Regional Anesthesia

air · Apr 3, 2005

Maybe we should add to the FAQ which programs have a lot of regional and line placement opportunities.

Excellent idea

snakebitten · Apr 3, 2005

I find it a sad state of affairs that there are CRNA's out there that graduate without being proficient at ALL regional blocks. I work in a rural city (Opted out state) ALONE. It gives the profession a black eye when I hire a locum to help me out and the surgeons/staff are upset that our schools are sending people out who cannot do an epidural,SAB,axillary,interscalene etc...They end up supervised by me, which defeats the purpose of me hiring them in the first place. Alot of people on this forum are crying about MD's trying to take away their autonomy and supervision etc..well in my opinion, if you cannot do deliver ALL aspects of anesthesia you deserve to be supervised. As a independent provider, when I hire a locum, I give them the keys to the carts and expect them to be able to do everything all week all by themselves. Now I understand that some programs have their hands tied for various reasons and they cannot teach their students regional skills. Don't go to those schools! Your just giving other providers more of a reason to control your work. I consider regional anesthesia on all patients for postop pain relief and intraoperative care. What are you going to do if your asked to help out in pain management? Oh well enough--:angryfire

deepz · Apr 3, 2005

....... if you cannot do deliver ALL aspects of anesthesia you deserve to be supervised. ......

The A$A agrees with you. I personally don't.

"STATEMENT ON REGIONAL ANESTHESIA

(Approved by [ASA] House of Delegates on October 12, 1983, and

last amended on October 16, 2002)

While scope of practice is a matter to be decided by appropriate licensing and credentialing

authorities, the American Society of Anesthesiologists, as an organization of physicians

dedicated to enhancing the safety and quality of anesthesia care, believes it is appropriate to

state its views concerning the provision of regional anesthesia. These views are founded on

the premise that patient safety is the most important goal in the provision of anesthesia care.

Anesthesiology, in all of its forms, including regional anesthesia, is the practice of medicine.

Regional anesthesia involves diagnostic assessment, the consideration of indications and

contraindications, the prescription of drugs, and the institution of corrective measures and

treatment in response to complications. Therefore, the successful performance of regional

anesthesia requires medical as well as technical expertise. The medical component generally

comprises the elements of medical direction and includes:

a. Preanesthetic evaluation of the patient.

b. Prescription of the anesthetic plan.

c. Personal participation in the technical aspects of the

regional anesthetic when appropriate.

d. Following the course of the anesthetic.

e. Remaining physically available for the immediate diagnosis

and treatment of emergencies.

f. Providing indicated postanesthesia care.

The technical requirements for regional anesthesia will vary with the procedure to be

performed.

The decision as to the most appropriate anesthetic technique for a particular patient is a

judgment of medical practice that must consider all patient factors, procedure requirements,

risks and benefits, consent issues, surgeon preferences, and competencies of the practitioners

involved. The decision to perform a specific regional anesthetic technique is best made by a

physician trained in the medical specialty of anesthesiology. The decision to interrupt or

abort a technically difficult procedure, recognition of complications and changing medical

conditions, and provision of appropriate post-procedure care is the duty of a physician.

Regional anesthetic techniques are best performed by an anesthesiologist who possesses the

competence and skills necessary for safe and effective performance."

CougRN · Apr 3, 2005

I find it a sad state of affairs that there are CRNA's out there that graduate without being proficient at ALL regional blocks. I work in a rural city (Opted out state) ALONE. It gives the profession a black eye when I hire a locum to help me out and the surgeons/staff are upset that our schools are sending people out who cannot do an epidural,SAB,axillary,interscalene etc...They end up supervised by me, which defeats the purpose of me hiring them in the first place. Alot of people on this forum are crying about MD's trying to take away their autonomy and supervision etc..well in my opinion, if you cannot do deliver ALL aspects of anesthesia you deserve to be supervised. As a independent provider, when I hire a locum, I give them the keys to the carts and expect them to be able to do everything all week all by themselves. Now I understand that some programs have their hands tied for various reasons and they cannot teach their students regional skills. Don't go to those schools! Your just giving other providers more of a reason to control your work. I consider regional anesthesia on all patients for postop pain relief and intraoperative care. What are you going to do if your asked to help out in pain management? Oh well enough--:angryfire

well you have a right to your opinion but what about this. how about helping these CRNA's so that they learn the skill and can then provide all types of care needed. unfortunately there are programs that have their hands tied. as a practicing CRNA i would hope that you would want to help further education when needed. i realize it is hard to hire a locum that can't do everything you need them to do. but maybe you should screen better before hiring them. as a profession we need to work harder to ensure that all of us are proficient in these skills but we need to work together rather than get on each other because we weren't trained in school. JMHO.

gaspassah · Apr 3, 2005

as for the matter of not attending schools that dont teach regional, we already have a shortage of crnas, and competition at the schools is already stiff. so to theoretically decrease the number of schools, because there are only so many slots, the end result would be a lesser number of students to equal lesser numbers of future crnas. best to learn what you can while in school and learn on the job for the rest. find someone on your staff proficient and seek them out as mentors.

d

sonessrna · Apr 3, 2005

as for the matter of not attending schools that dont teach regional, we already have a shortage of crnas, and competition at the schools is already stiff. so to theoretically decrease the number of schools, because there are only so many slots, the end result would be a lesser number of students to equal lesser numbers of future crnas. best to learn what you can while in school and learn on the job for the rest. find someone on your staff proficient and seek them out as mentors.
d

I also agree that if you don't know how to do something that you should be supervised. Then we should be supervised in school!!! I go to a very good anesthesia school and I haven't done my regional rotation yet, coming up. I'm frustruated that at myh large teaching institution I'm dsicriminated against because I'm an SRNA and in addition, I may not get the regional experience I could get from the expert anesthesiologists at my teaching institution. I'm payinmg tuition, I want to learn...teach me!! I will be seeking out a regional seminar or two when i get out of school, guaranteed. !!

air · Apr 3, 2005

I also agree that if you don't know how to do something that you should be supervised. Then we should be supervised in school!!! I go to a very good anesthesia school and I haven't done my regional rotation yet, coming up. I'm frustruated that at myh large teaching institution I'm dsicriminated against because I'm an SRNA and in addition, I may not get the regional experience I could get from the expert anesthesiologists at my teaching institution. I'm payinmg tuition, I want to learn...teach me!! I will be seeking out a regional seminar or two when i get out of school, guaranteed. !!

There is a shortage now of anesthesia personnel.

You can make it a pre-condition before job selection about being indoctrinated regional and line placement.

Everything would boil down to your ability to negotiate a proper employment package. I stumbled across an ASA article that predicts more and more regional will be demanded by patients and surgeons in the coming decades, to me that translates more and more providers with those regional skills will be first in line for perks( maybe a differential), choice of assignments.

As an srna, I know how painful and humiliating it is when they say this is not a "student case", what is a student case? After you have paid all that $$ to learn anesthesia, every case should be a schooling case, there has to be something i can do rather than send me out of the room.

Bamadawg · Apr 7, 2005

Here at Bridgeport we get first shot at all airway and regional. There is one attending who does his own RA but the rest are cool. I ve been here 10 months, only 7 in clinical, and I have had probably 60 opportunities at SAB/EPidural. I have done maybe 28 succesfully. I am in my OB rotation now and today, for example, I did 2 CESA s succesfully, one unsucessfully (converted to spinal) and one laboring epidural succesfully. I have had a chance at about 6 inter scalene blocks and assisted with others. I have done a couple of Bier blocks.

On another note, I have placed 7 central lines (with assist, but I stuck first and placed cath), 20 plus A lines, 4 PACs and been exposed to TEE 5 times. And I have not done my open heart rotaton yet. I still have 14 months to go. I am alone in the OR for short periods (30 min or less usually) and orienting to Call.

This is why I recomend Bridgeport. I am so lucky to have had this group to turn me on to this program.

Frank

heartICU · Apr 12, 2005

I also have had a good experience with regional techniques. My program does a lot of orthopedic procedures (tons of hips and knees), and they will do almost all of them under spinal unless its contraindicated. Their recipe for almost everyone is 2mg versed, then a spinal with 0.5% marcaine 15mg, 0.2mg epi, fentanyl 25mcg, and then give them 50mg benadryl. They sleep like babies.

I have also done a couple of epidurals for thoracotomy incisions, and a couple Bier blocks, and some interscalenes for shoulder surgeries. My program has a one month rotation that is all regional blocks, so we end up getting quite a bit...actually we get more than the residents at my facility, so I bet in the next year or two the residents will start coming to the hospital we go to for regional experience.