Question about MD/CRNA and my son's surgery

[labcat01, BSN, RN]

Hey all,

So my son had surgery last month and before the procedure, the CRNA comes out and explains how they are going to use the gas, gets consent, etc. She was great- we really liked her. Then the MDA comes out and corrects the CRNA saying they'll use gas AND a nerve block (I still question the necessity of that). She was kind of rude and abrupt- didn't make me feel all that comfortable.

My son went back to surgery comes out- he did great but didn't really handle the nerve block well (crying about his legs and how they hurt). The MDA had to come back to give him something. I ask and she says "Oh, I'm giving him morphine" and then walks off and tells the PACU nurse "I just gave him Toradol". Huh?

Anyway, LONG STORY SHORT- we probably would have been much happier with just the CRNA on our son's case (not trying to start a "who's better" debate). We just felt like we trusted the CRNA more. So here's the question- when doing surgery in a big teaching hospital where there are CRNAs AND MDs, how exactly does the relationship work? What is the role of the CRNA and do they act independently from the MDs.

Thanks for reading and your insight is greatly appreciated :)

[stanman1968]

In large faculties the MD says do it and frequently that is the way it is, a great reason for me not to work there.

[joeyzstj, LPN]

Give me the CRNA any day. I work with many CRNAs and MDAs closely every day. I will take a CRNA over and MDA any day of the week. I always laugh when patients come in the the hosptial insisting on requesting their Anesthesiologist. Im having a simple hernia procedure done sometime. I dont care so much abou the surgeon........we have great surgeons, but I want to pick my CRNA.

[alterego33]

When someone asks me the difference between a nurse anesthetist and an MD anesthesiologist, my answer is that we (CRNAs) bring our nursing experience into the anesthesia care. We listen to the patients, reassure them, watch them closely, are methodical with our techniques and are caring. When you consider that the anesthesia part of our education is practically the same, and our continuing education required, and our outcome data show extremely safe practice, CRNAs are the way to go.

[jwk]

Hey all,

So my son had surgery last month and before the procedure, the CRNA comes out and explains how they are going to use the gas, gets consent, etc. She was great- we really liked her. Then the MDA comes out and corrects the CRNA saying they'll use gas AND a nerve block (I still question the necessity of that). She was kind of rude and abrupt- didn't make me feel all that comfortable.

My son went back to surgery comes out- he did great but didn't really handle the nerve block well (crying about his legs and how they hurt). The MDA had to come back to give him something. I ask and she says "Oh, I'm giving him morphine" and then walks off and tells the PACU nurse "I just gave him Toradol". Huh?

Anyway, LONG STORY SHORT- we probably would have been much happier with just the CRNA on our son's case (not trying to start a "who's better" debate). We just felt like we trusted the CRNA more. So here's the question- when doing surgery in a big teaching hospital where there are CRNAs AND MDs, how exactly does the relationship work? What is the role of the CRNA and do they act independently from the MDs.

Thanks for reading and your insight is greatly appreciated :)

You didn't specify what type of surgery your son had, his age, if he had the block done while he was asleep or awake, whether ultrasound guidance was used or not, etc., so it's hard to know exactly what went on here.

However, adding nerve blocks on top of general anesthesia is becoming increasingly common and perfectly acceptable. The effects of general anesthesia wear off quickly, whereas a good block can give as much as 24 hrs of very good pain relief. Many centers are also using indwelling catheters for continuous nerve blocks. The quality of the block is of course dependent on the practitioner. For many, ultrasound guidance for nerve blocks is still a pretty new concept, whereas some newer practitioners may have done all their training using ultrasound guidance to do their blocks.