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

JULY 12, 2021

Anesthesia is a hands-on specialty. Anesthesiologists could chat with the surgeons and/or nurses, make an occasional phone call, and at times read materials they brought with them into the operating room. Since the development of the internet, anesthesia practice has changed forever.

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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. Mortality” means a patient death. No, they are not.

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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

JANUARY 29, 2018

Anesthesiologists still work in hospital operating rooms, but their expertise is also needed in other places, including invasive radiology, gastrointestinal endoscopy, electrophysiology and more. The job of a certified nurse anesthetist was listed as #11 on the Best Paying Jobs list.

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The Anesthesia Consultant

FEBRUARY 16, 2021

Anesthesia is not the career for you if you like to sleep late—surgery always begins at 0730 hours). 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.

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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 assessment is ASA II, and the plan is general endotracheal anesthesia. The patient consents.

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The Anesthesia Consultant

MARCH 24, 2022

The only way to end the sedative effects of propofol is for an anesthesia professional to support the airway, breathing, and circulation of the patient until the drug effects of propofol wear off in time. I’ve never administered a dose of flumazenil in my entire career, nor have most of my anesthesia colleagues.

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The Anesthesia Consultant

JUNE 12, 2023

I entered three anesthesia consultations into CHATGPT, one preoperative, one intraoperative, and one postoperative. INTRAOPERATIVE DECISION A 60-year-old man with a history of hypertension is having a knee arthroscopy surgery under general anesthesia. This could indicate a cardiac event or a complication related to the anesthesia.

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The Anesthesia Consultant

AUGUST 26, 2015

Anesthesiology is a wonderful profession, as I have described in many previous posts on theanesthesiaconsultant.com. But nothing is perfect, and anesthesia has one threat which could in time undermine the entire specialty. In the operating rooms, the patients are brought in by the surgeons. What is this threat?

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The Anesthesia Consultant

FEBRUARY 11, 2018

He writes, “Our specialty, anesthesia, has suffered an identity crisis for decades. 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. Read my column on bullying in the operating room. Hold your heads high.

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The Anesthesia Consultant

FEBRUARY 6, 2019

Every anesthesia provider must learn to free-solo anesthesia early in his or her career. A typical hospital will have dozens of other anesthesia providers working in the same building. Commercial aviation is sometimes compared to anesthesia practice. In anesthesia there is no guaranteed second anesthesiologist.

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The Anesthesia Consultant

APRIL 12, 2020

Surgeons, anesthesiologists, certified nurse anesthetists, and operating room nurses are barely working at all now, for the fourth consecutive week. The post UNDEREMPLOYED: AMERICAN SURGEONS, ANESTHESIOLOGISTS AND NURSES appeared first on The anesthesia consultant.

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The Anesthesia Consultant

FEBRUARY 22, 2018

THIS ORIGINAL ANESTHESIA CARTOON WAS PUBLISHED IN THE CALIFORNIA SOCIETY OF ANESTHESIOLOGISTS BULLETIN, VOLUME 52, NUMBER 2, APRIL-JUNE 2003. IS ANESTHESIA AN ART OR A SCIENCE? 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 26, 2018

Learjet anesthesia? Yes, anesthesia can be a glamorous specialty. 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.

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The Anesthesia Consultant

OCTOBER 28, 2018

The combination of autism and anesthesia requires careful planning. The parents/guardians and the anesthesia team need to be actively involved with forming the preoperative plan for uncooperative patients. It’s not infrequent that autistic patients need surgery and anesthesia. Anesthetizing uncooperative patients is difficult.

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The Anesthesia Consultant

JANUARY 19, 2017

A bell-shaped curve exists for the abilities of anesthesia doctors as well. I’ve been practicing anesthesia since the mid 1980s. I’ve met and worked alongside hundreds of anesthesia colleagues from all corners of the globe. Planning anesthesia care, based on your training, experience, and knowledge, is critical.

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The Anesthesia Consultant

OCTOBER 8, 2019

The most invasive type of airway tube used in anesthesia is called an endotracheal tube, or ET tube. At the onset of general anesthesia anesthesiologists place an ET tube through the mouth, past the larynx (voice box), and into the trachea (windpipe). If the patient has an ET tube, it is usually removed.

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The Anesthesia Consultant

DECEMBER 19, 2016

I ask this question when I’m teaching anesthesia residents and medical students. Control of the airway is the most important clinical priority in anesthesia care. The INTUBATION AFTER INDUCTION OF GENERAL ANESTHESIA section of the Difficult Airway Algorithm is bifurcated into two pathways. Their most frequent answer is.

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The Anesthesia Consultant

JULY 25, 2022

This was a landmark paper on the topic of anesthesiologist:CRNA staffing ratios, which documented that having physician anesthesiologists direct three or four operating rooms simultaneously for major noncardiac inpatient surgical procedures increased the 30-day risks of patient morbidity and mortality.

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The Anesthesia Consultant

SEPTEMBER 25, 2015

An anesthesia residency is three years long, preceded by one year of internship. One year after medical school, the same graduate who just completed twelve months of internship now reaches perhaps an even more difficult transition—the first months of anesthesia residency. After ten minutes, he left to pursue other duties.

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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. Anesthesia has never been safer.

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The Anesthesia Consultant

AUGUST 7, 2017

See Robot Anesthesia and Robot Anesthesia II ) AI already influences our daily life. Anesthesiologists work in operating rooms and intensive care units—acute care settings which demand vigilance, steady hands, and quick thinking. I’m fascinated by the topic of artificial intelligence in medicine. I can’t wait to see it.

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The Anesthesia Consultant

FEBRUARY 8, 2016

The most difficult challenge for any anesthesiologist is the transition from the end of anesthesia residency into the beginning of your first job. Their role is to teach anesthesia, to take care of patients, and to do research. Why are jobs posted on Internet sites usually inferior jobs? They are not guidance counselors.

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The Anesthesia Consultant

DECEMBER 29, 2015

How do you feel when you meet your anesthesia provider prior to a surgical procedure? In an abstract presented at the 2015 American Society of Anesthesiologists annual meeting, data from the 2014 National Anesthesia Clinical Outcomes Registry was compiled for every anesthesiologist of known age who performed at least 100 cases.

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The Anesthesia Consultant

OCTOBER 21, 2015

The incidence of cardiac arrest totally attributable to anesthesia mismanagement was low (0.47 per 10,000 anesthetics), and anesthesia mismanagement was responsible for only 1.5% 2) From 2010 to 2013 the National Anesthesia Clinical Outcomes Registry reported the risk of intraoperative cardiac arrest as 5.6 of deaths. (1)

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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

APRIL 2, 2016

This technique induced vasoconstriction and resulted in decreased blood loss, and made transfusion and post-operative anemia rare. The procedures are done under general endotracheal anesthesia, and can last from 3 to 8 hours. Our facility, the Plastic Surgery Center in Palo Alto, has two operating rooms.

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The Anesthesia Consultant

AUGUST 16, 2018

If something dire goes wrong during anesthesia and surgery and the flow of oxygen to the brain is cut off, an anesthesia practitioner has about five minutes to diagnose the cause of the problem and treat it. The good news is that catastrophic events causing sudden drops in oxygen levels are very rare during anesthesia.

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The Anesthesia Consultant

OCTOBER 8, 2015

Anesthetist options were limited. Before her surgery, Alexandra reclined awake on the operating room table. Her eyes were closed, and she was unaware I’d entered the room. About one patient out of ten is nauseated after anesthesia. I stood at the anesthesia workstation and reviewed my checklist.

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The Anesthesia Consultant

JUNE 23, 2016

GENERAL ANESTHESIA FOR DENTAL OFFICES CASE PRESENTATION: A 5-year-old developmentally delayed autistic boy has multiple dental cavities. The dentist consults you, a physician anesthesiologist, to do sedation or anesthesia for dental restoration. Options for anesthesia induction include: Intramuscular sedation. What do you do?

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The Anesthesia Consultant

JUNE 26, 2018

Point/Counterpoint: How new is modern anesthesia? Are modern anesthesia techniques radically different from the methods of twenty years ago? How can it be that general anesthesia has ceased to evolve? What about regional anesthesia? Anesthesia in 2018 is markedly different from anesthesia in the 1990s.

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The Anesthesia Consultant

DECEMBER 19, 2016

You’re are an experienced practitioner, but not a pediatric anesthesia specialist. One is how to safely perform the open-eye, full stomach anesthetic, and the other is the performance of pediatric anesthesia by non-pediatric anesthesia specialists. Why Did Take Me So Long To Wake From General Anesthesia? What do you do?

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The Anesthesia Consultant

SEPTEMBER 1, 2017

One goal of theanesthesiaconsultant.com is to make the practice of anesthesia safer. The practice of anesthesia on healthy patients is quite safe, but we want to do everything we can to avoid preventable errors. The safety of anesthesia on ASA I and II patients has been compared to the safety record of commercial aviation.

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The Anesthesia Consultant

NOVEMBER 16, 2015

Particularly in acute care, the computer keyboard and screen have no place between an anesthesiologist and his patient, an emergency room physician and his patient, an ICU doctor and his patient, or an ICU nurse and her patient. Nurses consistently have their backs to patients as they type, type, type data into computer terminals.

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The Anesthesia Consultant

MAY 6, 2017

A private practice single-specialty anesthesia group will usually provide anesthesia for similarly self-employed surgeons who are in private practice. For insured patients, the anesthesia group collects whatever the insurance company pays, along with the deductible or co-pay the patient owes through their insurance plan.

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The Anesthesia Consultant

MAY 4, 2016

If a patient suffers a bad outcome after anesthesia, did the anesthesiologist commit malpractice? If there was an anesthesia error, was it anesthesia malpractice? There are risks to every anesthetic and every surgery, and if a patient sustains a complication, it may or may not be secondary to substandard anesthesia care.

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