magazine article about addiction

paindoc · Oct 20, 2006

It is quite likely the people writing the article are way off base. Fentanyl is not a volatile gas, and can only be exhaled in water vapor, and this in extremely minute quantities. Most of those practicing anesthesia do not sit with their head over the patient's mouth, and especially given that most patients receiving any significant anesthetics are on rebreathing circuits. Perhaps this would be a good study....MAC anesthesia with high dose fentanyl just below the point of apnea, then have the CRNA/anesthesiologist attempt to breath in as much patient exhaust as possible....

Any volunteers?

TraumaNurse · Oct 21, 2006

Although this article had some valid points. I think they were WAY off base for most of the article. I think it's this type of poor journalism that puts a lot of misinformation out to the general public. Yes, drug abuse in anesthesia is a legitmate problem. But the article makes it sound like all anesthesia providers are junkies. This couldn't be farther from the truth.

THey also go so far as to suggest that people "request" 80% O2 and 20% Nitrous in order to decrease PONV and to request ropivacaine instead of bupivacaine because it is less cardio-toxic. They also say people should request a skin test prior to any anesthesia to determine if they MAY have a allergic reaction to a specific local anesthetic. In my opinion, to suggest to a lay person what to request as their anesthetic is ridiculous and unsafe. Anesthesia providers spend years learning about physiology, pathophysiology, chemistry and pharmacology as well as ANESTHESIA. The trained anesthetist should be the one to determine the best choice of anesthetic for a patient based on each persons individual needs. If a person has a concern, they should speak with the anesthesia provider prior to surgery, not walk in there and make specific requests based on misinformation.

I am writing a letter to Mens Health to suggest they be a little more careful in the information they are putting in their magazine. Although I don't take the material written in Men's Health as serious medical advice, many people out there may actually take it a little too seriously.

NurseCherlove · Oct 21, 2006

It is quite likely the people writing the article are way off base. Fentanyl is not a volatile gas, and can only be exhaled in water vapor, and this in extremely minute quantities. Most of those practicing anesthesia do not sit with their head over the patient's mouth, and especially given that most patients receiving any significant anesthetics are on rebreathing circuits. Perhaps this would be a good study....MAC anesthesia with high dose fentanyl just below the point of apnea, then have the CRNA/anesthesiologist attempt to breath in as much patient exhaust as possible....
Any volunteers?

Just a side note off the topic here...just curious...Paindoc, what brings you to this site? I've noticed there is another doc who sometimes visits this site and just wondered why. Don't get me wrong...I'm glad to have you here...Welcome!

paindoc · Oct 22, 2006

Since I do not administer anesthesia any longer (except for in office MAC), I have no axe to grind with CRNAs and have worked with them for years. Sometimes it helps to have a MD's perspective on issues in a non-judgemental fashion...

wallyballie_golf · Oct 23, 2006

The one thing that i did not like about the article was that it stated, "contrary to the shabby, shuffling junkie stereotype, the anestesiologists most at risk of addiction are the best in the business. They tend to be young, ambitious, highly talented physicians who graduated at the top of their medical-school classes and are ranked among the most popular and requested at their hospitals." I know that it is talking about anestesiologists, but in actuality, to people reading this article it is talking about the people that provided anesthetics.

This is leads to believe that the people best at providing anesthetics have to be or are junkies. Not to put this person on the spot, but i feel that this person's comments is more realistic to the idea of the ones that are the junkies, "Many who became addicted were the thrill seekers...the base jumpers, mountain climbers, mountain bikers, downhill skiiers....those that like a little living on the edge. But some were quiet and had rather bland lives....".

Again, like stated before, this is just poor reporting. Unfortunately, people will read this article and become scared of the fact that if they want the best treatment chances are they are getting a junkie, and if they get someone that is not the best they may not be getting the best treatment, but atleast they do not have to worry about the provider being doped-up.

That is just my two cents.

Wally

vamedic4, EMT-P · Oct 23, 2006

Having just read the article in question I can agree on some level with most of you. The article to me, however, didn't portray most anesthesiologists as addicted, only some..and it made that point several times.

And for these docs to choose fentanyl as their drug of choice?? Stupid. As we know, fentanyl is short acting, but given to patients already established on narcotic therapy. Taking this med without a level of narcotics in your system is setting yourself up for serious side effects...you know, the unconscious, apneic kind. And even if you give yourself a dose that allows you to function, you're gonna have to do it again soon anyway...soon you'll be upping the dose..and on and on until who knows what happens.

I have issue with other parts of the article, particularly the part that tells the tale of Dr. Angeluzzi- "Cole called attorney Richard Silver and was soon plunged into a dark side of medical care that he'd never dreamed existed. Silver began digging and learned that Sadie's anesthesiologist -- Dr. Jay Angeluzzi -- had behaved bizarrely during the procedure. First, he'd failed to recognize that Sadie had stopped breathing, even after the electronic monitor's alarms sounded. Then, instead of examining her, he'd turned off the alarms and left the room. It would be 9 critical minutes before anyone noticed Sadie was not responsive. By the time she was revived, her brain had been oxygen starved and ruined."

Oh, and NO ONE ELSE NOTICED?? Fishy at best. Nine minutes and NO one noticed that Sadie's sats were in the toilet, or that her anesthesiologist had left?? That doesn't just make the anesthesiologist look bad, it makes everyone involved look bad. And no amount of money on the planet is gonna make up for that.

vamedic4

will it be 0700 anytime soon?

zrmorgan · Oct 25, 2006

I guess we all have to wear respirators and mopgear in the OR from now on. I love the way the guy wrote it....how the researcher was looking everywhere for the trace fentanyl and "jackpot" found it in the patients mouth. Does "jackpot" mean he found the reason for substance abuse amongst anesthesiologists? I also am impressed with the addicts who to avoid leaving track marks inject themselves anally. Talk about desperate measures.

On a serious note, I am always amazed how in a lot of contexts the addict is portrayed as some sort of victim. What would motivate someone to walk around the OR taking samples for trace fentanyl that might cause us to be mysteriously susceptible to narcotic addiction?

To help their recovery, addicts need all fingers pointed in their direction, most importantly their own. True, we need to be supportive of our sick collegues, but to dismiss their problem as secondary to occupational exposure, or an ineffective coping mechanism for job performance stress is enabling the next generation of addicts.

BSNtobe2009 · Nov 5, 2006

Wow, that's amazing. I wonder if it's something that is known and what kind of protection they can use?