The Anesthesia Consultant

NOVEMBER 15, 2017

Let’s look at a case study which highlights a specific risk of general anesthesia at a freestanding surgery center or a surgeon’s office operating room, when the anesthesiologist departs soon after the case is finished. The patient enters the operating room at 0730 hours. The patient consents.

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The Anesthesia Consultant

APRIL 25, 2021

On March 28, 2021 the anesthesia world in the United States was rocked by the headline: “ Wisconsin Hospital Replaces All Anesthesiologists With CRNAs. “ The medical center previously had an anesthesia staff that included both MDs and CRNAs (Certified Registered Nurse Anesthetists). Why did this change happen?

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The Anesthesia Consultant

AUGUST 26, 2015

But nothing is perfect, and anesthesia has one threat which could in time undermine the entire specialty. No, it’s not the nurse anesthetists, nor the stress of covering surgeries in the middle of the night, nor the stress of saving patients who are trying to die in front of our eyes during acute care emergencies.

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The Anesthesia Consultant

SEPTEMBER 3, 2021

Very few patients die in the operating room, but significant numbers die in the weeks that follow. At times, physician anesthesiologists employ certified registered nurse anesthetists (CRNAs) to assist them in what is called the anesthesia care team (ACT) model. Will I Have a Breathing Tube During Anesthesia?

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The Anesthesia Consultant

SEPTEMBER 15, 2020

There are Two Laws of Anesthesia, according to surgeon lore. Surgeons work with physician anesthesiologists, with certified nurse anesthetists (CRNAs), or with an anesthesia care team that includes both physician anesthesiologists and CRNAs. Anesthesiologists win the tally for most operating room hours per week.

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The Anesthesia Consultant

MAY 2, 2023

Louis Imagine this: You’re an anesthesiologist in the operating room at a busy hospital. Your patient is in mid-surgery, and you receive a call from the Anesthesia Control Tower that the patient’s blood pressure is too low, your blood transfusion replacement is inadequate, and that the patient is in danger.

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The Anesthesia Consultant

FEBRUARY 11, 2018

In the late 1970’s I was a third-year medical student at a prominent Midwestern medical school, where an unspoken rank system existed in the operating room. The surgical attendings were the kings, the students were the peasants, the nurses and techs were serfs, and the anesthesiologists were the whipping boys for the surgeons.

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The Anesthesia Consultant

FEBRUARY 16, 2021

Empty Operating Room 0655 hours—You don a bouffant hat and a facemask, and enter your operating room. Your hospital contains multiple operating rooms, and today you are in room #10. Then we’ll roll down the hallway into the operating room. You may have nausea after general anesthesia.

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The Anesthesia Consultant

OCTOBER 28, 2018

The two hospital guards and the mother donned white operating room coveralls. At the mother’s consent, the guards laid the patient down on the hospital gurney, held him there, and the surgical team and the guards pushed the gurney down the hallway to the operating room (a significant distance of approximately 100 yards).

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The Anesthesia Consultant

FEBRUARY 22, 2018

Baker is doing in panel 4, but the anesthesiologist’s rapid heart rate and the adrenaline rush in high pressure operating room situations accompany the growth of every anesthesiologist from inexperience trainee to seasoned professional. Why Did Take Me So Long To Wake From General Anesthesia?

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The Anesthesia Consultant

MAY 6, 2017

A private practice anesthesia group needn’t be a physician-only group. In many private practice anesthesia groups, physician anesthesiologists supervise multiple nurse anesthetists in multiple operating rooms. These groups are still single specialty anesthesia groups.

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The Anesthesia Consultant

FEBRUARY 6, 2019

In an anesthesia care team, a physician anesthesiologist supervises up to four operating rooms and each operating room is staffed with a certified registered nurse anesthetist (CRNA). In many hospital operating rooms, a solitary physician anesthesiologist attends to his or her patient alone.

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The Anesthesia Consultant

DECEMBER 19, 2016

The INTUBATION AFTER INDUCTION OF GENERAL ANESTHESIA section of the Difficult Airway Algorithm is bifurcated into two pathways. After I induce general anesthesia and paralyze the patient, I find their larynx is anterior and difficult to visualize by direct laryngoscopy. Should anesthesiologists avoid these activities?

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The Anesthesia Consultant

APRIL 26, 2018

Norman Shumway MD PhD, a Stanford surgical professor and legend, invented the heart transplantation procedure and performed the first heart transplant in the USA on January 6, 1968 in operating room 13 of Stanford University Hospital. Why Did Take Me So Long To Wake From General Anesthesia? At this point I went home.

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The Anesthesia Consultant

MARCH 24, 2022

For a long operating room anesthesia case (e.g. Propofol administration requires an experienced clinician, e.g. either an anesthesiologist, a certified registered nurse anesthetist (CRNA), or an emergency medicine physician. Give your patient a dose of Versed before they enter the operating room.

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The Anesthesia Consultant

NOVEMBER 16, 2015

Nurses consistently have their backs to patients as they type, type, type data into computer terminals. In an operating room, the circulating nurse’s job is analogous to that of a court reporter/stenographer. Why Did Take Me So Long To Wake From General Anesthesia? What Are the Common Anesthesia Medications?

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The Anesthesia Consultant

JANUARY 2, 2016

More care team anesthesia and more Certified Nurse Anesthetists (CRNAs). Rather than physician anesthesiologists personally performing anesthesia, expect to see CRNAs supervised by physician anesthesiologists in an anesthesia care team, or in some states, CRNAs working alone.

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The Anesthesia Consultant

JANUARY 19, 2017

Some surgeons are bullies, and are condescending in their remarks and attitudes toward the anesthesia provider they’re working with. The most important value in the operating room is to care for the patient, but this value is never best served with a surgeon intimidating the operating room staff.

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The Anesthesia Consultant

SEPTEMBER 1, 2017

The study analyzed the United States Anesthesia Closed Claims Project database of 10,546 malpractice claims between 2001-2013. A total of 266 cases of brain damage or death during anesthesia care in the operating room under the care of a solo anesthesiologist occurred. Be extra wary when attending to obese patients.

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The Anesthesia Consultant

OCTOBER 21, 2015

Risk factors for cardiac arrest were children under one year of age, emergency surgery, ASA physical status 3-5, and general anesthesia. There were 11 cardiac arrests related to anesthesia care. The most popular posts for laypeople on The Anesthesia Consultant include: How Long Will It Take To Wake Up From General Anesthesia?

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The Anesthesia Consultant

APRIL 2, 2016

Our facility, the Plastic Surgery Center in Palo Alto, has two operating rooms. At times the second room is not occupied, and a solo anesthesiologist is the only anesthesia professional present on site and must be prepared to handle any and all emergencies. General anesthesia is continued until these garments are applied.

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The Anesthesia Consultant

JUNE 26, 2018

How can it be that general anesthesia has ceased to evolve? Anesthesia in 2018 is markedly different from anesthesia in the 1990s. Most of the drugs in use haven’t changed, but current-day anesthesia providers practice in a cockpit surrounded by computers. Why Did Take Me So Long To Wake From General Anesthesia?

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The Anesthesia Consultant

SEPTEMBER 25, 2015

Instead of writing histories, examining patients, making diagnoses, and prescribing medications as interns and internal medicine doctors do, anesthesia residents are rendering their patients unconscious, applying acute pharmacology, and inserting tubes and needles into patients in operating rooms at all hours of the day and night.

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The Anesthesia Consultant

FEBRUARY 8, 2016

If there’s a hospital location or an anesthesia group you’re particularly interested in, but they are not advertising a job opening. Find out who the leader of the group is, and call the operating room or the anesthesia company’s phone number. Why Did Take Me So Long To Wake From General Anesthesia?

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The Anesthesia Consultant

DECEMBER 19, 2016

Unless the hospital is very large, it’s uncommon to have anesthesiologists of multiple specialties on call each day, e.g. one for pediatrics, one for cardiac cases, one for trauma, one for obstetrics, and one for the general operating rooms. Why Did Take Me So Long To Wake From General Anesthesia?

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The Anesthesia Consultant

JUNE 27, 2017

The premise of Coma was that healthy young patients were developing brain death after general anesthesia, for no apparent reason. As well, extra oxygen tanks are present in every operating room as a safety back up, in the rare instance that the piped-in wall oxygen source is stopped or is inadequate. You can relax.

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The Anesthesia Consultant

JUNE 12, 2023

INTRAOPERATIVE DECISION A 60-year-old man with a history of hypertension is having a knee arthroscopy surgery under general anesthesia. The surgical team will be assembled, and the child will be transferred to the operating room for further assessment and management. Will I Have a Breathing Tube During Anesthesia?

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The Anesthesia Consultant

AUGUST 7, 2017

Anesthesiologists work in operating rooms and intensive care units—acute care settings which demand vigilance, steady hands, and quick thinking. These arenas will be: 1) diagnosis of images, 2) clinics, and 3) operating rooms/intensive care units. Why Did Take Me So Long To Wake From General Anesthesia?

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The Anesthesia Consultant

MAY 4, 2016

The surgery and anesthesia proceed uneventfully. The patient is awakened from general anesthesia and taken to the Post Anesthesia Care Unit. Abdominal surgery and general anesthesia in this patient population are not without risk, even with optimal anesthetic care. What Are the Common Anesthesia Medications?

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The Anesthesia Consultant

AUGUST 28, 2016

An operating room anesthesia practice is somewhat akin to being a taxi cab driver. The most popular posts for laypeople on The Anesthesia Consultant include: How Long Will It Take To Wake Up From General Anesthesia? Why Did Take Me So Long To Wake From General Anesthesia?

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The Anesthesia Consultant

AUGUST 16, 2018

Have the Stanford Emergency Manual 5 in your operating room suite, and ask a registered nurse to recite the Cognitive Aid Checklist for HYPOXEMIA to you, to make sure you haven’t missed something. If an anesthesia care team is attending to you, how many rooms is each physician anesthesiologist supervising?

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The Anesthesia Consultant

DECEMBER 29, 2015

Older anesthesiologists were: More likely to perform anesthetics under monitored anesthesia care, and less likely to perform regional, spinal, or epidural anesthesia. More likely to work part-time, and with a nurse anesthetist care-team delivery system. Why Did Take Me So Long To Wake From General Anesthesia?

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The Anesthesia Consultant

MARCH 22, 2019

This likely would lead to an increased role for certified nurse anesthetists (CRNAs), and an eventual increase in the number of schools training CRNAs, but in the short term there would be no way to staff adequate numbers of anesthesia professionals. Risk during an anesthesia career is omnipresent.

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