly 4 hours fewer. The difference in duration of analgesia when ropivacaine was the local anesthetic, however, was not considered statistically meaningful between perineural injection and systemic administration of dexamethasone. Considering the moderate-quality evidence, the pros and cons of perineural dexamethasone should be weighed carefully, especially since this indication is still considered off-label.

From "Efficacy of Perineural vs Systemic Dexamethasone to Prolong Analgesia After Peripheral Nerve Block"
British Journal of Anaesthesia (08/01/2017) Vol. 119, No. 2, P. 183 Baeriswyl, M.; Kirkham, K.R.; Jacot-Guillarmod, A.; et al.

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Newly Discovered Pathway for Pain Processing Could Lead to New Treatments

McGill University investigators say identification of a new biological pathway for pain processing could herald novel non-opioid treatments for chronic pain. In animal studies, the team found that cancer drugs known as epidermal growth factor receptor (EGFR) blockers worked as well as morphine to alleviate inflammatory and chronic pain. Now, according to co-lead study author Luda Diatchenko, scientists must determine if the findings in mice and fruit flies can be duplicated in humans and if there are any associated adverse effects. "This discovery is very exciting and important," the McGill dentistry professor declared. "It's really going to help us extend our knowledge about the molecular pathophysiology of chronic pain." Diatchenko and the other lead author, McGill psychology professor Jeffrey Mogil, hope their findings will spur clinical trials to evaluate the potential of EGFR inhibitors as a pain management solution. Even if the agents do not prove useful for pain control, they still could facilitate new drug development. "By re-engineering or tweaking these drugs, the road to getting to a useful pain treatment will be much, much shorter," Mogil said. The researchers reported their findings in the Journal of Clinical Investigation.

From "Newly Discovered Pathway for Pain Processing Could Lead to New Treatments"
Medicalxpress (08/08/2017)

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Validation of Innovative Techniques for Monitoring Nociception During General Anesthesia

While measuring analgesic status is integral to the anesthetic management process, the field still lacks a monitoring device to specifically capture this in patients under general anesthesia. Some innovative approaches have emerged in recent years, however—including the Analgesia Nociception Index, which tracks heart rate variability; the Surgical Pleth Index, which uses photoplethysmography to keep track of pulse rate and pulse wave amplitude; and pupillary dilation, as measured followed a noxious event. Researchers designed a study to compare these anesthesia monitoring systems to the traditional clinical markers: heart rate, mean arterial pressure, and bispectral index. Participants—all adults undergoing open radical prostatectomy—were anesthetized with propofol, followed by gradually higher doses of remifentanil. At each analgesic level, investigators introduced standardized tetanic and intracutaneous electric painful stimuli. By comparing baseline readings with values immediately after the application of noxious stimulation, they determined that the Analgesia Nociception Index, the Surgical Pleth Index, and pupillary dilation were sensitive and specific for painful stimulation—more so than heart rate and mean arterial pressure. Bispectral index, meanwhile, was not sensitive to pain nor was it responsive to the effects of analgesics, rendering it an inferior marker of analgesia. Despite their higher sensitivity, the anesthesia monitoring systems did not appear to be good predictors of hemodynamic alternation or nocifensive movements after stimulation. Also, as predicted, reactions to stimuli diminished as opioid concentration climbed.

From "Validation of Innovative Techniques for Monitoring Nociception During General Anesthesia"
Anesthesiology (08/17) Vol. 127, No. 2, P. 272 Funcke, Sandra; Sauerlaender, Sven; Pinnschmidt, Hans O.; et al.

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Abstract News © Copyright 2017 INFORMATION, INC.
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Anesthesia E-ssential is an executive summary of noteworthy articles of interest to nurse anesthetists. It is distributed bimonthly 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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August 17, 2017
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