Re: CRNA supervision by anesthia MD
Thanks TXCRNA-Due to a cancellation I was able to get the surgery done this morningn and I did go with the status qood (good suggestion). The only rough spot was when I reminded them that this was supposed to be a Bier Block without sedation (because of a really horrible previous experience with C/S); they basically ignored this until just before the surgery then mentioned as I was entering the O.R. that this may or may not be what they were going to do despite our previous discussion. That is until I mentioned I specified on the consent no sedation or GA bier block only; this resulted in a brief heated exchange (the MD who agreed to the no sedation part was not present)...to prevent cancelling the surgery, the anesthesiologist agreed to do the block without sedation but added that if I declined sedation that I couldn't get any painkiller (I agreed but it seemed a little one-sided to me)...after talking to my surgeon the anesthesiologist departed never to return (not sure why he left, but the CRNA said that the no sedation/no painkiller ultimatum was stupid) and she and the surgeon did the case (32 minutes). The bier block worked fairly well, but my heightened BP from the "preop discussion" prevented the block from being as effective as it could have been, but the surgery did get done. So the CRNA was an effective patient advocate (she offered fentanyl when I was less stoic about the cuff pain, but I survived without it). The anesthesiologist was not. When I have to have the other arm done, I'm asking for the same CRNA if possible. My only criticism is that despite resolving the sedation days in advance, the anesthesiologist tries a "power play" 5 minutes before surgery to change my mind. Fortunately I had 2 things on my side: I specified no sedation on the consent and a CRNA who had no problem with standing up to an anesthesiologist who was clearly trying to ignore my wishes. There is nothing like having a real patient advocate on your side and the CRNA was clearly mine.
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