CRNA100

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.

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.

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.

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.

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