Zinobile

I'm working on a case study that involved an anesthesia airway rescue resulting from RN-administered sedation in a remote (non-OR) location. I have pulled up numerous articles on the subject but I'm just wondering how many on this forum have ever experienced such an event. Whether propofol was involved, or fentanyl, midazolam, or brevital and etomidate are even now being used by RNs for conscious to moderate sedation, I'd be interested to hear the story. I realize this is a controversial topic and I am not interested in starting a dog fight. I would just like to know how prevalent an issue this is from this casual survey and if it has happened, the circumstances under which it occurred. Thanks, Z

Yes, it happens. There's an interesting story about a school in the Northeast, a program director, and a married student . . . no one finished out the year. Z

I am convinced now that I am well into my 2nd year that if you're in it for the money only, it's not going to be worth what you must endure through anesthesia school. The money is good, yes, but this is not for the faint of heart. There will have to be some other motivation to fall back on when things get rough, and they will. Money is a hollow end-point because for those who are focused on it, there will never be quite enough. Find another reason to do it and success will mean that much more. Z

I understand and respect your concerns. You're the "cream of the crop" amongst your peers, then you enter anesthesia school where everyone around you is the "cream of their crop". It can be disheartening for overachievers and competitive souls like us. You started grad school, learned a new language, made (and will continue to make) lots of personal sacrifices, worked like a dog, and came up 'average' amongst your classmates, and it's only just the beginning. Work hard at engendering teamwork w/ your classmates and help everyone you can. That's what will set you apart from everyone else. Don't be so hard on yourself. Good luck! Z

Where's the "other, better thread?" z

Check out Drexel U. http://www.drexel.edu Z

You have to do what's right for you. Time is going to pass anyway. I have 3 children as well, youngest I kind of fell into it. I wanted to go back to school but I couldn't decide on what for. I didn't want to spend $$ on a graduate education and not be able to find a job. I wanted to remain in the clinical setting, yet I never thought I was smart enough or diligent enough to go to anesthesia school. My husband got on board with the idea fast and together we made a plan. I don't know what programs you've been accepted into but my clinical site offers a great deal of flexibility. My children are also learning the lesson that "learning is lifelong". I expect them to continue their education until they're well into adult hood, as have I. They are proud of my accomplishments just as I am proud of theirs, and they like to brag about "mommy going to school" just like they do. We shop for school supplies together, pack lunches together, etc. It can be quite a positive role-modeling opportunity if you make it such. It all comes down to why you want to do it. Best of luck, Z

I had many of the same concerns as you expressed. My husband, a naval veteran, is very fond of the saying "sleep is a habit that can be broken". Think of it this way. You may have to change when you sleep and it may not be all at once. Since starting my program I am up late into the night but often I am able to catch a nap in the late afternoon. I fall asleep in places I never thought I'd be able to like cars, chairs, even at the library during studying! If you want it, you'll do it! Buena suerte, Z

Many hospitals offer this type of arrangement. They can be very advantageous for those who do not want to incur a lot of debt to get through school. If you choose this option, shop around. You can get a full-ride or partial, stipend, tuition, etc. Whatever you decide on, make sure you get it in writing from the institution. You will want to see in writing exactly what they will pay and how much, and exactly how much time you owe in return. You may want to ensure a buy-out clause so that if you want to leave before your entire debt is paid off you may do so by paying off the remaining balance of what you owe them, pro-rated to the time you've already served. Also, figure out how the reimbursement will occur, to you, to the school? There may be tax advantages to taking the tuition vs. a generous sign-on-bonus after you're done. Lots to consider, good luck, Z

I agree, these are great sites for MH information. Did you know that farmers gas all their pigs at slaughter with halothane? I read that since malignant hyperthermia in pigs makes their meat inedible, farmers expose all new piglets to halothane to make sure they will not develop MH. That way, they limit the expense they will incur by raising a pig until the time of slaughter only to find that it develops MH and is a total loss. I'll have to see if I can find that source. Good luck in your project. Z

Thank you for the thoughtful responses. I learned a lot from this experience! Z

Yes, that's what he meant. As the previous posts so articulately stated, the ongoing question "is the patient relaxed enough?" is similar to the rhetorical question, "which came first the chicken or the egg?" By that I mean, a patient with some muscle relaxation on board (and loss of some twitches on TOF) is as relaxed as the surgeon who is operating on him. In my limited, humble experiences it seems as though the experienced, comfortable surgeons are as relaxed as their patients and don't have a hard time. The same can be said for those who are uptight and having difficulty closing. Z

I can tell you that everyone in my program was qualified (experience, GREs, recommendations, etc.) What I can't tell you is: 1) What were their scores on GREs? 2) What were their undergraduate GPAs? 3) How did their interview go? 4) What other mitigating factors were involved? There are very many applicants to CRNA programs. There aren't as many who get invited to join the program. There are many variables from school to school such as, what type of students do they prefer? (Experienced vs. green), (independent vs. requiring-or accepting-full faculty management) etc. There are many contingencies and sometimes it all comes down to the interview. Best of luck. Z

There is a student in my program that was "let go" from another program. I guess it all depends on the program and the people. There are a lot of factors that go into "fitting in" in school. Everything I heard prior to applying was that I would have to do whatever, whenever, however, as often, and with a smile on my face "thank you, sir, may I have another?" Going in with this expectation makes it a lot easier to "get along" with the powers that be. Clinical faculty vary from place to place as well so each site will be a new and challenging experience in humility and education. I personally struggled with this concept since I felt as though I was an experienced and competent ICU nurse. I had even achieved CCRN status. None of it means anything in anesthesia school though. You sit in class with 10-15 other experienced critical care nurses, over-achievers that are also the "cream of the crop" who all want a piece of the action and want to prove themselves worthy. There are many who can't navigate all the different personalities and dynamics involved. Z

It's a far, far better thing I do . . . Imagine this . . . I have one patient at a time. Except in emergency situations of course, I have an opportunity to view their chart, assimilate the data, assess them, talk to them, sometimes even their loved ones, and establish an individualized plan for them. I develop a rapport and gain the trust of the patient enough so that I am able to put them to sleep without them coming off the table in fear (drugs help with this too), and I take care of only that patient during the entire course of their surgery, wake them up at the end so that they are comfortable and not nauseous, escort them to PACU and transfer care. When they stay in the hospital I can make post-op rounds and check on them after they've put some time between the surgery and they usually remember me, and thank me. Of course there is paperwork but that is a moot point. When I worked in ICU I had up to 5 patients at a time because of poor staffing, covering breaks, etc. It's logistically not possible for me to be in more than 1 OR at any time, and I promise there won't be more than 1 patient in there either!! :) Z

If you have a PDA you may want to consider some of the programs available in lieu of a brainbook. I have "Massachusetts General" Guide to Anesthesia, "Clinical Anesthesia", and another one that I can't think of right now that I downloaded from http://www.skyscape.com. I also use A to Z drugs and another program on Anesthesia Drugs. I find that I use them quite a lot, especially to look up obscure stuff that I'd have to log onto a computer and google. It really helps. I am sorry but I can't help with a brain book. Best of luck, Z

Has anyone else seen this done? Just curious, because some docs & CRNAs at my site mix 1 mL of anectine in with their propofol stick for induction prior to LMA insertion. Those that don't have VERY STRONG OPINIONS on the practice, yet those that do have just as strong opinions and, as always, I'm in the middle. Any observations? Thoughts? Z

Thanks for the tip A - my Zemuron man "just happened to have one" in his trunk when I saw him after reading your post. :) Z

The more the better, and critical care too. I find that there are now many situations in which my critical care experience lends to problem-solving situations that I personally would not have without it. That said, please know that many programs seem to be oriented for the nurse without as much experience and newer to nursing as a whole. I think it may be something about teaching nurses without having to break old (bad) habits??? I don't know for sure. Either way there is a place for you if it is in your heart. Study hard and make EXCELLENT grades as you complete your program and BSN, work hard and soak it up and if you really want to do it, start now into looking at programs and shadow a CRNA for a day. Each of the interviews I attended asked if I had done that. Best of luck, Z

I'd do it. Consider the alternative. As far as I'm concerned, if I'm not injecting the lethal drugs but providing the sedation so the patient does not feel pain, that is completely within my realm of practice, theoretically speaking. I have provided anesthesia services during organ harvests. While it is not customary to provide any type of sedation or analgesia, complete neuromuscular blockade is often used in order to facilitate the surgeons' approach to the target organ(s) and optimize surgical conditions. Additionally, a cascade of events occurs when a patient's brain dies that will lead to the total collapse of the remaining systems if vigilant intervention is not in place. Hence the Organ Procurement Specialists that come in and guide the critical care from determination of brain death to actual organ harvest. The primary goal and a challenging one at that is to maintain perfusion of the target organs. Brain death rapidly deteriorates to vascular collapse without swift intervention. These interventions are ongoing during organ harvest and are the SOLE RESPONSIBILITY of anesthesia services. Once the aorta is cross-clamped, the ventilator gets turned off and anesthesia's role is complete. Z

Felicitades!!! Z

LIVE IT UP IN JULY!!!!! :)

OMG..... what is happening to the CRNA forum? Another good thread hijacked. I concur. This is why I stay away . . . Z