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Topics About 'anesthesia'.
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An anesthesia provider pushes 200 milligrams of propofol into an IV line. Within twenty seconds, the patient’s speech slurs, their eyelids droop, and the brain monitor flattens from a crisp 98 down into the 40s. The patient isn't sleeping, and their body isn't resting. Their mind stopped existing. In roughly three hours, that same mind will boot back up with memories, personality, and fears intact. Hundreds of millions of surgical procedures occur globally every year, with updated baseline estimates topping 310 to 330 million annual operations (Weiser et al.d, 2016; The Lancet Commission on Global Surgery. Anesthesia providers induce general anesthesia hundreds of thousands of times a day. Yet, modern medicine cannot fully explain the precise mechanism that turns off human consciousness. Clinicians know the molecular binding sites, and they track real-time electroencephalogram (EEG) changes on monitoring screens. But science still lacks the bridge connecting a drug binding to a receptor to the sudden, total erasure of subjective experience. That gap in knowledge is not an academic debate. It dictates why intraoperative awareness happens, why emergence delirium wrecks recovery units, and why a subtle pulse spike on the monitor demands immediate action. Not Sleep, But a Reversible ComaA frequent misconception among surgical patients (and non-OR staff) is that general anesthesia is simply a chemically induced deep sleep. Sleep is an active, cyclic metabolic state featuring predictable transitions between Rapid Eye Movement (REM) and non-REM stages, regulated by circadian rhythms and homeostatic sleep pressure, during which the brain remains easily rousable by external sensory stimuli. General anesthesia is a drug-induced, pharmacologically reversible coma. Brain metabolic activity drops significantly lower than in natural sleep, and sensory pathways cannot pass signals to the cortex. -
Hi everyone. I am an SRNA. I have seen some say that doing endoscopy anesthesia is something they hate because they think it is boring, but I really like it. What are the pros and cons to this type of position? There is a high paying job (180K in southeast, not rural, W-2) like this near me, and can't see how there are cons. I mean, you don't have to work weekends or call and the hours are perfect. One of my professors says if you are going to work a job like this then you have to make sure your oral airway skills are really good bc there is no backup to this kind of job. I'd really appreciate any feedback on this. Thank you!
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Firstly, I have to disclose that I am in my third year of nurse anesthesia training preparing for graduation, so I am not a board certified CRNA yet. Anything I say is coming from the perspective of a new generation of CRNA DNP training which I've noted can be slightly different from those of older generations. I am also the elected political representative of my class throughout our program so I do stay more engaged and informed than some other anesthesia trainees. Last disclosure, I do serve the AANA and work on a committee that serves the board of directors. Now, to understand where this new bold statement from the AANA came from I think it's necessary to understand it is in response to the ASA's statement about the Anesthesia Care Team last fall. Their statement unabashedly self-aggrandizes themselves and downplays CRNAs actual role as experts and independent anesthesia providers. In fact, they use wording that implies better education and training from their own assistants (AAs) than nurse anesthetists who has been providing safe competent anesthesia since the civil war. Although, most CRNAs don't blame them for making a political statement like this promoting themselves and downplaying their competitors in the marketplace. That is the duty of a professional organization, to promote that organization. Anesthesia has been aggressively political since the early 1900s when physicians decided to start learning anesthesia and tried to make it illegal in California for a nurse anesthetist to continue practicing anesthesia. Who wants competitors if you think you can eliminate them, it just makes business sense. After the political statement made last October by the ASA large amounts of CRNAs were outraged and demanded an immediate defending response from the AANA. The AANA is always careful and intentional in what it does, so they created a task force of influential and level headed CRNAs who would investigate the issue and come up with a diplomatic response. They spent 6 months discussing this and coming up with the response you are now reading. This statement was intentional and well thought out. It is supported and celebrated by a huge majority of CRNAs/SRNAs judging from responses in person and in private CRNA forums consisting of tens of thousands of CRNAs. It's disconcerting that I have seen some negative comments online by people who aren't physicians. You would expect many physicians to react negatively to a non-physician provider talking about their education, training, and similar patient outcomes but it is odd to see some others ill-informed negativity. The biggest confusing issue I see people have is that in the AANA's statement that is in response to the ASA's care team statement is that billing methods are often fraudulent. What many may not understand is that in a medical direction billing model (which is what the ASA is wanting everywhere) involves meeting 7 TEFRA requirements to bill for CMS. These requirements are very often not met even when physicians bill in medical direction, which is Medicare fraud. This is not just anecdotal. The ASA produced research they performed themselves that was published recognizing that a huge number of medical direction practices are not meeting the 7 TEFRA requirements. Medical direction benefits the physician because they can bill for 4 different cases at once while they are not providing the anesthesia but 4 different CRNAs are performing the anesthesia. You can see why they would want this to be a standard delivery method of anesthesia. Even when their own research shows they are fraudulently billing in many places they continue to push this model. This model is oftentimes the most restrictive and oppressive to CRNAs who choose to work with that anesthesia group. It is also one of the more costly models for hospitals to sustain, so it's not economically responsible or sustainable for many facilities. CRNAs mention these issues with medical direction because it supports the movement nationwide for the collaborative model of anesthesia care. This model requires that both CRNAs and MDAs be independent full practice providers who work together on a team. They are equal partners and practice under their own license to provide safe high-quality anesthesia to their patients. In this model, there are no 7 TEFRA regulations so Medicare fraud is not an issue. The economic reason some in anesthesia will not like this anesthesia delivery model is that you can not bill for services of 4 CRNAs at once providing anesthesia. Each provider can only bill for their own anesthesia for a single case. It would do away with someone sitting in the break room drinking coffee while 4 other providers are working and earning you profit. You can see why certain people would not want this to happen. I just wanted to clear that portion up about the AANA's statement so it had some context and people who are not in the anesthesia realm understand where that came from. Those of us in anesthesia are just so used to that issue I think we forget others are not informed about it. What do you guys think about the new statement?
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Looking for input from nurses on other endoscopy units. We have a mostly self-contained unit with our own pre-op and phase II recovery. Our general anesthesia patients go to the main PACU. However, they (PACU) want us to start recovering our own generals. Do other endoscopy units do this? I have never heard of this anywhere. We are concerned that this will not be safe for patients as well as not work for our high volume of outpatients. Any input from other endo nurses? Thanks!
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Hi all, I was asked this week to push Glycopyrronium PRN for symptomatic bradycardia on a mother-baby floor if my patient became symptomatic for a hr in the 30s after a c-section (hr in the 50s prior). I told my charge RN that I did not think this medication was an appropriate PRN due to it is not in ACLS protocol and I work on mother-baby, not PACU, where the patient is not monitored by an ekg machine. She responded that I was making excuses because I 'didn't want to give a new medication that I hadn't given before'. I do not think that an unmonitored 'med-surg' type floor for healthy moms and babies was an appropriate place for this patient to be with episodes of symptomatic bradycardia (hr in the 30s). I also don't think I should have been ask to give a PRN anesthesia medication on this type of floor. Any thoughts? am I overreacting?
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I am an ICU nurse who left the world of ICU and started in the PACU recently. The training was very much focused on unit specific charting and did not cover when I should report abnormal findings to anesthesia. Recently one of the anesthesiologists was laughing about a nurse (not knowing it was me) who had contacted anesthesia repeatedly related to a prolonged and continuous respiratory rate of 5 and 6. They stated "that's what PACU is for" That brings me to the question. What parameters are appropriate to contact anesthesia for? In the ICU I would absolutely report respiratory depression, especially if persistent and with no way to monitor ETCO2. In this case the patient was extremely somnolent and would only respond for a few seconds to physical stimuli. I contacted anesthesia 3 times at 30 minute intervals to request a small dose of narcan and was told to just keep watching because "giving narcan is so mean" This same provider has also ridiculed me for contacting them after a patient with a baseline heart rate of 70 suddenly started dropping down to a heart rate of 40 after being stable for an hour after reversal with neostigmine/glycopyrolate. Are these things normal findings in PACU that I just need to monitor as they suggest? Its unfathomable to me to think of NOT reporting these findings.
