redding6

I can understand the hesitation to have general anesthesia in an out patient arena but I can assure you that, as an Oral Surgery RN, our clinic performs a variety of procedures every day with IV or conscious sedation as well as general anesthesia and have had no, as in none, adverse outcomes. The Oral Surgeon's training include rotations in anesthesia and their boards include passing anesthesia testing. Having an ETT in the mouth while extracting wisdom teeth is no problem. Every patient is monitored with NIBP q 5", and SP02, ECG and Respiration continually. The patient is recovered in the procedure chair for at least 30" post the last administered IV drug and 60" post general anesthesia and then released only with an escort who promises to remain with the patient for the duration of the day. The office personnel are trained to recognize a variety of emergent situations and we have mock codes quarterly. The crash cart gets checked every day and the Oral Surgery tech's know how to perform the initial actions in any scenerio even though they do not push meds, they do start IV's and can place defib pads as well as charge the Zoll. The surgeon would be the on e who would administer the ACLS drugs and the defib charge itself if I wasn't there. Personally, prior to working in the Oral Surgery Clinic I would have been skeptical also, but I would go under the gas in my clinic today if I had to without any fear. I hope this helps put you at ease regarding your upcoming surgery.

Whew!!! Let me clear some things up here. I am a RN X 22 years, 15 in ICU/CCU, 4 in PACU and now 2 in an Oral Surgery Clinic. We do IV sedations as well as general anesthesia, IN THE CLINIC, for a variety of procedures but mostly extraction of wisdom teeth, aka 3rd molars. Our Oral Surgeons are certified in anesthesia as part of their residency and we perform AGA or general anesthesia every Thursday. They intubate weekly, in the clinic, pediatric as well as adult patients. We have two anesthesia machines as well as a crash cart so access to airway equipment is no more than arms length in the procedure rooms. The IV sedations are done four days a week. The assistants actually start the IV's. They have all attended a hospital sponsored IV Phlebotomy class and then have to perform 20 IV starts under supervision before being allowed to start an IV unsupervised. They are pretty good at it too! The surgeon draws up the medications and gives the initial doses of Fentanyl and Versed, no propofol, until the patient is in a "moderate sedation" status, vital signs stable and patient is responsive to verbel stimuli. The surgeon wears a listening device in his or her ear which is attached to a head placed on the patients chest at the trachea/corina area so the sounds of inspiration and expiration are being monitored constantly by the surgeons left ear. The cardiac and respiratory alarms are set on the overhead monitor which displays rhythm, SPO2 including waveform, and NIBP q 5 minutes. One assistant scrubs in sterile with the surgeon and another assistant is the monitor/circulator, never leaving the room. Vitals are charted q 5 minutes. This is when the surgeon may ask the assistant to give the patient another small dose of Fentanyl or Versed. During the procedure if the patient starts complaining of pain or starts moving in the chair becoming restless, additional doses of Fentanyl or Versed are given but in very small amts. Propofol is only given with the general anesthesia procedures. Although I am the only RN on staff, the assistants have demonstrated to me in real situations that they are competent in recognizing critical changes in a patients condition and they do know how to call a code, retrieve the crash cart and perform BLS. The only time an assistant "pushes" a drug is under the direct visual supervision of the surgeon who is performing the surgery and he tells the assistant exactly how much to give in volume amounts not doseage amounts, in other words, he or she may say to push another 1ml of versed. When general anesthesia is given, one surgeon is administering the anesthesia and another is performing the surgery. I recover the patients in the clinic and discharge them according to PACU standards. Hope this eases the worries of those who thought the assistants were "pushing" the drugs on the patients the same way RN's are managing sedation and pain in the ICUs . Thanks

I have worked at MAMC for 7 years this month. I worked in one of the two ICU's they have, named ICU-East (includes peds, PICU) and ICU-West (includes post hearts and IABP's). Both are great places to work and the critical care course taught by MAMC is considered excellent. I worked ICU-East from 1999-2000 and this completed my 15th year in ICU, so I was starting to experiance the dredded burn out. I transferred over to the PACU, and worked there for the next 4 years. I finally moved on to the OR and clinic life. All in all, having worked 3 different areas in MAMC, I feel it is one of the best hospitals in the country. I was a travel nurse for 7 years and this gives me the ability to make that statement. Being a civilian in a military hospital has it's pro's and con's though of course. One of the best benefits is that most unit Head Nurse positions are held by a Major, and most residents are Captains. So when the nurse outranks the resident, whoo-hoo! But I haven't really encountered very many difficult personalities within the resident's roster, some are incompitant, but not with really big egos. So I think you will like Madigan. The Pacific Northwest is beautiful and you are coming at a really great time. Our best (driest) months are July and August, cannot be in a more spectacular environment during the late summer and early fall. Winters are mild. Ok, enough jabber. Hope you have a good time here. Bye.

Ugh! Up until one time in my nursing career, I would have had a hard time believing what you wrote except I too witnessed what I thought was a horrific practice of piling dead bodies in two and occasionally three layers deep, in the morgue, because the county could not accept anymore "John Doe's". Fortunately, it is the exception instead of the rule (as far as I know). I was a young thing working in the ER at Parkland Hospital in Dallas back in the 80's and one of my jobs as an aide was to transport bodies from the ER to the morgue, we ALWAYS put them in thier own space, whether it be a drawer/bin, or in a large walk-in cooler. But years later, at a hospital in Washington DC, I was initiated to the practice of piling bodies in the morgue. Words cannot describe the horror of what I thought was unthinkable, how undignified! Now I hear it is not so very rare, although not very common either to double duty the cadavers. Oh well, lets take care of the living as best we can. redding6

Thanks to those who replied to my question about participating in an organ harvesting, very insightful responses you gave. I will use the responses in my CE (not verbatim, but generalized). The situation in the OR at the time of the harvesting process seems very much to be decisive on whether the nurse (and team) is left with a positive or negative impression. Thank you all again for your reply(s). redding6

thanks for replying! I pictured myself in that room that you described. Very somber indeed. Reminded me of the Parkland ER (Dallas) when a trauma victim died. A lot of "could that be me". I haven't seen an organ harvest, but I have heard from those that have....very brutal, as you described. Thanks again. Kathy

Thanks Alyce for replying, I am really surprised no one has done a study on the topic for their masters degree, or some other reason. AORN for OR nurses has touched on the topic in their article in 1999, but really, no one has done a study. Oh well, I would say I look forward to your input except that would mean you had to do an organ harvesting procedure and it may mean you in fact are finding yourself depressed about it. So, maybe I don't want that to happen after all! Thanks either way. Kathy

I am not finding any information on depression amoung OR nurses who have assisted with organ harvesting. A few articles actually mention the existence of OR nurses finding the experience difficult to deal with, but I wonder if anyone has done a study or workup on the subject. I am an OR nurse and am attempting to do a CE on the circulators duties in the organ harvesting process. My CE will be targeted at OR nurses and so I thought the objective of the effect the process has on the OR nurse would be interesting. Maybe this is a topic for someone to do a paper on. If you know of any article, study, or someplace where one can be found, could you post it? Otherwise, anyone out there assisted with organ procurement and found it depressing. Thanks, Kathy