ali anesthesia

The hospital should have a discharge planning department. These people can work magic in finding places that accept Medicaid. Hopefully this patient has a family who will assist in finding a place for her. Just some random thoughts.

Good scenario. I have seen one case of MH and it is something I will never forget. It is my understanding that any agent can trigger MH, but it is mostly seen with succinylcholine. This will not make me popular, but I don't work with anesthesiologists, so I assume my own liability. Nurses talk WAY too much about legal issues. I am very diligent and administer good anesthesia and am not worried about lawsuits or protecting my license. Ali

In the essence of clinical topics, I would like a discussion on how you insert LMAs. Do you do it with cuff totally deflated or partially inflated. I do it both ways, and am not sure if one is better than the other. Would love to hear other opinions. I will also cross-post this on another forum and compare the answers.

It is crucial that you have a thorough understanding of inorganic, organic and biochemistry if you have any interest in becoming a CRNA. The better foundation you have on these topics, the easier it will be for you to understand and learn pharmacokinetics and physiology. There are no shortcuts in anesthesia.

Lizz, You did a nice financial analysis of opportunity loss in regards to nurses and nurse anesthesia education. However, you left out a few very important considerations. Most nurse anesthetists practice for many years--well into their 70's, while most nurses leave nursing at a much younger age. Also, there is very little "burn-out" in anesthesia and most CRNAs love their work and profession. That is something I can not say about nursing. My decision to be a CRNA had to do more with having a professional career than just a job. I have a very good friend who works in California, not Kaiser and makes around $250,000 a year in a private practice setting. It is a cash business and she does have to pay her own malpractice insurance and other expenses. I do have to agree that if money is the main motivation to be a CRNA, you are going to be disappointed, because anesthesia education is very competitive and difficult, which is necessary because anesthesia administration is stressful and demanding and we earn every penny we make.

Buying my house was the single best investment I ever made. Depending on your area of the country, now may be an excellent time to purchase--low interest rates, buyer's market. I would like to add a word here on personal comments. There are many people who think CRNAs make too much money...mostly out of ignorance in not knowing what is involved in doing anesthesia. That is probably a reason some of the previous posters wanted to know why you asked the question. It is always interesting to me how people get defensive when it comes to money. It is very much a personal issue.

I suggest you reveal who you are and your motivations. If you want to get involved in a ....ing contest, be prepared to suffer the consequences. No matter how you or anyone else try to manipulate the facts, there is no study showing any difference in CRNA care and MDA anesthesia. The AAs don't fit in this equation, because of the legal requirement of MDA supervision. You better believe the AANA has the best interests of its members at heart. If they didn't, why should they exist? We are considered one of the best lobbying groups in the nation in both the state and federal levels. We are one of the most sought after professions, with high standards to even qualify to get into the programs. If you have a problem with this, post on another forum where you will have a captive audience. I would rather see posts here by professional anesthesia providers (not AAs) and people who are interested in our powerful profession. Ail (CRNA)

The real question is: what is the value of administering anesthesia. The ASA has established that years ago with their relative value guide. It seems like the value of administering anesthesia is higher than treating runny noses and type 2 diabetes. Make of it what you want, but it is the reality. I know many physicians who wish they had gone the CRNA route. One of the surgeons I work with insisted his son become a CRNA instead of going to medical school. Ali A

Easy answer. All of the accrediting agencies (including those who accredit office surgery centers) require an RN to circulate. There are not two different standards of care, one for hospitsls, one for office surgery. There is one standard and the CRNA will be held to that standard. It is particularly important to practice to a high standard in a solo practice doing elective surgery. I do anesthesia, I don't circulate, I do not document anything on the Intraoperative Nures Notes. Amen Ali

You have to decide what is best for you and how you handle stress. Yes, anesthesia can be stressful and there are days that you earn every dollar you make, and there are days that are boring and routine. The main point I want to make is this--CRNAs rarely suffer BURNOUT like nurses in other specialties. There are probably many reasons for that, but I believe that most CRNAs have figured out how to handle the stress and work with it. You will find CRNAs who are working well into their 70's. A CRNA who used to post here, (Yoga) has been in a full time anesthesia practice for over 45 years. But, if stress is an issue for you, consider another field. Try shadowing a CRNA for about a week, so you can get a better understanding of the environment.

I don't want to get in a contest of the wits with you, but I continue to believe you are off-base. Believe me, I understand the legal concept of informed consent and know of the multitudes of studies which show that the patient remembers very little about it. My patients and I have a discussion about my anesthesia plan for them; a plan that is developed by considering patient pre-existing diseases, the surgical procedure, intraoperative safety and post-operative pain control. Part of my duty as a PROFESSIONAL is to educate the patient and also to learn from them. You have no idea who I am and what I tell my patients, so I would advise you to tread lightly here. When I consider versed to be indicated, I give it; when there could be an issue of patient safety, I may use an alternative. It is an excellent drug, and like all drugs must be used as indicated and with proper monitoring of the patient. I have had patients tell me they are "allergic" to oxygen. Does this mean that I have to do their anesthetic without oxygen? Of course not. While I agree this forum is open to the public, I believe the public should be aware that ONE person's experience, while important to them, does not mean that everyone will respond that way. When you can present evidenced-based scientific information on this topic, I will pay attention, otherwise you are simply exploiting this board to vent your own anger. One final word, I am in a position to administer anesthesia to MANY physicians and nurses (I get a lot of request cases). They have been very accepting of my choice of anesthesia and the ones with the most knowledge and education, are the most accepting and easiest to deal with. There is a message there. Ali Anesthesia

On another board, there is a lot of discussion from CRNAs regarding the caliber of people applying for anesthesia school. It is the general consensus that more and more people are applying because they think it will be easy money and that they are not motivated to understand the professionalism required to be a CRNA. I hope all of you who are considering this career path, spend a lot of time shadowing a busy CRNA. A friend just got off 48 hour call with lots of trauma and OB cases. Another colleague is available 24/7/365 and has to pay for and find his own relief. It is not a field for everyone, nor should it be. I like to think we are the elite. But that is just me.

I have read through all of these posts and wish to say a few things. It is most unfortunate that you had a complication that may have been related to anesthesia. But I think you are way off course in your desire to dictate anesthesia drugs and techniques, based on limited knowledge and understanding. While I understand the concept of informed consent, the anesthesiologist's biggest mistake was not refusing to do your anesthesia. It was elective surgery and he/she was under no obligation to take you on as a patient. While I respect your right to present your situation here, I am not sure what you expect from us. I will not change my practice of doing what I think is best for my patient, totally understand that informed consents are important, but rarely are understood by the patient and do not need to learn anesthesia from a non-anesthesia professional. Sorry to be so hard on you, but I consider this a discussion board for CRNAs or students, not disgruntled patients.

Another perspective--I have problems with PACU nurses not wanting to take the patients from the OR. They are always understaffed and busy or want the patient street ready when they get them. If you don't like to work in the PACU, find another place to work. Anesthesia a stressful enough in a busy hospital where short turnovers are expected. Then having to deal with delays because of PACU issues just does not make sense. Our chief CRNA solved this problem with PACU supervisor, when she said the PACU budget would be charged for the extra OR time. I understand your issues, I used to work in PACU, but having been in anesthesia gives me a whole new perspective. The patients deserve the best care--I give it to them in the OR, so it is not unreasonable to expect it in PACU. Ali CRNA

Just compare how much burn out there is in ICU and anesthesia. Being a CRNA is more of a career than most other types of nursing. How many older ICU nurses do you find? Most CRNAs consider anesthesia as a life time career. Just my thoughts. Happy to be in anesthesia, love the work, good reimbursement, nothing beats the opportunity to be independent and make my own decisions regarding patient care.