Current Anesthesiologist vs CRNA Literature

[UltimateHombre]

Sorry to intrude in your forum. I am currently on the speech and debate team at ASU. I compete both regionally and nationally at many collegiate tournaments throughout the year. I am currently in the process of writing a persuasive speech about the Anesthesiologist vs CRNA battle.

I feel pretty strongly about the topic and i really want to inform those within my circle of influence about the stark difference in training. Obviously my call to action is requesting everyone to use Anesthesiologists.

Anyway, for me to do well at national tournaments i need very current literature to cite. Anything within the past year will do, but if there is anything within the last 3 months that would be awesome. I am requesting your help, because i simply don't have access to medical journals or the resources you do.

Any help would be greatly appreciated!! Thank you in advance!!

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[Coastie]

Sorry to intrude in your forum. I am currently on the speech and debate team at ASU. I compete both regionally and nationally at many collegiate tournaments throughout the year. I am currently in the process of writing a persuasive speech about the Anesthesiologist vs CRNA battle.

I feel pretty strongly about the topic and i really want to inform those within my circle of influence about the stark difference in training. Obviously my call to action is requesting everyone to use Anesthesiologists.

Anyway, for me to do well at national tournaments i need very current literature to cite. Anything within the past year will do, but if there is anything within the last 3 months that would be awesome. I am requesting your help, because i simply don't have access to medical journals or the resources you do.

Any help would be greatly appreciated!! Thank you in advance!!

One is an MD with extensive training in basic and clinical sciences, as well as an extensive residency and fellowship. The competition is fierce along the entire path, and out of your pre-med group in undergrad, only the best make it to the end.

One is a nurse with training which can have a majority of it online (BSN, CRNA classes minus clinicals). You can walk into a CRNA program if you meet the requirements and are willing to pay tuition.

Where's the argument?

 

[ICd8U]

The only recent published article is one that was much discussed in this site and other places. There are a lot of arguments against the validity of the study, but again this is the only recent published document comparing patient outcomes between anesthesiologists and CRNA's.

http://content.healthaffairs.org/content/29/8/1469.abstract

Good luck!

 

[BLADEMDA]

Originally Posted by BLADEMDA
In this issue of Anesthesiology, Arbous et al.1 provide a jolting report on the positive impact that anesthesia providers can have on their patients. How? Simple anesthetic management principles seem to have a major effect on perioperative mortality. The routine use of an equipment checklist (odds ratio, 0.61), direct availability of an anesthesiologist to help lend a hand or troubleshoot when needed (odds ratio, 0.46), the use of full-time compared with part-time anesthesia team members (odds ratio, 0.41), the presence of two members of the anesthesia team at emergence (odds ratio, 0.69), and reversal of muscle relaxants at the end of anesthesia (odds ratio, 0.10) had dramatic, positive effects that were associated with reduced perioperative mortality within 48 h after surgery and anesthesia.
This report is remarkable in several ways. First, it is one of the few that have shown anesthetic management processes to dramatically reduce perioperative mortality. Second, it reports perioperative mortality rates matching a number of recent reports. Importantly, it supports the recent insightful article by Lagasse2 about perioperative mortality and his suggestion that the US anesthesia community may have overestimated its impact on improving patient safety in the past two decades. Finally, the authors have used a unique and thoughtfully planned multiinstitutional survey and case-control methodology to evaluate this low (but not low enough)-frequency outcome.
It should not be surprising that perioperative anesthetic management processes can make a difference. The US Federal Aviation Administration has long required the use of pilot checklists for evaluating the airworthiness of aircraft and starting procedures, a requirement strongly supported by outcomes of real and simulated air flight. Why would our specialty, so often compared to piloting, be different? The Federal Aviation Administration also requires two pilots for most commercial aircraft operations, nicely matching the report's finding that the presence of two anesthesia providers at emergence is associated with lower perioperative mortality. The positive impacts of immediate availability of an anesthesiologist when needed and continuity of anesthesia providers in the care of individual patients likewise make sense but, until this study, rarely have been shown to be associated with reduced perioperative mortality.
Have we really overestimated our positive impact on patient safety? Clearly, a number of recent studies suggest that our oft-quoted estimate of 1:200,000 or more patients who have an anesthetic-related death may be flawed.2 The basis for this estimate is accurate but usually misinterpreted. Eichhorn et al.3 reported this low rate of anesthetic-related mortality in healthy patients, an important distinction occasionally neglected in anesthesia patient safety statements. This current study, like others, suggests that the anesthetic-related mortality rate is still too high. The good news is that we have room for improvement and, now, data to support anesthetic management changes that may help.
The study of rare medical events is extremely difficult; it often is extraordinarily frustrating to obtain numerators large enough or denominators that are sufficiently robust to allow calculation of frequencies of the events and subsequent analyses for potential risk factors. Arbous et al.1 have used a multiinstitutional study technique common to clinical research in other medical specialties, notably cardiology, but infrequently attempted in anesthesiology and the study of perioperative mortality. This process has provided the authors with (unfortunately) a sufficient number of perioperative deaths to allow case-control analyses, a good way to seek associations between rare events and potential risk factors.
In general, efforts to seek associations between rare medical events and potential risk factors follow a progression. First, case reports and small case series describe unusual outcomes. If enough of these unusual outcomes can be gathered (typically at least 20 are needed, assuming valid controls can be assessed), a case-control methodology can be used to seek possible but not proven risk factors. Subsequently, potential risk factors identified by case-control studies must be evaluated prospectively in large populations to ascertain their validity. Finally, potential interventions to decrease the frequency of these rare events can be tested in randomized, prospective trials. The current study's elegant methodology takes advantage of the large numbers of perioperative death reports that they collected in multiple institutions by creatively and prospectively seeking data from randomly selected controls within each of those institutions. This methodology is applicable to many rare perioperative events and should be a model often copied in the future.
Although conclusions from one study should not lead to wholesale changes in practice, the findings in this study support many plausible assumptions that improvements in anesthetic management processes can positively influence patient outcomes. The use of equipment checklists, immediate availability of anesthesiologists to help when needed, especially to provide extra assistance at emergence from anesthesia, and routine reversal of muscle relaxants are processes that should be seriously considered when seeking opportunities to improve the perioperative outcomes of anesthetized patients.
Mark A. Warner, M.D.
Mayo Clinic College of Medicine, Roches-ter, Minnesota. [email protected]

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References

1. Arbous MS, Meursing AEE, van Kleef JW, de Lange JJ, Spoormans HHAJM, Touw P, Werner FM, Grobbee DE: Impact of anesthesia management characteristics on severe morbidity and mortality. Anesthesiology 2005; 102:257-68
Cited Here... | View Full Text | PubMed | CrossRef

2. Lagasse RS: Anesthesia safety: Model or myth? A review of the published literature and analysis of current original data. Anesthesiology 2002; 97:1609-17
Cited Here... | View Full Text | PubMed | CrossRef

3. Eichhorn JH: Prevention of intraoperative anesthesia accidents and related severe injury through safety monitoring. Anesthesiology 1989; 70:572-7
Cited Here... | View Full Text | PubMed | CrossRef

 

[BLADEMDA]

"Direct availability of the anesthesiologist decreases the risk of postoperative mortality and coma."


http://www.ncbi.nlm.nih.gov/pubmed/15681938

 

[BLADEMDA]

We must dispel the myth that anesthesia-related mortality has improved by an order of magnitude. Science does not support this claim.
http://www.ncbi.nlm.nih.gov/pubmed/12459692

 

[BLADEMDA]

This current study, like others, suggests that the anesthetic-related mortality rate is still too high. The good news is that we have room for improvement and, now, data to support anesthetic management changes that may help.

The positive impacts of immediate availability of an anesthesiologist when needed and continuity of anesthesia providers in the care of individual patients likewise make sense but, until this study, rarely have been shown to be associated with reduced perioperative mortality.

 

[BLADEMDA]

Debating this topic is fairly easy based on common sense, evidence from peer reviewed studies and comparing CRNA education to Pre-Flexner Report medical education.

CRNA Education is highly variable from school to school

They have low standards, routinely "embellish" their volume of cases/procedures plus have limited knowledge about Medicine to practice such a dangerous specialty unsupervised.

Until higher standards for CRNA education become the norm combined with more rigorous exams the CRNA, as a field of Nursing, is highly unqualified to practice "anesthesia" unsupervised.

 

[cincincyreds]

Did someone mention here that they gave the CRNAs a watered down version of USMLE step III and over 90% of them failed it. That is sad. I mean, you want somebody putting you to sleep who has no basic medical knowledge?

I'll tell you one thing. If I was on that plane above the hudson when the engines went out, I am so happy captain Sully was there.

Anyone can fly the plane, it is the experience to land it that counts, and when things don't go according to plan, the more experienced Anesthesiologist will save the day over any clown CRNA hands down.

In residency, I was doing training at an outside hospital and decided to ask a crna for 5 main causes of hypotension. They couldn't even give me two of them. Hmmm, lets see? preload, afterload, contractility, heart rate, heart rhythm.

These CRNAs are pretty stupid people, at least the ones I met. Luckily, I'm in all MD practice, so I don't have to deal with them.

 

[BLADEMDA]