[dfk]

Originally Posted by Electric

You are totally and absolutely correct here.

By the way, how does propofol work?

works on GABA receptors (as do all but one of the induction agents, ketamine). also acts on chloride channels to help prevent them from repolarizing.
hence, a nice relaxed state.

[deepz]

Originally Posted by platon20

......A surgeon has absolutely zero business doing this. Its the same thing as asking a family practice doctor whether his patient is a good candidate for brain surgery without talking to a brain surgeon first.......

Again, apples and oranges. Simply put, anesthesia is not surgery. If you wish to understand anesthesia as it has been practiced in America for over 120 years, you could start here:

http://www.gaspasser.com/unique.html

I find your dogmatic attitude to be curious. If you have an axe to grind with CRNAs perhaps you belong on an Anti-CRNA site, not Allnurses.

?

[dfk]

Originally Posted by platon20

A surgeon has absolutely zero business doing this. Its the same thing as asking a family practice doctor whether his patient is a good candidate for brain surgery without talking to a brain surgeon first.

Deciding whether a person is appropriate candidate for anesthesia is something ONLY an MDA or CRNA can do. Are you telling me that surgeons are capable of deciding what kind of anesthesia a pt can get? Thats absolute garbage. MDAs dont go up to surgeons and ask them "hey doc do you mind if I use GETA for this pt?"

This is the way it should work: CRNA comes to eval the pt preop. CRNA chooses the anesthesia plan. CRNA writes the orders for the anesthesia plan. CRNA runs the case solo. CRNA monitors the patient at all times and has sole authority, WITHOUT CONSULTING THE SURGEON, to cancel the case if the pt becomes unstable.

Now, the "rules" that somebody posted above dont fit that scenario. It says the surgeon has to order the anesthetic and has to sign some of hte anesthesia-related documents. Thats insane for a surgeon to "order" a drug when he doesnt even know the basics for how it works!

The only thing the surgeon should be doing is writing the op note. The domain of anesthesia belongs SOLELY to MDAs and CRNAs.

actually, you are not correct.
when surgeons talk to their patients prior to coming to the hospital, they will explain what they anticipate will take place, such as GETA or regional.
now, the day of the procedure can vary.
anesthesia will see the pt and decide what might be best in their eyes.
but if it is known that the surgeon prefers or wants GETA, that can be the way it goes. period.
yes, because the surgeon wants it that way.
now, am i saying this is ok?
not always.
now, as far as the anesthetic and the surgeon not knowing anything.
that's wrong also (to a point).
i have worked with several that, well, have a fair idea of what goes on behind the curtain.
now, they don't know the MOA like we do, and i'm sure they don't know what a MAC of anything is (probably), but you have to take into consideration that most surgeons have been around for awhile and have seen/heard alot.
i'm not defending that surgeons should be doing the anesthetic ordering and all, but i think they know more than you think.

[angel crna]

Oh please!!! I don't need supervision by either an anesthesiologist or surgeon. Before some of you answer, please be sure of your facts. Go to www.aana.com for information on this topic.

Surgeons don't want to/don't know how to/don't know anything about anesthesia.

I know I am new here, but I wish only CRNAs would reply to these legal and practice topics. It seems like misinformation has a way of multiplying until someone presents the facts.

[loisane]

Originally Posted by angel crna

I know I am new here, but I wish only CRNAs would reply to these legal and practice topics. It seems like misinformation has a way of multiplying until someone presents the facts.

Amen, amen, amen, AMEN!

Did I say AMEN?

loisane crna

[zrmorgan]

so back to the OP....those of you who have surgeons "supervise"

how do they do it? do they sign all your charts? do they simply do it so medicare(caid) will send the check?

it seems that is the reality that the opted-out states have accepted (ie what is the friggen point of supervision then if the supervisor is uninterested / undereducated in anesthetic technique?)

i would love to say i was "supervised", or "managed", or whatever, if the person who was the "supervisor" had a clue, and was interested in the goodANESTHETIC outcomes of the patient....but that is where we all have to draw the line...

they have to have a clue about anesthesia, and they have to be interested

we must not forget the rigorous training many surgeons have endured, I see a lot of undue disrespect in some earlier posts...but I do feel a lot better about surgeons who utilize more of their time sharpening their surgical practice, and less time being concerned about what anesthesia is doing. they can have their expectations of what a good anesthetic but they should leave the plan to the CRNAs and anesthesiologists.

Collaboration, no matter what setting, whether you are solo, or the surgeons hand-maiden, is cruicial. It is unfortunate "collaboration" often gets slipped in with "supervision" as I beleive they are entirely different (yes apples and oranges yet again)

[zrmorgan]

Originally Posted by platon20

I dont get it. A surgeon knows NOTHING about gas at all.

So I'm confused when I hear some CRNAs say that their "supervising physician" (in states that require a supervising physician) are the surgeons running the case.

Explain to me exactly how a surgeon can "supervise" or "collaborate" wtih a CRNA.

"supervise" I dunno... I had the same question....


"collaborate"....

CRNA: "Hey Steve, this guys a trainwreck do you mind if we admit him overnight and get someone from internal med to manage his (insert problem here) before we bring him to the OR"

Surgeon: "Well we could do that, but I was just planning on injecting sub lethal doses of local at the surgical site, I was thinking at most you could give a couple of versed, but its up to you..."

CRNA: "Hey, its your wifes birthday today, did you remember?"

Surgeon: "So, who's on call for internal med tonight?"

[foraneman]

[quote=platon20;2409137]So you are claiming that its impossible for a surgeon to be liable for a CRNA's error, even when the state law EXPLICITLY states that some kind of "supervision" is required?

I dont doubt that its a very rare occurrence, but its not as open and shut as you say. If what you said was true, then no surgeon would EVER be sued for anything that happens in terms of bad anesthesia outcomes unless they "interfered" with the anesthesia plan by changing orders or sedation protocols.[quote]

1. State law requiring "supervision" has nothing to do with surgeon liability.

2. A surgeon can be sued for anything that happens to the patient under their care. The question is will they be found liable.

3. Yes, I AM telling you that a surgeon is not liable for mistakes made by a CRNA, if these were not under the surgeons direct control. A surgeon is NO MORE liable when working with a CRNA alone versus a CRNA and MDA team....PERIOD.

4. Again, "supervision" is not used in this instance as it tends to imply. There is NO "direction" or "control" over the anesthetic. A CRNA would be found liable if they followed a surgeons orders running contrary to the standard of care, found in the best judgment of the CRNA.:studyowl:

[foraneman]

Originally Posted by zrmorgan

so back to the OP....those of you who have surgeons "supervise"

how do they do it? do they sign all your charts? do they simply do it so medicare(caid) will send the check?

it seems that is the reality that the opted-out states have accepted (ie what is the friggen point of supervision then if the supervisor is uninterested / undereducated in anesthetic technique?)

i would love to say i was "supervised", or "managed", or whatever, if the person who was the "supervisor" had a clue, and was interested in the goodANESTHETIC outcomes of the patient....but that is where we all have to draw the line...

they have to have a clue about anesthesia, and they have to be interested

we must not forget the rigorous training many surgeons have endured, I see a lot of undue disrespect in some earlier posts...but I do feel a lot better about surgeons who utilize more of their time sharpening their surgical practice, and less time being concerned about what anesthesia is doing. they can have their expectations of what a good anesthetic but they should leave the plan to the CRNAs and anesthesiologists.

Collaboration, no matter what setting, whether you are solo, or the surgeons hand-maiden, is cruicial. It is unfortunate "collaboration" often gets slipped in with "supervision" as I beleive they are entirely different (yes apples and oranges yet again)

Collaboration and supervision ARE the same thing in this context. The surgeon does not supervise or dictate the manner in which the anesthetic is delivered...ever....in any state.

[Summitk2]

Originally Posted by angel crna

I know I am new here, but I wish only CRNAs would reply to these legal and practice topics. It seems like misinformation has a way of multiplying until someone presents the facts.

Angel (and loisane), I couldn't agree more. However, you may have noticed that CRNAs don't participate too much in this forum anymore. I think those of us who are not CRNAs and truly want to be correctly informed would love for a CRNA to set things straight. However, even the CRNAs don't seem to agree and others are vague. Is aana.com really the only reliable source of info? I noticed you (as a CRNA, I assume) didn't add anything to clarify this discussion aside from the aana website link. Do you have the correct info on this legal and practice topic? If so, please help clarify the answer to the OP's question. We need CRNA input on this CRNA forum.