Non anesthesia provider providing anesthesia

[EMS/ICU/SRNA]

I overheard an ED attending discussing a policy regarding the administration of propofol w/ an RN at work today. Apparently the policy states that propofol or any other medication may be administered to a non-intubated pt if an attending ED/Pulmonary physician is in the room. This would be done for a procedure ie: reduction of a fx....etc. I asked him why anesthesia personnel would not provide the anesthesia. He responded that the ED/Pulmonary physician is able to provide all services that anesthesia could. What do you guys think about this?

[deepz]

........It is so nice being able to learn from somebody elses mistake. .......

Good judgement comes from experience.

Experience comes from bad judgement.

?

[jer_sd]

here is a different twist to this topic .

how do crnas feel about other "mid-level providers" as sedation (not anesthesia) including possibly deep sedation? pnps frequently sedate for children's hospitals, what about other nps or pa-cs performing moderate to deep sedation?

or eve\n better a np or pa-c performing a procedure having the patient sedated (moderate) by a rn with out anesthesia provider or md/do in the area?

would you support your collogues with these practices or do you feel that is getting too close to your arena?

jeremy

[jwk]

here is a different twist to this topic .

how do crnas feel about other "mid-level providers" as sedation (not anesthesia) including possibly deep sedation? pnps frequently sedate for children's hospitals, what about other nps or pa-cs performing moderate to deep sedation?

or eve\n better a np or pa-c performing a procedure having the patient sedated (moderate) by a rn with out anesthesia provider or md/do in the area?

would you support your collogues with these practices or do you feel that is getting too close to your arena?

jeremy

it's not a question of "getting too close to your arena". it's a question of what's safest for the patient. the measure we often use is that a practitioner must be able to manage a patient one level "deeper" than what they're expecting. someone giving "deep sedation" should therefor be able to manage someone who gets a little deeper and into the general anesthetic range. that means only an anesthesia provider should be handling those patients, since only an anesthesia provider can legally administer a general anesthetic in any state.

[austin heart, BSN, RN]

This thread, like the other one in GI, makes me very scared! People try and be cowboys and they really don't know what they don't know. It all will serve as a reminder to myself to ask what the qualifications (degree) of the person providing my anesthesia or sedation. I really don't want some nurse pushing Propofol on me just because they think that they are qualified, please give me someone who IS qualified.

[MmacFN]

As a twist on the conversation...

I give succs, vecc and roc all the time. The intent, however, is always to intubate. What seperates my administration of that medication in flight from having an ER doc using propofol in the ER for closed reduction prepared to intubate.

Here are a couple of questions for the list:

1) Do you believe that giving propofol, with such a short half life, is more dangerous than roc or vecc?

2) What is the worst thing that could happen, in your opinons, with giving propofol in the ER for these emergent procedures at the doses which are being administered besides the need for intubation? Are they worse than paralytics?

Food for thought

[rayman]

Mike, I think one of the key points is that some people are thinking of propofol as just another sedative...using it casually when in fact it is an anesthetic. As others have pointed out the package insert says so and it also says it is to be administered by an anesthesia professional. They are not understanding that it is much more than that and as someone else said, in essence, a lawyer certainly will after which any arguments will probably be moot.

[MmacFN]

hey ray

Yes i do understand what people are concerned about. I agree with them. I was just asking another question in regards to saftey issues and potential for harm. Just looking for general opinions

[Zachary2011]

Do you give versed as an RN, well if so, diprivan is no different, Has pretty much same effects with a much shorter half life. And as with versed you need to have an Ambu bag, and Resp Box at hand for possible BVM and intubation if unable to BVM effectively. We give Diprivan all the time in our ER also for reductions and such and use the gtts for post intubation sedation. Just need your ER doc there for airway managment. I guess I dont understand the big deal w/ diprivan and some nurses not thinking it should be in there job description. Nothing to be too concerned about, so easily titrated even by IV push, onset is like 30 sec.s and pt. is back to baseline LOC in 15 min.s Its a wonderful med and so much safer then Versed .

[rn29306]

Do you give versed as an RN, well if so, diprivan is no different, Has pretty much same effects with a much shorter half life. And as with versed you need to have an Ambu bag, and Resp Box at hand for possible BVM and intubation if unable to BVM effectively. We give Diprivan all the time in our ER also for reductions and such and use the gtts for post intubation sedation. Just need your ER doc there for airway managment. I guess I dont understand the big deal w/ diprivan and some nurses not thinking it should be in there job description. Nothing to be too concerned about, so easily titrated even by IV push, onset is like 30 sec.s and pt. is back to baseline LOC in 15 min.s Its a wonderful med and so much safer then Versed .

I cannot believe that you posted this on a CRNA forum. YOU are the reason this is going on. Don't tell me that LPNs are now pushing diprivan.....

DIPRIVAN DOES NOT EQUAL VERSED.

I took it amonst myself to underline your more amusing components to your thread.

Someone else can field this troll post, I'm going to bed.

[maturner]

Do you give versed as an RN, well if so, diprivan is no different, Has pretty much same effects with a much shorter half life. And as with versed you need to have an Ambu bag, and Resp Box at hand for possible BVM and intubation if unable to BVM effectively. We give Diprivan all the time in our ER also for reductions and such and use the gtts for post intubation sedation. Just need your ER doc there for airway managment. I guess I dont understand the big deal w/ diprivan and some nurses not thinking it should be in there job description. Nothing to be too concerned about, so easily titrated even by IV push, onset is like 30 sec.s and pt. is back to baseline LOC in 15 min.s Its a wonderful med and so much safer then Versed[/size] .

LMAO

[yoga crna]

Do you give versed as an RN, well if so, diprivan is no different, Has pretty much same effects with a much shorter half life. And as with versed you need to have an Ambu bag, and Resp Box at hand for possible BVM and intubation if unable to BVM effectively. We give Diprivan all the time in our ER also for reductions and such and use the gtts for post intubation sedation. Just need your ER doc there for airway managment. I guess I dont understand the big deal w/ diprivan and some nurses not thinking it should be in there job description. Nothing to be too concerned about, so easily titrated even by IV push, onset is like 30 sec.s and pt. is back to baseline LOC in 15 min.s Its a wonderful med and so much safer then Versed .

Zac,

What is a respiratory box and what does BVM mean? I have never heard of them before.

Please read the package insert before the next time you give the drug and then post here how you will explain to a jury about your anesthesia qualifications to give propofol.

It is NOT safer than versed. Show me your evidence based references, the kind that will hold up in court.

Yoga

[MmacFN]

for the record... i didnt say that versed = dip comment.

Tee Hee