Anesthesia Questions?

[NickB]

I had a right thyroidlobectomy performed yesterday and am curious why they did a couple of things. 1. Why did an anesthesiologist do my preop questioning, but then a CRNA actually performed the anesthesia? 2. They gave me a drug prior to entering the ER that really lit me up, and then gave me the drug that put me under. What was the first drug that he pushed and why did they give me that before they gave me the drug that put me under? This was not only my first surgery, but my first time ever in a hospital. Ironically, I am starting nursing school this January and this was actually a cool way for me to get a first hand experience with many different areas of nursing in a hospital setting. Thanks for reading and I appreciate any input.

[stanman1968]

1. the mda did the pre-op as part of a jobs program for anesthesiologists.

2. I have no idea what "lit you up"

[ICUDOUCME?]

Hi Nick,

In many hospitals, but not all (especially rural areas) the anesthesiologist will do the pre-op interview and then turn the case over to the nurse anesthetist. The doc can then charge for supervising the case. He/She is also required to be available throughout the case if needed. This is called the "anesthesia care team" approach. From the anesthesiologist's viewpoint, this ensures a thorough evaluation of a patient's readiness to undergo surgery and safety of the patient throughout the case. From the nurse anesthetist's view, the involvement of the doc is unnecessary since we are trained to do the pre-op evaluation ourselves and monitor the patient's safety and respond to problems on our own.

So, as you can see, there is a conflict and a controversy here. Bottom line is that nurse anesthetists provide approx. 65% of the anesthetics in the country and a much higher percentage of the rural anesthetics. It's cool to work in an environment where you can call on a collegue in the middle of a case (be it an anesthesiologist or another nurse anesthetist) for help if needed. So it just depends on the attitudes of the people involved as to how they work together.

Common drugs given before surgery are typically to calm you down. So the fact that you got "lit up" is a puzzle. I really can't guess what they gave you.

[NickB]

You'll have to excuse my description. I really couldn't explain it any other way.

[putmetosleep]

Maybe it was Versed that they gave you first?

[NickB]

By "Lit Up", I don't mean excited, I mean high as a kite. It certainly did calm me down. I believe the CRNA referred to it as Margarita. That makes sense as to why they did it. My BP was quite high during my preop screening. Thanks for taking the time to answer my questions. This was my first experience with anesthesia so I was trying to learn from it.

[subee, MSN, CRNA]

You'll have to excuse my description. I really couldn't explain it any other way.

And a perfectly fine way to describe the relaxation that accompanies Versed. The drug is administered so that the patient is calm when entering the OR and decreases the chance of recall of any of the events that occur during induction of anesthesia. You now understand the abuse potential of such a drug; for that reason, it is a scheduled drug.

[loveanesthesia]

I'm glad you were informed that a CRNA was providing the intraoperative anesthesia care. Recently I talked to another CRNA who practices in an ACT, and the CRNAs there are not 'allowed' to identify themselves to the patient as a nurse anesthetist, they are referred to as nurses that help the MDA.

[jwk]

I'm glad you were informed that a CRNA was providing the intraoperative anesthesia care. Recently I talked to another CRNA who practices in an ACT, and the CRNAs there are not 'allowed' to identify themselves to the patient as a nurse anesthetist, they are referred to as nurses that help the MDA.

Hadn't heard that one before. That's very bothersome, and could probably be construed as fraudulent behavior on some level, considering that the charges submitted are usually done on behalf of both the CRNA and the MD.

[NickB]

Actually, he referred to himself as the Anesthesiologist. I asked him if he is an MDA or CRNA and then he told me he is a CRNA. I think my next question to him was " how did you get through school financially?" to which he replied "LOANS." Had I not been asking them questions, I would've thought they were all Doctors.

[subee, MSN, CRNA]

Hadn't heard that one before. That's very bothersome, and could probably be construed as fraudulent behavior on some level, considering that the charges submitted are usually done on behalf of both the CRNA and the MD.

JWK, I agree. This is a liability issue, both for the jerk CRNA who misrepresents himself as an MD and for the CRNA who doesn't let the patient know who will be with the patient during the surgery. I've never worked for a group, or even heard of a group, stupid enough to require this of their CRNA's and woe the CRNA who goes along with this egregiously stupid policy. I've only had one patient in over 25 years who refused to have care from a CRNA and that patient was sent the youngest, most inexperienced MD in the group.

[loveanesthesia]

Actually, he referred to himself as the Anesthesiologist. I asked him if he is an MDA or CRNA and then he told me he is a CRNA.

Just to give him the benifit of the doubt, are you sure he didn't say Anesthetist? I always clearly state I'm a Nurse Anesthetist, but then often people will, within a couple of minutes call me the Anesthesiologist. This is from patient's, surgeon's, and sometimes nurses. I always correct them because this is a particular pet peeve of mine. I do a great job, and I want CRNAs to take credit for it. We certainly get the credit if something goes wrong.