Experienced CRNA...ask me anything

[06crna]

Okay...If you've read my posts you know that I will be retiring soon.

Now is your chance to ask a practicing CRNA anything.

12 years of experience from solo rural independent to medical-direction urban ACT. Former Chief and Clinical Coordinator of SRNAs.

I will not reveal my identity, specific locations, employers, or programs.

Anything else...ask away.

[Kooky Korky, BSN, RN]

Please address Anesthesia Awareness. Causes, prevention, can you tell if your pt is suffering?

[06crna]

I have never seen an AFE and don't know anyone who has except a close friend that is an OB attending physician at a large metro hospital. It is exceedingly rare.

When it does happen, it is typically catastrophic. Often presents as anaphylactic-like symptoms. Can progress rapidly to cardiopulmonary arrest. Everyone who works with pregnant patients needs to know about this - not just CRNAs and MDAs. Lots of excellent resources on medscape if you are interested.

[adam3]

"Those are not real jobs"..So they post jobs on gaswork for fun.Huh

[adam3]

I have never seen such salaries of low 90s even in metro areas.That equates to 43 per hour.Statistically,The average salary of all CRNAs is 185k as per AANA.So that means if one CRNA is taking 90k ,other might be making 270k .That is just not correct at all

[Wolf at the Door, BSN]

adam3 said:

I have never seen such salaries of low 90s even in metro areas.That equates to 43 per hour.Statistically,The average salary of all CRNAs is 185k as per AANA.So that means if one CRNA is taking 90k ,other might be making 270k .That is just not correct at all

In FL it is

[Wolf at the Door, BSN]

06crna said:

I have never seen an AFE and don't know anyone who has except a close friend that is an OB attending physician at a large metro hospital. It is exceedingly rare.

When it does happen, it is typically catastrophic. Often presents as anaphylactic-like symptoms. Can progress rapidly to cardiopulmonary arrest. Everyone who works with pregnant patients needs to know about this - not just CRNAs and MDAs. Lots of excellent resources on medscape if you are interested.

I should have included during a C-Section. I would think it falls on those two. The Scrub tech wouldn't know and the nurse is away from any monitoring what so ever.

[m1lkofamnesia]

Where in FL are CRNAs being paid $90k? I've talked to several recruiters in FL, and and all are paying $120k-$130k for new grads.

[/username, BSN, RN]

Do you prefer watermelon or grape juice?

[offlabel]

06crna said:

I have never seen an AFE and don't know anyone who has except a close friend that is an OB attending physician at a large metro hospital. It is exceedingly rare.

When it does happen, it is typically catastrophic. Often presents as anaphylactic-like symptoms. Can progress rapidly to cardiopulmonary arrest. Everyone who works with pregnant patients needs to know about this - not just CRNAs and MDAs. Lots of excellent resources on medscape if you are interested.

It probably happens more than folks realize. There is a period between the time the baby delivers and the time the uterus is closed that there is a brief, spontaneously resolving drop in SpO2. It happens a lot and it is probably due to sucking air or amniotic fluid into the uterine veins. Moms are usually very hemodynamically stable, although treating hypotension with a spinal is usually attributed to the spinal, not a trickle of air or AF. Most moms just don't have the anaphylactoid reaction.

[offlabel]

How old were you when you entered anesthesia practice? 12 years doesn't seem that long to be in practice before retirement. No criticism here, just wondering.

[06crna]

"Anesthesia awareness" is a lengthy and complex topic, and the term means different things depending on setting, anesthesia type, situation, etc. . I am going to assume that you are referring to the case in which a patient is awake, aware of the surgical procedure...but cannot move or communicate.

Despite what Hollywood and sensational media may portray, these cases are exceedingly rare. A likely scenario would be a patient under general anesthesia, paralyzed by drugs, intubated and ventilated, but not anesthetized by either IV infusions or inhalational gases.

There are so many failsafes in anesthesia that a competent and vigilant CRNA would recognize the situation. Even if the patient was given beta-blockers or medications to lower heart rate and blood pressure, anesthetists are constantly "sweeping the field". That is to say, we are constantly scanning the patient, the machine, the surgery, etc. Even if we don't look like we are looking, we are. And listening. It becomes second nature and automatic.

Off the top of my head potential causes: medication swaps/errors, inhalational agent vaporizer failure, empty vaporizer, IV pump failure, loss of IV access, lack of recognition/vigilance, anesthesia machine technical issues.

Prevention: standard monitoring that is part of every anesthetic, optional depth-of anesthesia brain monitoring (BIS), NEVER disable or zero-volume anesthesia machine and monitor alarms. But the best prevention is a competent, experienced, vigilant anesthetist.

Re: suffering. That is not a term we typically use in anesthesia. We note responses to stimulation, which may be painful, by increases in heart rate, blood pressure, and respiratory rate (if the patient is breathing spontaneously). We then process the information we have at hand to decide how to treat it.

A separate, but related, issue to awareness is recall - and this is not uncommon. Some specialties are more likely to experience this than others (cardiac, neuro, OB) due to the type of surgery and anesthetic. Some patients even report that they remember going to sleep or waking up with a breathing tube. These are normal and expected experiences. Some patients are not undergoing general anesthesia, but sedation, and we specifically counsel them that recall is a a distinct possibility. They must accept that risk prior to signing the anesthesia consent.

[06crna]

Wolf - Yep. OK. In the scenario you describe (significant AFE during C-section), the anesthetist would likely recognize the signs of circulatory collapse.

Here is a link to an Anesthesiology journal case review. It is informative and well-written.

[Prompt resuscitation by obstetric anesthesiologists saved a parturient with amniotic fluid embolism: a case report]. - PubMed - NCBI

Perhaps this occurs, with varying severity, more often than we realize. I just asked my OB-fellowship trained friend - response is "Who knows? Can't measure what we don't recognize."