"When Anesthesia Fails" on Discovery Health Channel

Qwiigley, BSN, MSN, DNP, RN, CRNA · Dec 19, 2003

You will find when you start doing your clinicals that people are not something you can use one specific recipe with to do their anesthesia. Yes, you want them deep, but not too deep. In the case of the tubes being tied, most surgeons do this procedure in 7-10 min. If we were to give the woman too much paralytic/induction agent, then we'll all stand around the pt for a half an hour for her to wake up. In this case the anesthesia provider most likely induced with propofol and mivacron. Mivacron is table glue that wears off quickly. The propofol dose chosen most likely gave her enough "sleep" to be intubated (these are done lap), but either the surgeon was slow or the woman's liver function is fast. All possibilities and more.

The BIS can be useful, but not too many people use them. Most people play with them, but still watch their pt's VS and background knowledge of pharmacology.

EmeraldNYL, BSN, RN · Dec 20, 2003

I saw it. The program didn't make a single mention of nurse anesthetists!! So for all you practicing SRNA's/CRNA's out there, why do you think the BIS monitor is not used more often?

deepz · Dec 20, 2003

Originally posted by EmeraldNYL
......why do you think the BIS monitor is not used more often?

Aspect Medical, makers of the original BIS, seem to be pushing awareness as a national topic of discussion for their own purposes, i.e. $$$. They assert that recall occurs 200,000 times a year in the US. I don't think so, or I'd have seen it many, many times in my almost forty years as a gaspasser. Lurid claims make for headlines; headlines raise awareness (!!) and raise hackles and raise bottom line revenues for Aspect Medical.

BTW I use the BIS almost daily. Great device.

deepz

Sheri257 · Dec 22, 2003

Originally posted by deepz
Aspect Medical, makers of the original BIS, seem to be pushing awareness as a national topic of discussion for their own purposes, i.e. $$$. They assert that recall occurs 200,000 times a year in the US. I don't think so, or I'd have seen it many, many times in my almost forty years as a gaspasser. Lurid claims make for headlines; headlines raise awareness (!!) and raise hackles and raise bottom line revenues for Aspect Medical.

BTW I use the BIS almost daily. Great device.

deepz

I finally had a chance to watch this program, and this post explained a lot.

I guess the old saying, "Follow the Money," is true.

So, thanks.

CCU NRS · Dec 22, 2003

Originally posted by lizz
I finally had a chance to watch this program, and this post explained a lot.

I guess the old saying, "Follow the Money," is true.

So, thanks.

Well they should be used all the time I think. I know I would want one if I was having surgery. Of course what you are saying is this is akin to open free marketing like the commercials that say ask your doctot is -------pill is right for you.

I can see that too

Sheri257 · Dec 22, 2003

Originally posted by CCU NRS
Well they should be used all the time I think. I know I would want one if I was having surgery. Of course what you are saying is this is akin to open free marketing like the commercials that say ask your doctot is -------pill is right for you.

I can see that too

I agree. I'll defer to deepz when he says it's a great machine.

It's just that the program only briefly mentions that awareness is rare, and you'd really have to listen carefully to catch that.

The vast majority of the program focuses upon the victims, so people could easily have the impression that this happens all the time when, apparently, it doesn't.

The victim cases were kinda old too, one of them going back 40 years. The others were 9 and 13 years ago.

That's why the commercial angle made more sense to me, in that some company was probably pushing the idea that awareness is a major problem, when it's probably not.

Sarah Kat · Dec 22, 2003

Originally posted by lizz
That's why the commercial angle made more sense to me, in that some company was probably pushing the idea that awareness is a major problem, when it's probably not.

I think the issue isn't the commonality of the situation, it's the long term effects on the people who DO experience it. I am thankful it isn't common, people wouldn't want to have surgery at all.

Sheri257 · Dec 22, 2003

Originally posted by Sarah Kat
I think the issue isn't the commonality of the situation, it's the long term effects on the people who DO experience it. I am thankful it isn't common, people wouldn't want to have surgery at all.

As deepz pointed out, the company is making commonality an issue by claiming 200,000 recalls happen every year, which may not be true. They're using this claim and, presumably, the Discovery Channel, to sell the device.

My point is that people could watch the show and easily assume that awareness is common and, as you mentioned, not want surgery because it.

If it's a good device and they want to sell it, fine.

But selling it in overhyped fashion by misleading the public into believing that recall is a major problem is wrong, in my opinion. And I think this program is doing that.

kmchugh · Dec 23, 2003

First, to recall: Yes, it does happen, and yes it can be a terrible thing. But, you also must know the facts. Aspect has been pushing the issue very hard, and has made it known that they want their BIS monitor to become a "standard of care," much as BP, pulse, and oximetry are. Why? Not for the benefit of patients, but for the financial benefit of Aspect.

In publishing the numbers of "200,000" annual cases of recall, Aspect does not give the full story behind these numbers. First, consider this: How many surgeries are done annually in the US? Last I read, 200,000 cases of recall turns out to be less than one percent of total cases. Next, in those numbers, there are actually a majority of patients who reported recall, but did not feel that it was a negative experience. Take for example one case of recall related to me by a CV surgeon. He did a relatively uneventful CABG for a patient, and was visiting with the patient on post op day one. The patient related that his night in the SICU was fairly comfortable, and that he was in no severe pain. He was curious, however, what the surgeon meant by "give a hundred." He had heard the phrase intraoperatively, and was just curious. Further questioning by the surgeon revealed that the patient had heard this, and it is a common command given by the surgeon as a patient is coming off bypass. However, in this case the patient had no specific recall of pain or discomfort. In fact, he related the experience as not being negative at all.

Additionally, a number of the patients who are included in this statistic are patients you would expect to have recall. For example, there are patients, particularly very unstable trauma patients, for whom nearly any of the anesthetic agents we use would be almost instantly fatal. In these cases, the anesthesia provider has a difficult choice to make: Do I risk recall, or do I risk killing this patient? I assisted in the anesthetic management of one of these patients while a student CRNA. It's a tough case, but ultimately you must do what is best for the patient. (Also, I believe included in this statistic are patients undergoing fairly minor procedures under MAC.)

The BIS monitor is a good monitor, and for certain procedures (such as open heart and carotid procedures) it can render valuable information to the anesthetist and surgeon. However, it is just another monitor. When they were available to me, I did not use them for the vast majority of cases, and were I having most types of surgery, I would not want my anesthesia provider to use it. Why not? It is another monitor that can distract you from your real responsibility, which is the patient. You don't treat monitors, you treat people. Monitors are valuable, but you can get information overload. Anesthesia providers must learn to rely on themselves and their experience, they must rely on their senses and what is happening with and to the patient. We cannot become overly reliant on what the electronics are telling us.

Like anything else, when you start looking at statistics of anesthesia, you must look at all the data to form an accurate picture. Considering only the data cherry picked by someone else will lead you to a conclusion that the person chosing the data wants you to reach. Neither scientific nor smart.

Kevin McHugh, CRNA

Sheri257 · Dec 23, 2003

Originally posted by kmchugh
First, to recall: Yes, it does happen, and yes it can be a terrible thing. But, you also must know the facts. Aspect has been pushing the issue very hard, and has made it known that they want their BIS monitor to become a "standard of care," much as BP, pulse, and oximetry are. Why? Not for the benefit of patients, but for the financial benefit of Aspect.

In publishing the numbers of "200,000" annual cases of recall, Aspect does not give the full story behind these numbers. First, consider this: How many surgeries are done annually in the US? Last I read, 200,000 cases of recall turns out to be less than one percent of total cases. Next, in those numbers, there are actually a majority of patients who reported recall, but did not feel that it was a negative experience.

Fascinating info. Thank you very much.

Unfortunately, the program didn't mention this important information.

Qwiigley, BSN, MSN, DNP, RN, CRNA · Dec 23, 2003

As always, Kevin, great clarity of thought and the subject.

deepz · Dec 23, 2003

Originally posted by kmchugh
.... were I having most types of surgery, I would not want my anesthesia provider to use it. Why not? It is another monitor that can distract you from your real responsibility, which is the patient. You don't treat monitors, you treat people. Monitors are valuable, but you can get information overload. Anesthesia providers must learn to rely on themselves and their experience, they must rely on their senses and what is happening with and to the patient. We cannot become overly reliant on what the electronics are telling us.
...........

I hear what you are saying here, Kevin, but I find you standing atop the slippery slope overlooking the realm of the Luddite. Yes, too many electronics can be confusing at times, like in the middle of a trauma resuscitation (ketamine works quite well for preventing recall BTW), and yes, it is important for gaspassers to rely on all their senses when monitoring the patient, but what, then, (reductio ad absurdum) would you have us do to monitor your personal anesthetic? -- relapse to the days of only a manual BP cuff and a precordial stethescope?

(I'd bet you don't carry a PDA, do you? Neither do I.)

I adopted this axiom long ago regarding adopting new stuff -- anesthesia technology, drugs, technics, etc:

don't be the first to jump on board the latest developments, but also never be the last to embrace them.

deepz