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Happy Labor
Day!!!
Fun Facts:
On September 5, 1882, some 10,000 workers assembled in New
York City to participate in America's first Labor Day
parade.
This first Labor Day celebration was eagerly organized and
executed by New York's Central Labor Union, an umbrella
group made up of representatives from many local unions.
Oregon became the first state to grant legal status to the
holiday in 1887; other states soon followed.
In 1894, Congress passed legislation making Labor Day a
national holiday.
For many decades, Labor Day was viewed by workers not only
as a means to celebrate their accomplishments, but also as a
day to air their grievances and discuss strategies for
securing better working conditions and salaries.
For many, the holiday is a time for family picnics, sporting
events, and summer's last hurrah.
More Fun Facts,
September 5th in History:
9/5/05: John G. Roberts is nominated for Chief Justice of
the Supreme Court
9/5/97: Athen's Greece selected for 2004 Olympics
9/5/90: Pete Sampras ends Ivan Lendl's bid for 9th straight
U.S. Open final
9/5/1901: National Association of Professional Baseball
Leagues forms
Save yourself
time by keeping us updated with your credentials. Fax any
updated information to 248.646.0361 as soon as you receive
it or visit
www.nationalanesthesia.com
and create your online profile today! This will help in
keeping you credentialed in your current assignment or
preparing for a new one.
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A message from the President
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Summer is coming
to a close and we hope that you were able to
enjoy the sunshine and longer days. It's
amazing how time flies, it seems like the
warm weather just arrived and it's already
getting chilly outside.
A couple of weeks ago National Anesthesia
took a trip to San Diego for the AANA
conference. It was great seeing both new and
old faces because we love having the
opportunity to connect with you in person.
You can read more about Jill, Jason and
Christi's trip to California in the article
"National at the 2009 AANA Annual Meeting."
In this month's issue of National News you
will find the article "Oxygen in Surgery May
Hasten Memory Loss" which explains the
effects of extended exposure to
high-concentrated oxygen. The article "A
Picture is Worth a Thousand Words" will
express the time and heartfelt emotion that
goes into Operation Iraq, a cause that
National Anesthesia has supported for the
past couple years. We've included a few
pictures to give you a glimpse of this great
organization. To wrap up this month's
newsletter you will read part two of our
three-part series from "The Changing Face of
Surgery." This installment provides
information on the types of same-day cases
that will be done in the future. It is
unbelievable to think that some complex
cases will be done as outpatient procedures.
At National Anesthesia we have many great
jobs. In Florida we have a fantastic
opportunity for multiple CRNAs and the
client will consider new grads. There is an
outstanding case variety plus no call or
weekends. We also have multiple
opportunities in New York City. Whether you
are an anesthesiologist looking for
something permanent or PRN or a CRNA looking
to settle into a great, new full-time
position, we have the job for you!
We have a great
permanent position on the coast of New
Jersey, which is independent office-based
work with a great compensation package. A
little further north we have another
permanent position in south central
Massachusetts. A small hospital in that area
is looking for a CRNA to add to their
growing practice. Don't wait another minute
connect with us today at 1- 800-642-1999 or
visit our website at
www.nationalanesthesia.comm
to register online!
Stephen Read, President
National Anesthesia Services, Inc.
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Quote of the month
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Live with
intention.
Walk to the edge.
Listen hard.
Practice wellness.
Play with abandon.
Laugh.
Choose with no regret.
Continue to learn.
Appreciate your friends.
Do what you love.
Live as if this is all there is.
----- Mary Anne Radmacher |
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National at the 2009 AANA Annual Meeting
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Another successful
visit to the AANA Annual Meeting took place
in San Diego, CA from August 8 to August 11.
Jill Binder, Christi Brewer and Jason Read
attended and we truly enjoyed the venue, the
exhibitor hall and spending some time
together. The weather was spectacular and we
thoroughly enjoyed the sights, sounds and
tastes of San Diego. We had a fantastic time
in our booth and had a wonderful spot in
which to see everybody. We hope that those
of you who attended also enjoyed yourselves
and were able to squeeze in some playtime.
The annual meeting is always a great
opportunity to meet new people and share our
company information. We enjoy being able to
spend time and talk to all the students
about our permanent placement program and of
course, seeing those of you who are usually
just a "voice" on the phone is always a
highlight each year! We love hearing the
exclamations across the exhibit hall when
somebody recognizes our booth and realizes
what we look like! Hopefully nobody was
scared away! Congratulations to Natasha
Adams, CRNA, who was the lucky winner of our
raffle and took home the Garmin GPS system!
Please be sure to connect with National if
you have any new information to share with
us in regards to your career plans or your
staffing challenges!
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Oxygen in Surgery May Hasten Memory Losss
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Prolonged exposure
to high-concentration oxygen during or
following surgery may contribute to
Alzheimer's disease-like memory loss among
elderly patients, says a new study.
After studying the effects of oxygen on
genetically altered mice, researchers at the
University of South Florida and Vanderbilt
University came to suspect that oxygen may
trigger the symptoms in people genetically
predisposed to the disease and in those with
high levels of the protein beta amyloid,
which is found in brain plaques associated
with Alzheimer's disease, says their
article, which appeared in the Aug. 5 issue
of the journal NeuroReport.
"The combination of brain beta amyloid and
exposure to high concentrations of oxygen
provides a perfect storm for speeding up the
onset of memory loss associated with
Alzheimer's disease," says lead author Gary
Arendash, PhD, of the Florida Alzheimer's
Disease Research Center at the University of
South Florida, in a press release.
This research may help explain why some
elderly patients experience confusion and
memory loss in the days and weeks after
surgery. "No one really knows why it
happens," says L. Jackson Roberts, MD, a co-
author from Vanderbilt. "If all it takes to
prevent this is reducing the exposure of
patients to unnecessarily high
concentrations of oxygen in the operating
room, this would be a major contribution to
geriatric medicine."
---Kent
Steinriede
http://www.outpatientsurgery.net
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A Picture is Worth a Thousand Words |
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For the past
two years, National Anesthesia Services has
supported Operation Iraq: The Spirit of
Christmas. This organization provides care
packages to troops on the front lines of
Iraq and Afghanistan during the Holiday
Season in order to bring them a little bit
of comfort and love from home. We thought it
would be fun to share a few of the pictures
we have received of the effort this past
November. Enjoy!
Please see below for another photo. |
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The Changing Face of Surgery Part 2
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What new same-day
cases might we see in 2020?
If Medicare lets
ASCs perform unicompartmental knee
replacements in 2009, what will it allow
freestanding facilities to host in 2020?
Level-1 spine fusions, says Joyce Deno, RN,
chief operations officer for the eastern
region at Regent Surgical Health in
Westchester, Ill.
Natural orifice translumenal endoscopic
surgery (NOTES) procedures may make their
way into day- surgery facilities once the
techniques are refined and surgeons get over
the learning curve.
Eventually, procedure times will become
shorter, says Gloria Van Milligan, RN, MSN,
CNOR, a healthcare consultant with the Sg2
consulting group in Skokie, Ill.
In the coming years, general surgeons may
incorporate more endoscopic techniques into
their practices. "The growth of NOTES and
endoluminal procedures for GI diseases will
make it a necessary skill for general
surgeons who wish to offer a full menu of
therapies," says Steven Schwaitzberg, MD,
FACS, chief of surgery at Cambridge Health
Alliance in Massachusetts. As medicine
advances, general surgeons will need to
adopt the therapies that allow them to
better treat the diseases of the abdominal
organs. "The change from cut to scope will
not mean the surgeon will stop taking care
of those diseases," says Dr. Schwaitzberg.
"It is likely that some procedures for GERD
or morbid obesity will emerge."
However, there's a long way to go. Using
NOTES techniques, a cholecystectomy
currently takes 4 hours to perform.
Bariatric procedures may be among the first
NOTES procedures performed in an outpatient
setting. One possibility is transoral
gastric stapling, an incisionless procedure
in which a stapler is passed down the
throat.
Currently the procedure requires general
anesthesia and takes between 1 and 2 hours.
Patients go home after 24 hours. Eventually,
the device used in the transoral
gastroplasty (TOGA) could be modified for
use with conscious sedation on an outpatient
basis, says Sreeni Jonnalagadda, MD, FASGE,
a professor at Washington University School
of Medicine in St. Louis, Mo., and an
investigator for a TOGA study. "This is a
part of the evolution of technology. Open
bypass to laparoscopic bypass to endoluminal
therapy with general anesthesia to,
hopefully, endoluminal therapy with
conscious sedation, or same-day discharge
following endoluminal therapy with general
anesthesia," says Dr. Jonnalagadda.
Endoscopy's offshoot, robotics - long touted
as the next big thing - has yet to arrive in
outpatient surgery centers because of the
cost and setup time for each procedure. U.S.
hospitals, on the other hand, have purchased
825 robots in spite of the $1 million to
$1.7 million cost.
But the 2020s might be the decade for robots
to emerge in outpatient surgery. Just as
lithotripsy and MRI machines have become
smaller, robotic tools will be scaled down
in coming years. It's inevitable. "A lot of
first-generation instruments are bigger,"
says William Hanson, MD, director of
surgical intensive care at the Hospital of
the University of Pennsylvania and author of
The Edge of Medicine: The Technology That
Will Change Our Lives (Palgrave Macmillan,
2008).
Today's robots are bulky. But smaller
versions and new designs are on the horizon.
British researchers are developing the i-Snake,
an articulating tube about the diameter of a
penny. The robot, which incorporates a
camera and instruments at the end, will
slither through the GI tract and airways and
leave no external scars. The combination of
smaller diameters, smaller instruments and
better imaging capabilities will let
surgeons make increasingly smaller
incisions, says Dr. Hanson.
But for robots to make their way into
surgery centers, the price will have to drop
well below current levels and more surgeons
will have to know how to use the robots,
says Ms. Deno.
Other procedures that will become more
common in surgery centers include liver
biopsies, new ablation treatments for
Barrett's esophagus and implantation of
gastric pacemakers, says Ms. Van Milligan.
More complicated and equipment-intensive
same-day procedures, such as endoscopic
retrograde cholangiopancreatography (ERCP) -
a procedure to treat the liver, gallbladder,
bile ducts or pancreas using a combination
of fluoroscopy and endoscopy - will remain
in hospitals, says Steven Morris, MD, JD,
chief executive of Atlanta Gastroenterology.
In contrast, fewer GI procedures will be
done in physicians' offices because the cost
and requirements of mandatory quality
assurance measures and accreditation
agencies such as the Joint Commission will
make them no longer practical, says Dr.
Morris.
On the other hand, virtual colonoscopies,
which do not require sedation, may be
performed in an office setting, says Ms. Van
Milligan. Currently virtual colonoscopies
are not covered by Medicare because of
insufficient evidence of efficacy. But that
may change when more studies come out. The
technology may become more interesting to
Medicare when more people are added to
government healthcare spending and Medicare
is forced to stretch reimbursement dollars
as far as possible. "This question is tied
up in the future reimbursement plan for the
nation as we move toward nationalized health
care," says Ms. Van Milligan.
How might anesthesia change in 2020?
Machines might do a lot of the thinking and
heavy lifting for anesthesia providers in
the not-too-distant future.
Meet McSleepy, a device that measures depth
of hypnosis based on EEG analysis, pain with
a pain score algorithm and muscle relaxation
using phonomyography to record the
low-frequency sounds created during muscle
contraction. McSleepy then uses a series of
algorithms to control infusion pumps that
deliver the best mix of anesthesia
medication for the situation in less time
than it would take a human anesthesia
provider to make the calculations for proper
dosage. McSleepy could reach the market in 5
years, says Thomas Hemmerling, MD, DEAA, an
anesthesiologist at McGill University in
Montreal, Canada, who along with colleagues
has created the McSleepy prototype.
A similar computerized sedation system might
appear in endoscopy suites first. This
spring, an FDA advisory panel recommended
approval of Sedasys, a computer-assisted
personalized sedation (CAPS) system for use
with propofol during colonoscopies and upper
GI tract procedures. The CAPS system
automatically adjusts the propofol dose
based on monitoring of oxygen saturation,
respiration rate, heart rate, blood
pressure, end-tidal carbon dioxide and
patient responsiveness. When it detects
signs of oversedation, the machine
automatically reduces or stops the flow of
propofol, increases oxygen flow and
instructs the patient to take a deep breath,
according to the manufacturer, Ethicon
Endo-Surgery.
----Kent
Steinriede
http://www.outpatientsurgery.net
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Operation Iraq Photo
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General Disclaimer::
The materials have been compiled by National
Anesthesia Services. Inc. from internal and
external sources. However, while we have
attempted to provide accurate information in
this publication, no representation is made
or warranty given as to the completeness or
accuracy of the Materials. In particular,
you should be aware that the Materials may
be incomplete, may contain errors, or may
have become out of date. You should
therefore verify information obtained from
this publication before you take any action
upon it.
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