Laughing Gas

I do agree with what you are saying. An RN with ACLS giving versed for a scope is one thing. I have personally been approached by surgeons asking how they could get by doing procedures in their offices, which traditionally have been done under GA or big MAC. Do we need to draw some lines in the sand? How much do we let the patient experience because the doc wants to do this in his office? It is perfectly acceptable to do a colonoscopy with no sedation. If the patient doesn't mind that is. The problem is that the procedures seem to be crossing the barrier. For example.... A surgeon talked a woman into having a procedure normally done under GA, done under local. This was not a local procedure. The pt and doc both told me that they wanted no sedation. I educated the pt on the probable discomfort. Two minutes into the procedure she was yelling. I asked if I could intervene. The pt agreed. The surgeon protested. In a bit of a post conference with the MD, his motives were clear. He wanted to start doing these in his office, without sedation. No it is not feasible to provide anesthesia for every colonscopy and wart removal. And an RN pushing some mid is ok too. But how long before its a med tech pushing diprivan for veins? Defining anesthetics drugs, and who can use them is far from elitist. It in fact is what we do. If we don't have a say in patient safety as pertains to the safety of pharma, then who does? I know surgeons who would let dietary sedate patients as long as the case went on time. Most HMO's would let a chimp do the anesthesia if it cost less. Elitist turf protection in the eyes of people motivated by cash, possibly. Patient protection in the eyes of an anesthetist, always.

I believe propofol's use is or at least was intended to be restricted to induction of GA, haha I know. And if you want to get literal, we can induce states of altered consciousness through many different ways, H2O intoxication, Jack Daniels, CO, anything can be used for anesthetic purposes. I have caused apnea in a healthy woman after 1 mg of versed. So yes these are anesthetic agents, aside from my anecdote. Propofol is titrated to effect. Do you trust a podiatrist concentrating on his procedure to instruct his med tech to titrate the diprivan to provide anesthesia and avoid apnea? The question of who should be awarded anesthesia care based on income goes way beyond the scope of this discussion. In a nut shell, everyone should be treated equally. Does this happen? No. Does equal care work? No Canada (to the tune of Oh Cananda) You are correct, there are no easy answers. The issue is based in the fact that patients are having procedures done requiring anesthesia in office settings. Maybe we need to ask, can this be done in your office, OR do you need anesthesia. Not... how can we do anesthesia in our office when no one knows what the heck they're doing. Safety is our only job. We are not invited to this job. Hence there is little regard or understanding about safety. Patients pay the price.

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I understand your point about supervision. But go ahead and look for anything endorsed by the ASA or nearly any hospital doctrine and you'll see the word supervision. Yes it is rare for a CRNA to make as much, yet it is not incredibly difficult either. Just gotta put up with the krap.

Anytime someone is giving anesthesia drugs, other than an anesthesia provider, you are asking for trouble IMO. Most of the inserts tell you not to touch the drug unless you are anesthesia (paraphrasing a lot here). I am willing to bet that the vast majority of healthcare workers do not know how to ventilate a patient. If you think it is just squeezing the bag, then you have just proven my point. Ventilating a semiconcious patient who does have some effort is not the same as ambuing an arrested pt. I did not see that CRNA's were even mentioned in the article, let alone villianized. I actually agree with it. If someone is giving me or my family anesthetic drugs, it had better be a CRNA or MDA. And yes, I'd pay out of pocket for it. My life probably depends on it.

Salaries have nothing to do with reimbursement, not directly anyway. We can bill as much as an insurance company is willing to pay. Salaries come into play when you work for an MD controlled practice. CRNA's can easily pull in as much as MD's if they control their own group. As for hospital decisions on what to pay employee MD's and CRNA's, that is probably based on the hospital's practice standards and the MD's ability to bill for multiple cases, and get reimbursement for supervision.

1.The right to privacy has nothing to do with illegal drug use. 2. X is more dangerous than alcohol. I can have a beer and be 99.9% full functioning. I bet after 1 X tab I'm not so hot. 3.When was the last time I heard about an X related death? About 2 weeks ago, 3 teens died. 4.ETOH can be just as dangerous due to driving? Cell phone use and inattentive drivers are pretty darn dangerous too. So are 16 and 86 year old drivers. Any other intelligent comparisons? 5.Working with a hangover is dangerous. Working with any distraction, flu, hangover, bad gas pains:wink2: is dangerous. What's your point? CRNA's should not be coming in hungover either. 6.Ecstacy addiction, you don't think so. How long have you been researching this? Was this part of your PhD thesis? Not that it matters. But you have 2 choices; Do you select the CRNA who had a bowl of corn flakes for breakfeast and spent the weekend playing with the kids..... or the CRNA who just got a good 20 minutes of sleep between X hits this weekend? Hurry the mask is coming down on your face! Since you think that privacy governs this area, we'll let you honor the impaired CRNA's rights by risking your life. Best of luck, you'll need it.

I hope the people condoning this aren't CRNA's. Anesthesia providers have the highest incidence of substance abuse above all other groups. It is an illegal drug. What else do they take? Why would they be honest about ever being impared at work? Turn them in. This is not the cub scouts. If you take your responsibilities seriously about being an anesthetist, you would take some official action. Tell the chief CRNA, or supervisor. And for god's sake, non nursing people read this board. It looks really bad when nurses tell other nurses to turn the other cheek to substance abuse. At least act like you're mildly bothered.

This is quite a dilema. Rarely are people torn between one or the other. You either know early on, or your lot in life leads you in one direction. In GENERAL... Your CRNA career can be molded to what you want. 9-5, home with the kids, 24 hours etc. Get home, don't worry about your profits, or employees. And be in the top 5% in income. And obviously, do an awesome job that is challenging and rewarding. (don't try to zing me on the money thing) MD has alot more earning potential, but IMO much greater headaches. In what I have seen and heard, alot of the MD's get mired down in business, fighting with HMO's etc. Alot of the Docs in my group also pull anywhere from 50 to 80 hour weeks. If I were 18 I would probably go the MD route. But I honestly wouldn't trade nurse anesthesia for MD now that I'm here. You both administer anesthesia, you just pick the peripheral scenery.

There is never any such thing as free ride. Someone is collecting, rest assured. There has to be another signature on the chart with the SRNA. Why would something like this keep you awake at night? Unless you are billing for yourself, you shouldn't have much interest i would imagine.

I agree, it is too bad that alot of the admissions boards aren't more liberal. Most prospective students are not 18 years old. Most have motgages and families too. But this is one of those times when you can't hate the player, hate the game. It is a seller's market, and you are a buyer looking for a CRNA program. You are bidding with alot less money than most other players when you go into it looking for special conditions. As long as there are people willing to make huge sacrifices to become CRNA's, then there is no reason to make things appear easier, ie lower the price. The crowd of people that you are in direct competition with for admission are probably willing to do everything that you aren't. That dedication becomes apparent early in the courtship, and seperates the crowd. I don't mean to sound disrespectful questioning your dedication. But, there are fifty people behind you willing to put their lives on the back burner to become CRNA's. Just as an FYI while I was in school, I had three kids. 7, 4, and 4 months. Wife, mortgage, 2 car notes, etc, etc... I don't feel as though I missed a minute of their lives. Best of luck.

Very true. It is simply a popularity contest. Usually people vote who run programs, or have some "medical background". For instance, I doubt U Akron is listed even though there is a 96% first time pass rate for the last 13 years, with a 100% pass rate in the last 5 years. And this is with classes of 28 to 32. The national average I'm told is around 83% ?? I just sounds better to vote for the big names I quess.

I'm not on Valley's pay roll..... If Valley was telling what was on the exam, the AANA would shut them down faster than a speeding bullet. It is a focused review of Anesthesia topics. They do try to keep you informed of en voque hot topics that you may want to focus on. You should be able to take and pass boards without valley, but I am glad I didn't take the chance. Like most things in life, you get out of it what you put into it.

There are family friendly programs. But this is a relative term. It seems that a big part of traditional CRNA training involves extreme dedication. (Your holiday vacation will not be the week of Christmas, but the day of Christmas. ) Not to burst your bubble, but most programs would look upon your wanting a nontraditional lighter load as possibly unmotivated. To get into and through CRNA school you jump through hoops. There is an overabundance of people willing to do whatever it takes to get in. Anything less than this attitude can be detrimental to admission. I do have friends in other various ANP programs who claim to have more relaxed criteria for clinical/class time. Maybe NP is the better way to go. Good luck

Check ehealthinsurance.com Much better alternative than COBRA. It was up over 800 a month for our family of 5. We are paying 211/mo with a higher deductible in an Aetna plan.