Hours of Boredom, Moments of Terror...

"Hours of boredom, moments of terror"  What a load of bullshit. Anesthesia only seems boring to people who believe that if you are not constantly fiddling with instruments, you can't be doing anything meaningful. (do we know anybody like that?) Moments of terror? I guess that refers to the feeling of loss of control you might have when you realize that the problem at hand (i.e. airway) is something that you don't know a thing about, and so you have to rely on (and trust) the skill and competence of your colleague while you stand by and watch.

"passing gas."

You know you are just "passing gas" when:

-you don't know the difference between an ACE inhibitor and an ARB.

-when somebody calls the ether screen the "blood brain barrier," you don't get it.

-you can't list the drugs that predispose to torsades in a patient with a long QTC (or you don't know your current patient's QTC!)

-you're not as comfortable with a flexible fiberscope as a direct laryngoscope.

-you don't know what "open lung concept" ventilation is.

-you don't look at the heart while coming off bypass.

-you cancel patients for "cardiac clearance" (Egads!)

-you didn't auscultate for undiagnosed aortic stenosis before you induced.

You're just "passing gas:"

-if you didn't set your alarms.

-if you don't know which nerve roots form the phrenic nerves.

-if you can't conduct a resuscitation "by the book" and you don't know when it's appropriate to "throw the book out"

-If you don't know that the most important member of the surgical team is... everybody, because if the $12/hour person in sterile processing doesn't get it right, the whole thing is a disaster...

-if you can't clearly articulate what differentiates you from a CRNA, and why it matters.

I could go on forever...feel free to chime in; I'll compile them all and re-post the complete list sometime...

Comments

[rlewis]

What does differentiate you from a CRNA and why does it matter---gaspasser

[mkeamy]

Simply put, an anesthesiologist is a physician. A CRNA is a nurse. Why should this matter? Parenthetically, do we ever ask why a surgeon has to be a physician? Why not have nurses or techs do surgery?
But back to the question, which now becomes, why should an MD give anesthetics. Well, sometimes, it's not necessary, I suppose. A simple hernia or gall bladder. As long as there are no medical complications. Just like probably a nurse could do an appendix. Just like pharmacists's mates did them on subs in WW II in movies. If it goes well, no problem. Patients whose cases are complicated by medical diseases (coronary artery disease, sickle cell anemia, diabetes, etc, etc) benefit from having a physician versed in the underlying disease process and how it impacts on the surgery and anesthetic. How about Monkberg's cystic medial necrosis in a patient underging cerebral artery aneurysm clipping? (saw one.) As I said in my post "We have met the Enemy and He is us," I have no difficulty with the care team model.I like CRNA's. It leverages the knowledge of the anesthesiologist across a wider area. But When things get ugly (which they can, unexpectedly) a diligent anesthesiologist is a good person to have around. I have no problems with CRNA's; they have a problem with me, because they don't like it that I think there is a difference between MD anesthesiologists and CRNA's. They want to be the same. But they are not. They are good, but they are not MDs. And sometimes (you can't always predict when) an MD is necessary.
Thanks

[jm]

If you want to know the real difference between a CRNA and an anesthesiologist, look at anesthesioboists thoughtful posts on "informed consent, sign here please," and then go look at the CRNA forum www.nurse-anesthesia.org and look in the "passing gas forum" for "This is unreal you have to see it." You might want to take a look at versedbusters.blogspot.com too and see some of the posts there as well. You will have a well rounded view of Anesthesiologists, CRNA's and some very unhappy patients!