Anesthesia E-ssential

AANA Anesthesia E-ssential
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A Resource for Nurse Anesthesia Educators, Second Edition

With 169 additional pages of content, the second edition of the essential resource for nurse anesthesia educators includes the latest information and best practices for understanding legal issues and reimbursement rules, fulfilling new educational requirements, writing exam questions and evaluations, incorporating simulation into your curriculum, encouraging research and scholarship application, promoting diversity and inclusion in healthcare, and avoiding burnout.

Edited by 
Bernadette Henrichs, PhD, CRNA, CCRN
Judy Thompson, DNAP, CRNA, APRN

Price: $59.95. (Also available as an e-book.)
Order now  from the AANA Bookstore.
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Hot Topics

AANA is a Health IT Week Partner

National Health IT Week (Oct. 2-6, 2017) is a nationwide awareness week focused on the value of healthcare IT. AANA is proud to be a partner association again this year to highlight the benefits health information technology can bring to U.S. healthcare. Learn more about the week and how you can get involved at Natonal Health IT Week.
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MHAUS Recommendation Available for Public Comment

The Malignant Hyperthermia Association of the United States (MHAUS) has released a draft recommendation for public comment regarding effective cooling methods to treat hyperthermia associated with MH.
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Read the 2017 Proposed Bylaw Amendments and Resolution Online

The 2017 proposed AANA amendments and resolution to be discussed and voted upon at the Sept. 9, 2017, AANA Business Meeting are available online now. See the business meeting agenda.

If you do not have online access, you may request that a hard copy be mailed to you via a message to or phone (847) 655-1101.
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There's a New Way to Participate in the Business of the AANA!

The new electronic voting on the proposed bylaw amendments and resolutions will begin with the September 2017 AANA Business Meeting. On Saturday, Sept. 9, 1 p.m. PDT, the AANA Business Meeting will be live streamed with access through AANA's website. On Sunday, Sept. 10, all eligible voting members of the association will receive an email allowing them to vote on the proposed bylaw amendments and resolutions. You will also have access to a recording of the debate on the specific issue. Voting will be open for 24 hours. Be sure to update your email address in AANA's records, and watch for your voting email on Sunday, Sept. 10.


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Get a Free eBook Edition of
The Painless Guide to Mastering Clinical Acid-Base

During the five-day period of Aug. 23-27, 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.

Don’t miss out on this special offer. Order now!
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Meetings and Workshops

Registration Open for Spinal/Epidural Workshop with Obstetric Essentials
October 25-28, 2017, Park Ridge, Ill.

This comprehensive workshop combines enrollment for two of our most popular live CE activities, the Essentials of Obstetric Analgesia/Anesthesia Workshop and the Spinal and Epidural Workshop.  

Earn valuable Class A CE credits and stay current with expert lectures and hands-on instruction. 
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Register Now for the Fall Leadership Academy
November 3-5, Rosemont, Ill.

AANA Fall Leadership Academy features expert speakers in six educational tracks including AANA Foundation Advocate Workforce, Business and Facility Leadership, Federal Political Director, State Grassroots Advocacy, State President-elect, and State Reimbursement Specialist. Hone and develop leadership skills for your practice, state, and business. Plus, you'll expand your network of colleagues around the country. 
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Registration Open for Upper and Lower Extremity Block Workshop

Expand your skills and expertise in upper and lower extremity block anesthesia through this hands-on workshop, to be held Oct. 7-8, 2017, in Park Ridge, Ill. The program will include case studies, hands-on demonstrations, return demonstrations, and skill validation. 
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to view or place job postings
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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.

Ketamine Alone Is Best Sedative for Children's Emergencies

After analyzing data from more than 9,650 patients, researchers have determined that ketamine alone is the safest sedative for emergency department (ED) scenarios involving children. While the Canadian study found that propofol alone as well as a combination of propofol and ketamine are safe and effective, fewer serious adverse events (SAEs) and interventions occurred with ketamine alone. The rate of SAEs was just 0.4 percent for ketamine by itself, versus 2.1 percent for ketamine and propofol and 3.2 percent for ketamine and fentanyl. Based on the findings, primary investigator Maala Bhatt, MD, director of Pediatric Emergency Research at the University of Ottawa, recommends that ketamine only "should be considered the first-line sedation medication for children undergoing sedation in the ED, especially in settings where recognition and rescue of adverse events in children is not commonly performed." Surprisingly, however, her team also discovered that higher ketamine doses produced greater rates of vomiting and oxygen desaturation—the two most common associated SAEs. The findings should inform future research objectives, according to Bhatt and company, who reported the study results in JAMA Pediatrics.

From "Ketamine Alone Is Best Sedative for Children's Emergencies"
Medscape (08/21/17) Pullen, Lara C.

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Local Anesthesia Safe, Effective in TAVR

Although patients undergoing transcatheter aortic valve replacement (TAVR) typically are put under general anesthesia and intubated, a new meta-analysis suggests local anesthesia may safely be used instead for certain patients. Investigators reviewed 26 studies with a collective participation rate of more than 10,500 patients. The data indicated that local anesthesia lowered 30-day mortality for any reason in TAVR patients and curtailed the need for inotropic/vasopressor drugs. As reported in Catheterization Cardiovascular Interventions, local anesthesia for TAVR also reduced procedure time by about 25 minutes and fluoroscopy time by nearly 2 minutes. Additionally, patients who underwent local anesthesia spent 0.18 fewer days in intensive care and 2.09 days fewer for their overall hospitalization stay. The research was led by Pedro A. Villablance, MD, of Montefiore Medical Center and Albert Einstein School of Medicine in New York.

From "Local Anesthesia Safe, Effective in TAVR"
Healio (08/17/2017) Quaile, Dave

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Sciatic Plus Femoral Nerve Blocks Effective on Total Hip Arthroplasty-Related Pain

Reporting in Orthopedic Reviews, researchers say that supplementing continuous femoral nerve block (CFNB) with sciatic nerve block (SNB) can provide significant pain relief following total hip replacement. The conclusion is based on a prospective study of 40 participants having unilateral hip arthroplasty, who were randomized in a 1:1 ratio to receive either CFNB alone or CFNB plus SNB. Although patients in each group requested comparable amounts of analgesics and experienced nausea and vomiting at a similar rate, those who underwent SNB plus CFNB reported much lower pain scores at 6 hours and 12 hours postoperatively. The absence of any major complications, coupled with the drop in pain scores, suggests the combination treatment may deliver a faster and less painful recovery from hip replacement than CFNB by itself. The findings add to the body of evidence supporting multimodal drug therapy to manage pain following this procedure.

From "Sciatic Plus Femoral Nerve Blocks Effective on Total Hip Arthroplasty-Related Pain"
Clinical Pain Advisor (08/16/17) Bujara, Suzanne

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Paravertebral Block Improves Pain Control for Percutaneous Nephrolithotomy

Although a relatively simple procedure, kidney-stone removal results in a significant amount of postoperative pain—which researchers now believe can be alleviated through the use of paravertebral block. The technique has been demonstrated as effective for pain control after breast and thoracic surgery but is rarely used for percutaneous nephrolithotomy. Investigators from Loyola University Medical Center in Maywood, Ill., tested its applicability in this space, recruiting 45 patients to undergo either paravertebral block or a placebo intervention ahead of the operation. All participants then received general anesthesia at the hands of a blinded anesthesia team, and all had access to patient-controlled analgesia following the surgery. "Intraoperative opioid use, postoperative opioid use, frequency of opioid use and antiemetic use were significantly lower in the paravertebral block group as compared to the control group," confirmed study lead Scott Byram, MD, associate anesthesia professor and medical director of Loyola's acute pain service. He presented the findings at the 2017 annual meeting of the American Society of Regional Anesthesia and Pain Medicine.

From "Paravertebral Block Improves Pain Control for Percutaneous Nephrolithotomy"
Anesthesiology News (08/15/17) Doyle, Chase

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Intrathecal Ziconotide Long-Term Efficacy and Safety for Severe Chronic Pain

Intrathecal ziconotide has already demonstrated effective short-term analgesia in patients with severe chronic pain who do not benefit from usual therapy; and, now, the first evidence has emerged supporting its safety and efficacy over the long term. Interim analysis of the Patient Registry of Intrathecal Ziconotide Management (PRIZM) study compared how well the nonopoiod calcium channel blocker worked as a first-line treatment versus a secondary therapy. In the sample population of 93 participants, about 55 percent received ziconotide first in the pump (FIP+). Patients in the two groups had similar pain scores at baseline; however, the rating dropped dramatically over time for the first-line recipients. At six-month followup, pain scores were down almost 30 percent for the FIP+ group compared with a 6.4 percent increase for the FIP- group. At the one-year mark, pain scores had dropped by 34.4 percent and 3.4 percent, respectively. While FIP+ intrathecal ziconotide appears to be more effective over the long term than FIP-, it also was associated with more adverse events—nausea, dizziness, and confusion especially. "The adverse event profile was consistent with ziconotide prescribing information," according to the investigators, who report their findings in Pain Practice. The PRIZM trial will continue to follow patients for up to 18 months, with the final results offering more insight into long-term safety and efficacy.

From "Intrathecal Ziconotide Long-Term Efficacy and Safety for Severe Chronic Pain"
Clinical Pain Advisor (08/15/17) Wong, Crystal

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Evidence Does Not Support the Use of Gabapentinoids for Chronic Lower Back Pain

While more and more clinicians are choosing drugs like pregabalin and gabapentin to treat chronic low back pain, a new meta-analysis suggest that the gabapentinoids offer no relief but do carry a significant risk of adverse effects. The conclusion was based on eight randomized controlled trials. In three studies where gabapentin was compared to placebo, the drug did not have a meaningful impact on pain; and three others demonstrated that pregabalin actually was less effective than other analgesics. While there were no hospitalizations or deaths tied to the use of gabapentinoids, they were commonly associated with dizziness, fatigue, confusion, visual disturbances, and other adverse effects. "The existing evidence does not support the use of gabapentinoids for predominant chronic low back pain, and calls for larger, high quality trials to more definitely inform this issue," according to the investigators, who published the findings in PLOS Medicine.

From "Evidence Does Not Support the Use of Gabapentinoids for Chronic Lower Back Pain"
ScienceDaily (08/15/17)

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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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E–ssential Editor
August 24, 2017
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