I AMA Certified Registered Nurse Anesthetist (CRNA)

I've always heard many funny stories about people talking as they are going under anesthesia. Any that you can share?

One guy went to sleep talking about the college football team scrub hat that I was wearing, case is over, i pull the LMA and he started the conversation up where he left off 30 minutes earlier.

Do you feel that some do anesthesiologist resent CRNA'S? Do you think they think that you are undercutting them and their work? What do they do if anything that you don't do?

I am sure their are some. CRNAs have been around 100+ years and I don’t see us going anywhere.

They can supervise. I don’t supervise anyone. I do my own cases. It is more common to see MDs doing pain and hearts I would say. But you are starting to see CRNAs doing that too now.

Did some residents find this thread or something?

Yep, and you see how they are acting?

When I saw your response collapsed and downvoted, I had expected you to have said something like “we’re just as good as MDAs,” but I think you gave a fantastic and appropriately measured response. Shocked you got downvoted.

I’m not

Fair enough. I worked as an anesthesia tech for many years, then an ICU nurse, now SRNA. I was spoiled because the place I worked had a great interaction between the CRNAs and MDs.

It’s much worse on the internet than IRL.

I have heard that redheads need more anesthesia. Have you experienced this?

Not really. Mostly I notice it on the pot smokers.

Is it true that CRNAs are just cheep replacements for MDs? Would you rather have an MD do your surgery?

No

It depends. I want someone comfortable doing the case or procedure. It could be a MD or CRNA.

My husband is currently on the ICU, and had to be put to "sleep" for 3 weeks due to lung issues from influenza A. He was put under using a variety of drugs and according to his doc he is now considered an addict because of the high dosages they had to give him (propofol, remifentanyl, esketamine). Maybe its not the right place to ask, but what are the impacts of these drugs on the mind after such a prolonged and heavy use? How do you take care of a such a patient to wean them of the drugs?

When you expose your body to a repeated stimulus. Like narcotics, the body will down regulate the number of receptors so it takes a bigger dose to get a response. But that can be brought back to normal over time. It will take some time and he might go through some withdraws but they have ways of helping the symptoms. I don’t see this myself because they are only under for a short period of time. I don’t deal with long term vented patients under sedation.

What are your thoughts on CRNAs replacing Anesthesiologists and MDs in many institutions to save money? Are CRNAs equivalent to MDs and Anesthesiologists in terms of education?

Are CRNAs equivalent to MDs and Anesthesiologists in terms of education?

4 year bachelor's plus 4 years med school plus 4+ years of residency

Vs

4 year BSN plus 2 years CRNA school

Isn’t that a bit of a misrepresentation for the CRNA’s experience though? That is, don’t most CRNA programs expect their applicants to have at least a couple of years’ experience - possibly more if it takes them a while to get ICU experience?

That is, while post-BSN work experience isn’t required before admission to CRNA school, it’s almost certainly necessary for admission?

ICU experience is not anesthesia experience. And you can argue some of the med school for anesthesiologists doesn't cover anesthesia. People throw numbers out there to make it look daunting. In reality, CRNAs get 2-3 years of schooling specific to anesthesia. Anesthesiologists...depends on their rotations in school (as I believe anesthesia is not a required rotation but instead an elective one), but we're looking at 5 years minimum (2 as resident, 3 as fellowship). And obviously these timelines for both practices can vary.

So then why do many anesthesia residents have an ICU rotation if it is worthless?

Plenty of anesthesia for both MDs and CRNAs.

worst intubation story?

I was on the Covid intubation team. Our CRNA department did all the Covid intubations. That was rough. In the beginning we would intubate them upon arrival in the ER. They would usually be doing ok at that point so it wasn’t difficult. Then they figured out that was a terrible idea to intubate them so they started waiting and that made it difficult on us. You would go into the ICU and they would breathing 40-50 times a minute on Bipap on 100% looking terrified with sats in the low 80s. They would stop to the 50/60 O2 sats as soon as you took the Bipap off so you had to hurry. The last thing some of them saw was me standing above them.

Wait? Why was is a terrible idea to intubate when they arrived? It sounds like you are saying they did worse with late intubation (which makes sense to me. Why would you wait for their sats to drop that low?)?

They discovered that intubated patients did worse. So the goal became to avoid intubations at all costs. So that meant, by the time they were intubated, they were doing terrible. And the guideline was that the most experienced airway person should do all intubations. So the CRNAs in my department did almost all the intubations.

My girlfriend has type 2 myotonic dystrophy and is always scared when she needs to be put under.

I’m sure she is more vulnerable to problems, but she always seems to think the doctors might give her too much for her condition.

To be fair no doctor or medical professional has ever expressed any concern at all with it.

Is this something that would change the dose they give her? Or is it just an increased risk for overall problems?

Just got to be careful with the relaxation drugs on someone like her. But it is good to let them know so they are aware of it.

Thoughts on anesthesia assistants?

I don’t work with them and never have. My general answer is I would go to MD school or CRNA school. I wouldn’t do AA myself knowing what I know. You are limited to ACT medical direction models only. Which usually means large cities in bigger academic areas because they run those models. You can’t practice under supervision models, collaborative models, independent models, or the military. They are under the board of medicine. And if I am not a physician, I don’t want to be under the board of medicine.

Bro you work in a GI clinic, stop shilling the superiority complex.

He seemed to give an appropriate response to the question asked, and it didn’t give off a superiority complex when I read it. You’re a bit more free as a CRNA vs AA, get paid a little better on average, and have more job opportunities. Suggesting that those things provide a better job experience isn’t a superiority complex.

Also, talking about where he works (a GI clinic) in a demeaning way like that shows off your superiority complex.

I never said I only work in GI

“it is difficult to get a man to understand something, when his salary depends on his not understanding it.” - Upton Sinclair.

Is your job a snooze?

Yes! Lol

I like to compare it to poker. Hours and hours of boredom followed by moments of terror. Everything can be going great then everything can be going bad really quickly.

Hello, and thank you for your time. I am two years in on a stage four cancer diagnosis, (kidney, lungs, and bone). Early on I had to have a lung biopsy done and fentanyl was used to put me into the" twilight" state. I don't remember the procedure, but I can tell you that it hurt severely and for a few days afterwards. I do not brag when I say that I am a relatively robust person, so I was wondering if this is a reasonable amount of time for this type of procedure to heal? The reason I ask is because I may have to do it again and the doctors are not exactly forthcoming.

Sorry about that. To tell you the truth, I am not sure. I would talk to the pulmonologist. They would know better than me. But I am sure it does hurt.

You mentioned that you work with colonoscopies. I read somewhere that in some non-U.S. countries, it's not standard procedure to anesthetize the patient the way is typically done in the U.S. Do you have any thoughts on that? I have my first colonoscopy upcoming, and at least theoretically, I'd rather not go the anesthesia route. I probably won't have the option to decline it, but I'm curious what your thoughts are on the pros/cons of going without. Thanks!

I have heard that. I heard it isn’t even offered.

You get a few patients who decline anesthesia outright for a colonoscopy. Colonoscopy IMO is easier to do awake than an EGD.

Some want me to go very light where they are awake but a little sleepy. I have noticed the ones who come in and processed it and thought about seem to do well without anesthesia. The ones who are scared of anesthesia and haven’t really thought too much about it don’t do well at all usually.

If you outright decline anesthesia, they won’t even come pre-op you. They won’t be able to come in 1/2 through the case and start giving you anesthesia to finish. You just have to finish or cancel and come back.

You can ask for very light sedation. But the GI doc and anesthesia all need to be on board with it, so make sure you pick a GI Doc who is ok with doing basically awake patients. You need to be still during the case, no moving, no grabbing, talking to much or bearing down with your abdominal muscles. You will be looking at the screen the GI doc is looking at so the docs I work with usually just give you an anatomy lesson of your own colon. People seem to like it. There are 2 points to the procedure that are the most difficult. You get a lot of pressure as he they are coming around the sigmoid colon. Then it will ease up a bit. But when they get close to the cecum, you will get lots of pressure again as they go in. On the way out, it is easy. And if you do it this way, you can tell the anesthesia provider that you are uncomfortable and they can sedate you deeper. That happens to me sometimes that we try to go light per patient request but we don’t make it for whatever reason. But if you process it, come in prepared. You probably do ok.

Do you think anesthesiologists have an adversarial relationship with CRNAs? What about anesthesiologist organizations trying to limit CRNA scope of practice?

Some do, some don’t, some are neutral but neither side is going anywhere so we might as well get along. I understand why they do it. Like I said before, there is plenty of anesthesia to go around.

Are there risks or drawbacks from using anesthetics and if so what are they?

Like anything else it has its risks. But they are very low. My favorite line for patients is that anesthesia is safer than driving a car. That usually makes them laugh and lowers the anxiety.

I’m a registered nurse as well with a little over 2 years of experience and wanting to do a continuing education. I was thinking of going down the path of CRNA but I don’t have ICU experience is it really a requirement? And oh why not go into Nurse Practitioner? Any insights will help thank you.

Yea, you want that ICU experience. Dealing with vents, drips, etc. that is really helpful in school.

Some people have a NP and CRNA. But I would decide what do I want to do. If you want to do anesthesia, go CRNA. If you do NP, you have lots of options. Family, acute hospital, psych, etc.

They are 2 totally different jobs

Did you ever switch specialty? Or you were in the ICU from the beginning of your career? I just love being in the ER and I don’t think I can ever switch speciality.

Some schools take ER experience. But it really narrows down your choices. Look into working in the ER as a NP then. That’s what I would think about

What is your honest opinion regarding how current protocols deal with pain management? Do you think it is proper and/or effective. Both for post surgery care and chronic pain.

Thanks in advance

We are doing a lot more regional than we did in the past which is improving results. You can lower or even eliminate your narcotics from many procedures now. Ultrasound IMO has made regional safer and easier. Now many providers are trained in Ultrasound blocks.

We have some newer drugs that came out and so older ones that are coming back into the mix. I use Lidocaine, Ketamine, Precedex, IV acetaminophen, Tordol, Magnesium all the time for various cases. My goal is to get better post surgical pain control with low or even no narcotics. So I eliminate many of the narcotic side effects and improve patient satisfaction with a lower cost.

Chronic pain is difficult. I have a friend that does chronic pain and he said the worst part is not feeling like you are getting results. Feels like you are spinning your wheels.

I’m in recovery from severe drug and alcohol addiction (also a nurse btw 😁) and have had to have a couple surgeries since getting sober. I always talk to doc/CRNA beforehand about my sobriety and I’ve had nothing but support from them. Regionals have been wonderful for me. I had a really extensive abdominoplasty a couple years ago and only needed a day of narcotics thanks to regional anesthesia.

That’s perfect

I am severely emetophobic and struggling with future surgeries. I had my last surgery with propofol and was totally fine. But my prior surgeries with different anesthetics resulted in vomiting.

I read studies saying propofol causes less nausea. Why couldn’t I have that for all my general anesthesia?

Also, could I request stronger antiemetics? I was given a zofran and scopolamine patch behind my ear last time, but not sure if that’s sufficient for non-propofol procedure.

2 big causes of nausea is anesthetic gas and narcotics. So if you tell me that you throw up after every case. I would recommend doing what is called a TIVA (Total IV anesthesia). This is usually done with propofol. Or we could also discuss regional techniques so maybe I can avoid putting you to sleep at all if that is a possibility.

Scop and Zofran are both great drugs. But like I said earlier. Trying to avoid the cause of the nausea would probably do better. So trying a TIVA with propofol and limiting or reducing our narcotic would go a long way too.

Very very interesting, thank you. I was planning to get my tubes removed and this was a big concern. So if I can talk to the anesthetist/anesthesiologist about TIVA, that may be a big plus.

I wonder why that's not standard if it helps reduce post-operative vomiting/nausea.

It isn’t that uncommon.

I'm having surgery in two weeks. Surgeon said I should stop taking my edible marijuana. I take a low dose at bedtime for my anxiety/insomnia. I tried to stop and couldn't sleep. Is it really going to be a problem?? I never smoke, edibles only for sleepy time.

I would probably listen to him. It isn’t good to rely on that to sleep anyway. You don’t get good quality sleep.

How much do you make a year?

Between my main gig and side gig, about 250k.

Do these both involve anesthesia?

Yes

My father needs an upper arm fistulagram in a few weeks. What level of sedation and/or type of medication would you recommend?

Thanks for all you do.

That would probably end up being a general. No problem

If we were conducting a cost benefit analysis of being a CRNA vs. an Anesthesiologist how does the schooling/experience/training compare one to the other? How does the pay compare? How does the cost of training/experience/training compare?

Same series of questions but comparing CRNA to Family Medicine Doctor or General Practitioner.

I can’t speak to MDs school. CRNA school currently is about 125k from what I have seen recently in most schools. You need a BSN first. Then a minimum of 2 years of experience in the ICU, although most people come to school with 3-4 years of ICU experience. CRNA school itself is about 3 years after you start.

Do you anesthetize registered nurses, or...?

I am a nurse trained in delivering anesthesia.

Yea I- sigh

Must have missed the joke…. Sorry

Is it true that we don't really know how anesthesia works, and why it blocks the pain receptors? I was recently knocked out for a minor procedure and was fascinated by how instant the Propofol and other drugs worked. It took less than a count to "one..." AND how it blocks out any memory of the event.

The body is weird and extremely complex.

They have some solid theories on Anesthetic drugs but nothing concrete. But they don’t even know for sure what receptor Acetaminophen works on.

Yea, that’s why we do multi-modal anesthesia. Like propofol for example doesn’t let your brain form memories. But you still experience pain and will respond to it. So I still have to block your pain receptors somehow because Propofol doesn’t work there.

I work at a GI gig doing EGDs and Colonoscopy and use propofol almost exclusively so i am very comfortable with it. It’s a wonderful drug.

I’m woke up during my colonoscopy and remember the doctor was telling the staff about his recent trip to the Bahamas while he was churning up my guts. Why was I able to form that memory?

I tell people, any time you have sedation, you have higher odds of remembering. So that is always a possibility. Maybe you got a little light during the procedure for whatever reason and woke up.

Sometimes they do what is called conscious sedation with colonoscopy where the typical drugs are versed and fentanyl. Some patients with versed report never being asleep during the procedure and other say I missed 20 hours of my life. So you could have had that for your procedure which has higher odds of awareness.

Did the person introduce themselves as anesthesia or something else?

MD Anesthesiologist. He later told me if he had known how I reacted to the meds he would have given me the whole dose.

It happens, it happened to me. You just recognize it quickly and get you back down. You are correct though, you auditory comes back before visual when coming out of anesthesia so patients will typically report hearing conversations and not visual. Because the anesthesia provider recognizes you are getting light and gets you back down.,

You smoke pot? take narcotics, depression meds, psych meds? Those can all increase your propofol requirements. Pot is the biggest culprit by far. It even catches me off guard sometime how much propofol a daily pot smoker can take.

I get a norco a day but none of that other stuff.

That’s not much…

I've been told by a dentist that many patients go for a general anesthetic, when local anesthesia might be, medically, the best choice. I was told this after I had discussed options with the dentist and chose a local anesthetic.

Does it happen in other, medical, areas that people will choose a general anesthetic over a local anesthetic, when a local anesthetic would be more suitable?

Or, was what the dentist told me wrong?

I agree with the dentist. But the patient, surgeon, and anesthesia all have to be in agreement and cooperative. So if everyone isn’t on the same page, it can be difficult.

Yea, it happens a lot.

In your experience, how difficult was CRNA school? On top of most schools being extremely competitive, I’ve heard the coursework and clinicals are absolutely brutal. I’m currently an RN with some interest in becoming a CRNA, but I get the feeling that it’s just not in the cards for most us

Lots of people working in the ICU want to go to CRNA school but most won’t. It is a commitment. The average applicant has 3 years of ICU experience before they start school and school is 3 years once you get in.

It was very difficult. The amount of information you have to absorb is tremendous. You will eat, sleep and breath anesthesia. I had dreams all the time about anesthesia when I was in school. You have to be mentally ready to take on the challenge.

How do you feel about paramedics and intubation in the field?

I think it is a skill you should have in case you need it.

Have you started administering SGB blocks for long Covid / parosmia patients yet? This is the only known cure for this terrible outcome of COVID

I know CRNAs who do it but I personally don’t.

Do you ever miss the opportunity to interact on an empathetic and social level with patients? Not as an icu nurse I mean, but say, something like a Psych NP? I imagine the OR can be cold in a few ways and the work is mechanical/intellectual. Do you ever wish you had more of an interpersonal helping role that stimulates empathy, or do you find some or all of that in your profession? Or perhaps that is less important to your satisfaction at work? Thank you for your thoughtful answers!

It’s different. I have to develop a good rapport quickly. And they have to have trust in you very quickly. It depends on the patient, sometimes you have more serious talks, sometimes it is comedy, etc. Depends on my feel for them.

My satisfaction comes in the PACU when they are setting up drinking apple juice without any pain or nausea. You like to see positive results.

I'm 8 months post-op from total joint replacement of the temporomandibular joint, Le Fort 1 Osteotomy, Genioplasty, Bilateral Sagittal Split Osteotomy, and Bilateral Condylectomy. I've been morbidly curious about the intubation process they used.

How do you intubate someone when the surgery itself is in or around the mouth? Are there any graphics or maybe a YouTube link you might be able to find/share so I can visualize how they would've intubated me?

Nasal Intubation

how do i not be scared of anesthesia? i never been put to sleep before and i hope i never will be but i’m scared i wont wake up

Not uncommon. I just had a procedure and I was a little anxious going under too. It is very safe. Safer than being in a car as I said in another thread.

Any advice for someone wanting to go into the same career?

There is a CRNA subreddit that has a weekly student thread you can read and post on.

Be humble, be ready to learn and work hard.

Okay, a few questions/stories here:

1. When I was about 10, I had to have a mole removed from the inside corner of my eye before it could grow and block my vision. As you can imagine, it was a very simple procedure, but my parents and the eye doctor decided to put me under general anesthesia anyway so I wouldn't get scared and maybe blink or flinch. Is this normal? Do you operate differently with child patients?
2. A few years ago, I had to have a GI "upper scope" done. I think the duty nurse was a newbie, and she couldn't "stick" the IV needle, so they had the MD anesthesiologist do it himself. Is this a common occurrence in surgical centers? Do you get extra practice with finding veins in CRNA school?
3. During the same procedure, they used propofol, and I could walk within a few minutes of waking up. My mom was jealous as she had gotten much longer-acting drugs for her procedures. Do you think more providers are changing over to propofol and other drugs with shorter half-lives? Should they?
4. I have heard that over in the UK they frequently give "laughing gas" (nitrous oxide) for childbirth. I have had it used for a cavity filling and it was great. I could still feel pain (even with the numbing agent), but I cared about it much less. Do you think it should be more frequently used for non-dental procedures like childbirth or minor surgery?

1. I could “see” that because he is working right next to your eye. And I don’t want a kid moving around or getting scared at the wrong time. Because you could do some damage.
   
2. To tell you the truth. I don’t do IVs very much anymore. Most of the time they are started in the pre-op area. I might do a few a month and the pre-op nurses might do 10+ a day. I do use Ultrasound though so sometimes I am asked to help and I use it,
   
3. Yea, I work my side gig at a GI center and I pretty much just use propofol. It provides a better anesthetic for you and the GI doc. They get a good look and you are awake very quickly afterwards. Yea. GI docs really like propofol. Some GI docs I work with never did their own sedation in school.
4. I have heard it is making a comeback, especially in L+D. I personally don’t use it much. Each Anesthesia department develops what is standard for them and most of the time you just fall into what everyone else is doing. If everyone is using nitrous, you probably will too. If no one is using it, you probably won’t either.

Do you consider yourself a doctor?

No, I introduce myself as a Nurse Anesthetist. And it has been ruled multiple times that anesthesia can be the practice of nursing, medicine or dentistry. If I do anesthesia, it is under the practice of nursing. If a doctor does it, medicine, and dentistry for a dentist.

What’s the average salary for y’all? I know it’s one of the higher paying nursing specialties!

I would say 150k on the lower end up to 400k+ if you worked independent with your own billing and a decent payer mix. Average probably about 200k now

Do you have to pay a lot in like malpractice insurance or stuff like that?

I just have a moonlight policy now so it isn’t too bad.

Hey there, big fan of anesthesia medicinal and otherwise. Anyways, I've always wondered how many raw eggs should I eat in order to lengthen my lifespan? I have just started this new diet, the raw egg diet, and I don't seem to be losing weight.

Start with the Cool Hand Luke amount per day and go from there…..

I understand in general terms what the scope of practice is for RNs v. doctors/mid-level providers. What is the differences in scope of an anesthesiologist and you?

States can have rules. Hospitals can have rules. Then you have to follow those rules of the facility or state. Whatever they are. Some states allow CRNA to prescribe drugs outside the OR area. Some don’t. Some states allow CRNAs to do pain management. Other don’t. MDs can supervise CRNAs or AAs. CRNA don’t do that. It gets pretty confusing.

What level of anesthesia do you provide without an anesthesiologist there? Or am I misunderstanding what you do?

There is no rule in the US that CRNAs have to be supervised by a physician anesthesiologist. It can be any physician.

Some states have opted out of the requirement for any supervision from any physician.

Is it a requirement that y’all have awesome senses of humor? All the doctors and NAs who have put me under have been hilarious.

Easy when you are high….

What do we look like? Like are our eyes closed or is our eyes wide open aswell as our mouth? And if so do the medical professionals make jokes about it?

We close your eyes and tape them to prevent you hurting them. If I am checking your eyes to see how you are doing while waking you up and you are in stage 2 of anesthesia. It does look kinda weird. Your eyes will be every direction. Looks like a cartoon.

What was your academic path?

ADN, BSN, ICU, CRNA

How common is awareness during anesthesia? For what reasons does it occur? Why might someone be more susceptible to it?

I have a history of staying aware longer than expected (taking longer to "put down") and also becoming aware in the middle of procedures. The time it happened during a surgical dental procedure was pure nightmare fuel.

[I don't smoke marijuana. My mother has actually had the same problem, so we always thought perhaps it was genetic. I have also had difficulties with lucid dreaming and sleep paralysis for as long as I can remember.]

Not very. Usually it is when you have a trauma patient or OB. Trauma because you can’t give as much as you would like to and OB because you are in a rush to get baby out.

You take a lot of drugs, like psych, narcotics, depression, illicit drugs, MJ, etc. Some genetics is involved I bet.

But anytime you have sedation, awareness is always a possibility. I tell everyone that. Which is my guess what you had with dental. Awareness during sedation procedures is more common than full general procedures.

I have patients tell me they are difficult to get down and I get back to the room and get started and think to myself. “yep, I could see that.”

Just talk to your next provider and tell them the issues you had in the past. So they can be ready.

How does this differ from a CNA?

You mean nursing assistant? A lot

Can general anesthesia cause hiccups?

I have patients hiccup during EGDs, but we are in the stomach all around the diaphragm. I wouldn’t think so on general because almost everything I gives you relaxes you. We give muscle relaxants too so we wouldn’t see it if it did.

Have you had very many patients who struggle under, or begin to "come out" of total anesthesia? If so, how do you typically detect it, and solve the problem? If not, do you think there are still places in the world where this is a problem?

You mean awareness during anesthesia?

I've heard it called waking up, coming out, and several other things. I've assumed there are a few ways this can happen, each with different symptoms and severity? In college I helped to develop a device that could detect changes/trends in a patient's abdominal pressure during surgery, with the intention of creating an early warning system when a patient begins to "fight the ventilator." Specifically, we were advised that this could help detect if the paralytic was wearing off early. Initially, the physicians I worked with seemed excited by the idea, but business people I met later on seemed unimpressed, and told us it wouldn't be very helpful in modern ORs. When I saw your AMA I thought maybe you'd have some insight or experience one way or the other.

Ok, I got you. Most of the people that experience awareness are trauma and OB. Trauma because they are sick and anesthesia could kill them so you can’t always give as much as you would like to because their body can’t take it.

OB because when the baby is crashing and you need to get it out now, you have to put mom to sleep quickly and sometimes they have memories of them starting before they are fully asleep.

We have a machine we can use call a BIS Monitor. It monitors the brain activity of the patient and gives you a number. The number is supposed to correlate with anesthetic depth. But that isn’t a standard of care so you don’t have to use it. There was actually a study done with BIS when I was in school and awareness was higher with a BIS monitor than without.

But awareness under general is an extremely rare event. That’s good!

About you device. I watch the CO2 during the case, that will be the first thing to tell me the patient is trying to breath.

Do med students still do pelvic exams on unconscious patients without consent?

I heard some people at a few places got turned in for doing that and got into big trouble. I never saw it personally.

Here’s one I’ve always wondered, but no one seems to know, if you do then I’ll be happy.

Whenever I get general anaesthesia, when I wake up and for at least 3 hours after, I occasionally get this strange smell and taste. It smells sickly and heavy, imagine what a hospital smells like, then times it by 100 and imagine your swimming it it, it only lasts a few seconds and it’s gone again. I never get this any other time, and I wonder if it’s the after effect of my body breaking down the propofol or other agents. Any ideas what it is?

Local like Lidocaine can cause a metallic taste in your mouth. Not sure what would be causing it hours later though

Do you have your own practice/LLC and contract out to hospitals?

Would you say you like your job? What do you do when you have a "boring" case?

I work directly for a hospital and I have a LLC too.

I like it. It’s challenging. Nice to see patients wake up in PACU happy.

Usually music is playing, watch the surgery, talk to the people in the room.

What was your experience setting up the LLC? I'm a travel RN and considering ditching agencies and just traveling under my own LLC.

It’s easy

So I was recently diagnosed with severe gastro paresis and have had many endoscopic scopes done over the last year. For the first time they had to use a breathing tube during my last one because the food hadnt moved through from over 36 hours before the procedure. It’s been 10 days and my body is still in immense pain. I have never woken up from a scope and felt pain anywhere other than my throat but this time I feel like I have whiplash and serious muscle pain in my entire upper body. I also had a weird thing where one of the heart monitor stickers was somehow ripped off my body during the procedure so hard it took my skin with it and I have a scab now. Is that stuff normal? It’s crazy how much it still hurts and I am on some pretty strong muscle relaxers and pain meds but still feeling it.

This is just a guess. But they might have done what is called RSI rapid sequence intubation to protect your airway since it was known you had food. And the drug we use to facilitate that causes your muscles to spam basically. So maybe you are feeling the effects of all your muscles firing. Especially if you are young or strong 💪. That it just a guess.

Also, the GI doc could have dilated you and that can cause discomfort.

The stickers, no, that isn’t common. I had a patient with scars one time from the stickers when they came off. He said, “Let me take off the stickers.” I said no problem.

Hi. I am on suboxone and only my suboxone diagnosing doctor knows that being on this drug means that I need more anesthetic and not less. Sadly if I’m dealing with a situation where pain meds and anesthesia are necessary, doctors and nurses who don’t know about suboxone enough won’t treat properly. Do you have any suggestions as to how I can navigate my pain management needs for anesthesia?

I would tell anesthesia specifically what that I am taking that so they can get a good plan together. We can do regional, local infiltration, or other classes of drugs. We have options.

Is there a way to get a colonoscopy without full anesthesia?

I need to get one done but the hospital refused to give me anesthesia because of my living situation and getting an Uber ride there.

Yea, got to have a ride. They should have told you in the pre-op instructions. Uber not allowed to take medical patients like that.

You could go awake and not take any anesthesia. That’s what some people do if they don’t have a ride. Or Try to get a friend to drive you. Or maybe get a medical ride share company to take you home. They have companies that give rides like that. Call the place where you are getting the procedure and see what they say.

What is your go to protocol for if you take the breathing tube out of a patient after surgery and they have laryngospasms? Is there anything that patients with laryngospasms can do prior to the procedures to lessen the chances of those occurring when they are waking up?

Breathing treatment in pre-op before you go back reduces the airway reactivity. I do that if they smoke, especially recently, have severe GERD, dip tobacco, asthma, recent airway infection, post Covid, post pneumonia, etc. I like good doses of lidocaine. That usually prevents it from happening. But if it does, I get the positive pressure on them quick and that usually works. Sometimes you have to do the Larsen maneuver. If not, more propofol, lidocaine, or succs. Make sure you suction them well at the end to prevent that spit from hitting the cords and causing it. Or if you doing GI, really get them on that side. I have seen lots of pillows wet after a case from the patient. But I had them on that side so it went there instead of back to the cords. Work on those mask skills so you have confidence to use them when the patient does spasm.

But sometimes, it just happens.

Is it thru that you handle up to 3 patients simultaneously when in surgery?

No.

1 MD can supervise up to 4 rooms and bill for each room. That would be an ACT model (Anesthesia Care Team).

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Why would CRNAs have a problem with pharmacists?

Is it true that hospitals pressure women into epidurals in order to justify having an anesthetist on staff?

I haven’t encountered that. My wife did not want an epidural and no one from anesthesia came to talk to us. When I worked in a L+D area. If they said they absolutely did not want an epidural, I didn’t talk to them. If they though they might want one, I would go pre-op them for it and give them the talk about it so they could make their own decision. And that way we would be ready if they decided they wanted it.

The nursing staff might push it though because you are easier to manage with an epidural in than without. The night nurse on my wife’s first kid kept telling her she could get anesthesia to get an epidural if she wanted.