The 20th Annual OANA Spring Conference is the #1 event in the OKC area for Nurse Anesthetists! Register online soon.
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Using the latest technology is only one of the ways CRNAs advance patient care and safety.
Keeping OANA strong in Oklahoma takes the financial support of its members. Please consider donating today to the OANA Political Action Committee!
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It is time—time to abandon our damagingly divisive, politically Pyrrhic, and ultimately unsustainable struggle with advanced practice nurses (APNs). I urge my fellow family physicians to accept—actually, to embrace—a full partnership with APNs.
Read more →I am a December graduate of Texas Christian University who finished my clinical education at Hillcrest Medical Center in Tulsa. As a native of Texas, I had always assumed that I would return to Texas after graduation. Largely because of friendships that have developed and opportunities here in Oklahoma, my wife and I stayed in Tulsa and I now work at Hillcrest. I am looking forward to helping the OANA promote and protect our practice here in Oklahoma.
Read more →Park Ridge, Ill.—A new U.S. Air Force (USAF) policy governing anesthesia delivery in USAF facilities worldwide recognizes the full scope of Certified Registered Nurse Anesthetists (CRNAs) practice, thereby ensuring military personnel and their dependents access to the safest, most cost-effective anesthesia care.
Read more →Goetzinger, Katherine R. MD; Harper, Lorie M. MD, MSCI; Tuuli, Methodius G. MD, MPH; Macones, George A. MD, MSCE; Colditz, Graham A. MD, DrPH
Abstract
OBJECTIVE: To estimate whether the use of regional anesthesia is associated with increased success of external cephalic version.
DATA SOURCES: We searched MEDLINE, EMBASE, the Cochrane Library, and clinical trial registries.
METHODS OF STUDY SELECTION: Electronic databases were searched from 1966 through April 2011 for published, randomized controlled trials in the English language comparing regional anesthesia with no regional anesthesia for external cephalic version. The primary outcome was external cephalic version success. Secondary outcomes included cesarean delivery, maternal discomfort, and adverse events. Pooled risk ratios (relative risk) were calculated using a random-effects model. Heterogeneity was assessed using the Cochran's Q statistic and quantified using the I2 method.
TABULATION, INTEGRATION, AND RESULTS: Six randomized controlled trials met criteria for study inclusion. Regional anesthesia was associated with a higher external cephalic version success rate compared with intravenous or no analgesia (59.7% compared with 37.6%; pooled relative risk 1.58; 95% confidence interval [CI] 1.29–1.93). This significant association persisted when the data were stratified by type of regional anesthesia (spinal compared with epidural). The number needed to treat with regional anesthesia to achieve one additional successful external cephalic version was five. There was no evidence of statistical heterogeneity (P=.32, I2=14.9%) or publication bias (Harbord test P=.78). There was no statistically significant difference in the risk of cesarean delivery comparing regional anesthesia with intravenous or no analgesia (48.4% compared with 59.3%; pooled relative risk 0.80; 95% CI 0.55–1.17). Adverse events were rare and not significantly different between the two groups.
CONCLUSION: Regional anesthesia is associated with a higher success rate of external cephalic version.
Read more →Park Ridge, Ill.—Ten years ago, in a historic, precedent-setting move, Iowa became the first state to opt out of the federal physician supervision requirement for nurse anesthetists. Recent studies have confirmed the safety and cost-effectiveness of Certified Registered Nurse Anesthetists (CRNAs) without physician supervision.
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The AHA today filed a friend-of-the-court brief supporting the Colorado governor's decision to opt out of Medicare's physician supervision requirement for certified registered nurse anesthetists to improve access to care for rural residents. The brief urges the state Court of Appeals to uphold the governor's decision that exercising the opt-out was in the best interest of Colorado's citizens and consistent with Colorado law. Noting that Colorado is one of 16 states to opt out of the physician supervision requirement without reporting any adverse consequences, the brief states, "The passage of time has only reinforced the federal government's assessment from 2001 that removing the physician supervision requirement would not affect quality of care or patient outcomes."
Prominent Denver doctors argue they don't have a duty to lock up potent surgery sedatives, despite the 2009 operating-room theft and fraud by Kristen Parker that infected 18 patients with hepatitis C, according to court documents.
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Federal Trade Commission staff, in response to a request from Tennessee State Representative Gary Odom, stated that there may be reduced access to pain management services in the state, as well as higher costs for those services, under a bill proposed in the Tennesssee legislature that would require on-site physician supervision of pain management services in some facilities.
Tennessee House Bill 1896 would require physician supervision of pain management services administered by advanced practice nurses (APNs), as well as certified registered nurse anesthetists (CRNAs), who are APNs with specialized training in anesthesia and pain management. The Bill also would limit which physicians may supervise or provide such services. The limitations would apply to health care facilities such as physician and nursing practices but not to facilities such as hospitals and nursing homes.
"Access to pain management services in Tennessee is likely to be compromised by unnecessary limits on the abilities of APNs, CRNAs, doctors, and other health care professionals to provide those services, with no demonstrable safety benefits," the FTC staff comment stated. CRNAs are key providers of anesthesia and pain management in many rural and underserved areas, and "access problems may be especially acute for elderly patients with chronic pain, as well as rural and low-income Tennesseans."
The FTC staff also stated that, based upon available evidence, it is not clear that the restrictions proposed in the Bill are necessary to protect patients. "Because the full costs and benefits of the Bill remain uncertain, and because the Bill's competitive impact may be substantial, especially for rural or underserved Tennessee health care consumers, we recommend that the House investigate the full competitive implications of H.B. 1896 before adopting any of its restrictions. Absent findings that its provisions are likely to ameliorate identifiable safety concerns, we recommend that the Bill be rejected."
The Commission vote approving the staff comment was 5-0. It was sent on September 28, 2011. (FTC File No. V110011; the staff contact is Daniel Gilman, Office of Policy Planning, 202-326-3136.)
Perioperative intravenous ketamine may be a useful addition in pain management regimens. Previous systematic reviews have included all methods of ketamine administration, and heterogeneity between studies has been substantial. This study addresses this issue by narrowing the inclusion criteria, using a random effects model, and performing subgroup analysis to determine the specific types of patients, surgery, and clinical indications which may benefit from perioperative ketamine administration.
We included published studies from 1966 to 2010 which were randomized, double-blinded, and placebo-controlled using intravenous ketamine (bolus or infusion) to decrease postoperative pain. Studies using any form of regional anesthesia were excluded. No limitation was placed on the ketamine dose, patient age, or language of publication.
Ninety-one comparisons in seventy studies involving 4,701 patients met the inclusion criteria (2,652 in ketamine groups and 2,049 in placebo groups). Forty-seven of these studies were appropriate for evaluation in the core meta-analysis, and the remaining 23 studies were used to corroborate the results. A reduction in total opioid consumption and an increase in the time to first analgesic were observed across all studies (P < 0.001). The greatest efficacy was found for thoracic, upper abdominal, and major orthopedic surgical subgroups. Despite using less opioid, 25 out of 32 treatment groups (78%) experienced less pain than the placebo groups at some point postoperatively when ketamine was efficacious. This finding implies an improved quality of pain control in addition to decreased opioid consumption. Hallucinations and nightmares were more common with ketamine but sedation was not. When ketamine was efficacious for pain, postoperative nausea and vomiting was less frequent in the ketamine group. The dose-dependent role of ketamine analgesia could not be determined.
Intravenous ketamine is an effective adjunct for postoperative analgesia. Particular benefit was observed in painful procedures, including upper abdominal, thoracic, and major orthopedic surgeries. The analgesic effect of ketamine was independent of the type of intraoperative opioid administered, timing of ketamine administration, and ketamine dose.
