Tampa Two

Another argument for not ALWAYS paralyzing and ensuring your decision to paralyze (muscle relaxation with a paralytic agent) is specific for that patient, surgery, and situation is knowing that historically, of all the allergic reactions (including anaphylaxis) that occurs due to a drug given in the Operating Room by Anesthesia, the category with the highest incidence are paralytics. So, because paralytic agents have the highest incidence compared to other anesthesia drugs for causing severe allergic reactions, does that mean we simply NEVER give them? Of course not, but it again goes back to nearly all things in anesthesia in that there are no absolutes, and each drug given should be patient specific and taking into consideration the type of surgery, case length, comorbidities, etc. Just multiple factors involved, not simply one. For the original poster who asked the question, "Why not ALWAYS paralyze?" If you gave this question to every anesthesiologist and CRNA in the USA who has been practicing for more than 3 years, without knowing anything about the patient, surgery, or situation, the overwhelming majority would cringe at the word "Always" when used in the question. The word "Always" is an all inclusive word, and those are frowned on in the anesthesia world because their usage and practical application are extremely, extremely Rare.

I can testify to surrending a license and ending a career. I'm now a Physican's Assistant and I also teach at a Community College in Virginia in an ADN program for anatomy and physiology. In 2008, I was licensed in Virginia, Wyoming, and Texas. Virginia my home state and I was an ICU nurse. I devloped substance abuse and diverted from my work in Virginia and got caught. My license suspended for 1 year in Virginia with 5 year monitoring program/agreement, and suspended in Wyoming a year, and in Texas, they offered me a consent order which was 5 years of monitoring and requirements with their own program in order to keep my license even when I lived in Virginia. I would have had to check in 2 times daily and take drugs tests not just for VA, but in a separate system for Texas and do weekly meetings for Texas in addition to my home state of VA. I surrended my RN license to TX. Didn't want the hassle. In a year, I return to work in Virginia in the ICU as my same hospital who gave me a chance. I was in Virginia's monitoring program and doing well in recovery. 3 months into my job, my manager and human resources call me in and tell me I am on Office of Inspector General's Exclusion List. They put me on leave without pay and gave me 90 days to get off of the list to keep my job. I made calls to Texas and the Federal Medicare Offices and got an attorney. The exclusion was a 5 year mandatory for surrending my licence in Texas. Even though my Virginia license was now intact, I could not get off the list until 5 years were up (and I had a lawyer in this area well skilled). My career in nursing ended that day. Virginia said I could remain in their monitoring program for the remaning 3 years and 9 months, but when/if I went back to work as a nurse in 3 years and 9 months (when I came off the exclusion list) that I would have to have an additional 2 years of monitoring as a nurse, because to pass the 5 year monitoring program, I had to be monitored while working as a nurse for at least 3 of those 5 years. Also, I would have to have retraining when I came back to work in 3 years and 9 months because I would have been out of nursing so long. My career in nursing ended that day. There was nowhere to work. Nowhere to practice. Basically all healthcare jobs in nursing are tied to Medicaid or Medicare and the only place I could have worked would have been a testosterone clinic which were not around at that time, and the jobs are scarce, and they wouldn't hire a nurse in recovery anyway. I applied for PA school and started a year later. I graduated PA school with 4 months left until my Federal Office of Inspector General Exclusion was removed. I went to work 10 days after the exclusion was lifted, but had to wait 4 months after graduating PA school just to work as a PA. The OIG Exclusion list is a very scary and very real thing, and I was put on it and my career in nursing over because I surrendered a license in a state in which I never lived or never practiced and was half way across the country from Virginia. Interestingly, I never was placed on the Virginia Medicaid or Wyoming Medicaid Exclusion lists for what I had done, even though my licenses were suspended in both states and I was publically reprimanded, but Texas put me on their State Medicaid Exclusion List for 5 years, and it took about 10 months later for me to reach the Federal Office of Inspector General Exclusion Database (which came from Texas) and that exclusion was 5 years with no way to get off it, even with an intact license in Virginia and showing progress in recovery and doing well and even back to work! I agree with the one poster on the dangers of surrending a license. You may get away with it, but I can attest to the fact that you are playing with fire.