BigPappaCRNA

I think it is just a practice that has been handed down through time. When I first started practicing anesthesia in 1992, we didn't even have End Tidal agent monitoring. We just turned the Forane dial to 1% and hoped and prayed that they were getting the appropriate amount of vapor, but we never actually knew if they were. It wasn't until the late 1990s that end tidal agent monitoring became more common. Then the BIS came out (not saying it is good, or bad, just that it now existed) giving an additional layer of measuring. Now there are cerebral oximetry platforms and more importantly direct frontal lobe EEG monitors ( Sedline by Masimo) that have completely taken the guess work out of the equation. I would be far, far more comfortable doing a case with 1% Sevo if I could see the raw EEG waves and see they were going in and out of burst suppression. Then, I would paralyze. Just no good reason not to do so. The aversion is really from a bygone era. It likely won't go away for another generation (like Swan Lines, or test ventilating before giving muscle relaxants, or avoiding LR and only giving Normal Saline in ESRD, and countless others.). It will just take some time.

No. No only is it not common sense, your opinion is not evidenced based and not supported by a mountain of literature. Never paralyzing someone with an LMA is old school dogma, passed on through the years with no research to back it up. There are countless citations about the efficacy and safety of NDMR use with the LMA. Hell, even LMA literature from the manufacturers says it is OK to do. Hell, even the worlds leading airway expert, Dr. Benumof says it is appropriate. Now if you choose not to do so, that is fine, and reasonable. We should all practice at our own levels of comfort, but since students are reading this, I just had to correct your grossly incorrect statement.

Sorry Solarex, but he is 100% correct. Sugammadex is actually cheaper, directly compared with the prices of both Neostigmine and Glycopyrolate (both of which have soared since Sugammadex was released). This is not even taking into account the more difficult costs that are a little more difficult to quantify like weak patients, prolonged PACU stay, aspiration, and NAUSEA. Bottom line: Sugammadex is both less expensive up front in acquisition costs, and really laps the competition on the overall perioperative experience.

I have not used Etomidate in more than 10 years. Just see no reason for it. The adrenal suppression is well documented. Now, where there may be some area for discussion is in the clinical significance of the adrenal suppression. That is open to debate. I use Propofol now for almost any clinical situation. Just cannot imagine a clinical scenario that would make me choose Etomidate over Propofol. The emesis producing effects of Etomidate alone, make me hesitant to even consider it. Forgot to mention, I cannot for the life of me, figure out why a provider would ever split up and dose Etomidate and Propofol 50/50. I have seen it done, but no provider has ever given me a cogent rational for doing so.

Samuel Merritt has very, very few. Some of there students may rotate at UC Davis, and there are residents there, but it is a huge, enormous facility and from an SRNA point of view, plenty to go around. Samuel Merritt students also get to go to some amazing, truly amazing, all CRNA sites. Some of the students get 150+ nerve blocks in a month at some of these sites. Overall they have a very strong clinical experience, with minimal MD resident involvement. Kaiser's program also has minimal resident involvement. At all the Kaiser hospitals themselves, which are the overwhelming majority of the rotations. there are not residents, and there is no competition.

Get some good, strong, quality nursing experience. During that time, get your ACLS, and PALS, and your CCRN. Take all sorts of classes. Then...you will need to take some classes in order to show the program (and yourself) that you are capable to withstanding the academic rigor of a program. Take an Upper Division Chemistry course, or physiology, or micro. Maybe stats or something that shows them, and you, that you can do the work. Not trying to be a hard ***, but before you apply, quit your job, tell all your friends you are leaving, etc, you need to make sure you can actually do the work. Only you will know the answer to that question. BTW, I do not personally think getting a generic MSN will do you any good as far as getting accepted, and it will just take your focus off the prize. Good Luck.

I think you read his post wrong. His nursing GPA is 3.02. I do not want to pile on, but I do not think there is a program in the country that will take an applicant with that, at least as is.

We work in chronic pain management in all states and practice settings already. There are many, many pain management fellowships and post-graduate certifications a CRNA can get. Maybe a few of the older crowd were grandfathered in, but most are required to get a CRNA fellowship of some kind in pain management. It is no different than the MDA route, for the most part.

How about keeping it current. Expectations of some facilities that CRNAs actively work in the ICU due to the Covid crush.

To be clear, the profession did not change its name. The professional association for CRNAs changed their name. The AANA does not have the power to change the professions name. Our ability to practice is by state, and with our state nursing license. There will be 50 different opinions from them, plus, the NBCRNA will get a say in it as well. While the association changing their name is a good first step in the process, it is a marathon, not a sprint, and we are still on the first lap.

You will be able to practice as a CRNA with a masters degree for many, many years to come. However, this year is the final year that programs are admitting masters students. After this year, all admissions will be into DNP/DNAP programs, to meet the mandate to have 100% doctoral entry level by 2025. Your questions does not have a lot of merit at this point. Get your BSN, get your 3-4 years of quality ICU experience, and then enter a program.

This post has a very strong "troll" feel to it.

I don't find them to be any problem at all. Especially for a spine surgery which likely will be intubated. Just don't let them intubate your esophagus, problem solved.

I have heard this, but have not really seen the it. Most classes have a few scattered students in their 40s. The reality is both academically and clinically, they do very, very well, in fact they are usually near the top of their class. But, the other reality is that they tend to have lives outside of school, that get in the way of being successful. Maybe sick parents, maybe spouse issues, often financial issues, health issues, stress, maybe loser kids, whatever it is, but these are the reasons that many in that demographic don't seem to finish.

I just have to keep it real. You have not done too well in your courses up until this point. Only you know why that is, but I can tell you, the work needed to complete a CRNA program is exponentially more difficult. If you gave your school work your honest, best shot, than CRNA is probably not the best direction for you to expend your time, energy, and MONEY. At the very least, take two upper division or grad level sciences courses, ideally at the same time, and see how you do. Give yourself your best effort, and let these courses decide for you. Good luck.