[elkpark]

Originally Posted by jwk

Elkpark - what world do you live in? We do anesthesia for cosmetic procedures by the thousands every day - facelifts, rhinoplasties, otoplasties, breast augs, reductions, and lifts, abdominoplasties and brachioplasties out the wazoo for post-gastric bypass patients, not to mention countless liposuctions for those who need it and those who think they do. (and lets not forget the newest surgical sensation, labiaplasties, but that's another thread). Some can be done with local and sedation, some require general anesthesia.

What world do I live in? A world in which I don't risk my life for cosmetic procedures. But, gee, thanks for straightening me out -- I'll rush right out and schedule that boob job I've been putting off ...

[wtbcrna]

Originally Posted by paindoc

Fortunately, the irresponsible and financially impossible recommendations of an association with an axe to grind is not what drives medical care in this country. Prudent and acceptable dantrolene availability is certainly not on-site in every surgery center or doctors office in the US. For such an extremely rare condition, having enough available at one hospital that serves as a repository for dantrolene, should suffice for a moderate sized city.
It appears part of the reason for the press coverage is a pattern of the press jumping to conclusions regarding patient death or injury specifically in the state of Florida, that has been the center of a maelstrom driving states across the US to adopt outpatient anesthesia regulations.

The one site that I saw said it would cost a surgical clinic/hospital and extra 600.00 a yr to stockpile dantrolene. Even double or triple that estimate it is hardly even more than drop in the bucket when compared to the overall surgical operating costs in a moderately busy surgical clinic. There are two things to know about dantrolene: 1. The recommended shelf life is not an accurate reflection of actual product shelf life (it is known from ancetdotal evidence from other countries that the shelf life is actually several years longer), but the manufacture & other companies see no profit margin in doing a study that could potentially increase the shelf-life another two-three years. 2. Dantrolene is still stocked in such small bottles simply because the manufacture sees no profit incentive to increase the size of the bottle. Like all reasearch it doesn't solely fall on the pharmaceutical companies to finance these things.

We are lucky at USUHS to be one of the 5 testing centers for MH in the US, and one of the top research facilities in the US for MH. Some of the medical staff and researchers at USUHS are among the top MH researchers in the world, and they don't think it is unreasonable to stock 36 vials of dantrolene in all hospitals/surgical clinics. Also, with larger patients it can easily take well in excess of 36 vials to treat an MH episode.

MH incidence: 1/15,000 kids; 1/50,000 adults
Increases to 1/5000 with succ & other triggering agents.

I don't think that is that rare when you consider all the surgeries done in the US everyday.

[stanman1968]

well to slightly modify your words paindoc
"If there was an MDA, what steps were performed to reduce the damage once recognized ? Was dantrolene administered and if not why not? Why did it take an hour to get the patient to another facility? "
What I see that your last post does not expose your bretheren to the same level of scrutiny. Or is it like pain managment being handeled quitetly behind the scenes? ROFL as if the ASA would disipline its own members.
When you and yours subject yourselves to the same withering criticisim that you subject my profession to then you will have some credability. The health care orginization grinding the biggest ax is the AMA with a close second of the ASA.

[paindoc]

Hmmmm....if that is the only cost of Dantrolene, then it makes little sense not to stock it in an ASC. A physicians office, where triggering agents are rarely used with versed/fentanyl sedation or propofol sedation, is not a logical location for the drug. The initial report in the news is that the surgery was performed in a physician's office.

Regarding the appropriate anesthetic for a procedure- anesthesiologists and CRNAs all too often forget the purpose of the anesthetic is not for their comfort or enjoyment...it is for the PATIENT. Open craniotomies do not REQUIRE general anesthesia, therefore the myopic would contend that it is malpractice to administer such. Plastic surgery also does not require GA, but if this is for the comfort of the PATIENT and not that of the technician providing the anesthesia, then it is perfectly acceptable.

[paindoc]

Any anesthesia technician, whether they be CRNA or MD, should have recognized the issue and started immediate treatment. Anesthesiologists are not my "brethren"- I have never been a member of the A$A, and have little to do with the field of anesthesiology. Pain physicians are in a separate medical specialty from anesthesiology.

[stanman1968]

I am sorry but your original post singles out CRNA's and does not even consider one of your brethren being at fault. Your brethren being practitioners that do not know a CRNA's education or training but would presume to dictate our practice. And if you are not an anesthesiologist or a CRNA then I would have to say that you certainly are not in any position to criticize a field you are not trained in.
I am sure you would not appreciate me castigating you or your colleagues in the area of pain management, an area in which I am not well versed in i freely admit. Think about it.

[CerebralCRNA]

Originally Posted by paindoc

I have never been a member of the A$A, and have little to do with the field of anesthesiology.

Then how can you comment on areas like you have before with credibility if you are not experienced in the field??

[wtbcrna]

If I remember correctly, Paindoc was an MDA that switched specialities and went into chronic pain management.
I think what he meant to say is that he doesn't have much to do with the field anesthesiology anymore.

[paindoc]

Correct, thank you! I was an anesthesiologist for many years and taught residents in an anesthesiology residency program, and was also in private practice. Doctors offices only uncommonly have MD anesthesiologists available for rendering anesthesia: typically they utilize CRNAs. The original report I read cited a "doctors office" which apparently was incorrect.

[stanman1968]

Aww shucks, you don't get out that easy, your statment origionally was about a CRNA only, not the I wonder who did the anesthesia, I wonder what steps,... just CRNA.