an interesting and somewhat ignorant article title

Brian_SRNA · Nov 3, 2006

ANd it has been documented by many outside sources that the MDA has moved away from the bedside in many cases and is doing more managerial supervisory role, while the CRNA is at the bedside, "adminsitering at least 2/3 of the anesthetics in the US." Can't argue with facts. Sorry....

ann945n, RN · Nov 3, 2006

That's the point platon20. CRNAs aren't mentioned. This is an article written by an Anesthesiologist known to be unfriendly to CRNAs practicing office based or independent anesthesia in the US.
These quotes from the article...1. "But just imagine, says Miller (anesthesiologist), what might have happened if that (man who stopped breathing after a small dose of Midazolam and resuscitated by Miller)had taken place outside a hospital without a trained anesthesiologist present."
2. "Their is simply no way trained anesthesiologists can meet the demand-especially since the increase in surgeries has been accompanied by a simultaneous increase in what anesthesiologists are asked to do."
3. "That helps explain why, at a rough guess, some doctors estimate 45% of all sedation today is handled by people other than anesthesiologists."
Basically he's fearmongering. He's telling readers that they are in danger b/c they may not have a "doctor" giving their anesthesia. What he fails to mention is there are >23000 CRNAs in this country who are giving anesthesia on a daily basis in all manners of practice and that we are just as well trained and competent to do these procedures as the almighty Dr. Miller.
That's what all the anger is about. It's a common theme from the ASA (American Association of Anesthesiologists) that people will die or get seriously injured if an Anesthesiologist isn't involved in their care. I'm tired of it too. Time Magazine is read by alot of Americans and they should be more balanced. IMHO

I totally agree, the fact CRNA is not mentioned leads the unknowing reader to believe they are dangerous to put someone under. By not stating CRNA are also safe the article tosses them in to the 'crack pot' category. ERRR! :madface:

deepz · Nov 3, 2006

Can't our PR crews from AANA and state associations reach these people?...........

One irony is that Dr Ron Miller's daughter is a CRNA. Must make for lively conversation around the Thanksgiving dinner table. Unfortunately, in the larger dysfunctional family feud that is American anesthesia in general, doctor chauvinism is a common behavior pattern exhibited by the A$A.

We all have the link right there to send the author at TIME an Email BTW.

d

NeuroNP · Nov 3, 2006

Not so quick there -- and not so categorically black-and-white either, if you please. The quote you are responding to:
"CRNAs are advanced practice nurses who are the hands-on providers of approximately 65% of all anesthesia given in the United States each year" -AANA Website"
does not assert that American anesthesia is an either/or equation. It says CRNAs are the *hands-on providers* in 65%.
The AANA makes no claims as to whose hands are on the donuts in the OR lounge.
!

I could be wrong, but I don't think that paindoc's questioning whether or not CRNAs are providing 65% of anesthetics, but rather saying, don't assume that 100% of anesthetics are being provided by CRNAs or MDAs. I think (and correct me if I'm wrong) that he's just pointing out that together CRNAs and MDAs should be arguing that OTHER folks shouldn't be doing serious sedation. I can think of a lot of times when RNs and other docs have "managed" sedation. In the ED I used to work in, the RNs weren't allowed to push Propofol IVP, so the ED doc did it while the RN did the rest of the sedation. Not necessarily a bad set up, except that the ED MD was doing something else (shoulder reduction etc.). Eventually they got a new Medical Director and that changed. Now an ED MD does nothing but the sedation. Some other Doc has to do the procedure.

The fact is, I know that practices like that still go on, and THAT should scare people more than a CRNA (or AA, there, I said it!) providing the hands on anesthesia care.

deepz · Nov 3, 2006

I could be wrong.....

Yep

jjjoy, LPN · Nov 4, 2006

The subtitle of the article is the usual sensationalistic headlines we see everywhere. And if the article were written better, there'd be less debate over what it's point it is. And to mention anesthesiologists over and over again without mentioning others trained in administered anesthesia reflects even more poorly on the author.

Despite all the focus on anesthesiologists, the content of the article seems to be addressing the risks of the increasing use of anesthesia in doctors' offices, usually administered by doctors.

"There are tens of thousands, maybe millions, of sedation procedures done satisfactorily by other physicians," Guidry says. Still, a 2003 study published by Dr. Hector Vila, chief of anesthesiology at the University of South Florida's College of Medicine, showed 10 times the risk of death or permanent injury for surgery performed in doctors' offices rather than in ambulatory surgery centers."

deepz · Nov 4, 2006

.......the content of the article seems to be addressing the risks of the increasing use of anesthesia in doctors' offices, usually administered by doctors. .......

Oh really? By doctors?

Time for a reality check.

NeuroNP · Nov 4, 2006

Oh really? By doctors?
Time for a reality check.

Yeah. I don't know many doctors who are administering anesthesia/sedation in offices...

BTW, I'm not sure how to take your response to me last post. "Yep." OK, I get that you arre saying that I am wrong, but about what exactly? Are you saying that I'm wrong about paindoc's point? Or about something (everything) else? Elaborate please. I'm always open to learning. :-)

HyperTension · Nov 16, 2006

It's traditionally not the doctors in the outpatient setting that are administering those medications, but they are the ones ordering them, with RN's (and sometimes LPN's) that are drawing up and then delivering the medications to said patient. The issue at hand for that is that if your going to give a medication, you had better know what it is, side effects, indications, contraindications, ect, ect, ect,.. You may have given "2.5 of versed" and had 99 people just get a bit buzzy, but life and people are not a fixed eqation, and there is always a variable to be thrown into the forray.

It's when that variable hits that you have to be able to act on what is going on, as well as what can happen in the future. Bagging is always nice.. making sure the air is getting into the lungs is always nicer.. (see prev. post by deepz). Romazicon is good.. but what do you do while the patient lies apnic / agonal while you wait for that to work? :) Training, exposure, education, and compentece all help negate these. I have seen and taken care of individuals whom have arrived to the ED in resp. failure after a "Nurse" gave too much narcotic (CNA or LPN, but who cares right?). That is what the article is talking about in my highly uneducated mind, but at the same time, I agree that there are undertones that I find rather fustration and demeaning.

Laughing Gas · Nov 19, 2006

Anytime someone is giving anesthesia drugs, other than an anesthesia provider, you are asking for trouble IMO. Most of the inserts tell you not to touch the drug unless you are anesthesia (paraphrasing a lot here). I am willing to bet that the vast majority of healthcare workers do not know how to ventilate a patient. If you think it is just squeezing the bag, then you have just proven my point. Ventilating a semiconcious patient who does have some effort is not the same as ambuing an arrested pt.

I did not see that CRNA's were even mentioned in the article, let alone villianized. I actually agree with it. If someone is giving me or my family anesthetic drugs, it had better be a CRNA or MDA. And yes, I'd pay out of pocket for it. My life probably depends on it.

paindoc · Nov 20, 2006

Soooo....what are "anesthetic drugs"? Versed is a general anesthetic and so is fentanyl given in high enough quantities...so are those anesthetic drugs? Propofol can be a simple sedative given in low enough amounts so is propofol NOT an anesthetic drug when used in that manner?

While it is laudable that you would pay out of pocket for an anesthetist to be present during a colonoscopy, do the national healthcare economics dictate that everyone should have that choice? If not, why should only the wealthy be able to afford to have an anesthetist present during office, ASC, or hospital procedures that are traditionally handled by non-anesthesia nurses? Tough questions...sometimes there are not any good answers.

Laughing Gas · Nov 21, 2006

Soooo....what are "anesthetic drugs"? Versed is a general anesthetic and so is fentanyl given in high enough quantities...so are those anesthetic drugs? Propofol can be a simple sedative given in low enough amounts so is propofol NOT an anesthetic drug when used in that manner?
While it is laudable that you would pay out of pocket for an anesthetist to be present during a colonoscopy, do the national healthcare economics dictate that everyone should have that choice? If not, why should only the wealthy be able to afford to have an anesthetist present during office, ASC, or hospital procedures that are traditionally handled by non-anesthesia nurses? Tough questions...sometimes there are not any good answers.

I believe propofol's use is or at least was intended to be restricted to induction of GA, haha I know. And if you want to get literal, we can induce states of altered consciousness through many different ways, H2O intoxication, Jack Daniels, CO, anything can be used for anesthetic purposes. I have caused apnea in a healthy woman after 1 mg of versed. So yes these are anesthetic agents, aside from my anecdote. Propofol is titrated to effect. Do you trust a podiatrist concentrating on his procedure to instruct his med tech to titrate the diprivan to provide anesthesia and avoid apnea?

The question of who should be awarded anesthesia care based on income goes way beyond the scope of this discussion. In a nut shell, everyone should be treated equally. Does this happen? No. Does equal care work? No Canada (to the tune of Oh Cananda) You are correct, there are no easy answers. The issue is based in the fact that patients are having procedures done requiring anesthesia in office settings. Maybe we need to ask, can this be done in your office, OR do you need anesthesia. Not... how can we do anesthesia in our office when no one knows what the heck they're doing.

Safety is our only job. We are not invited to this job. Hence there is little regard or understanding about safety. Patients pay the price.