No harm found when Nurse Anesthetists work without supervision from Physicians

[Denatured]

No Harm Found When Nurse Anesthetists Work Without Supervision By Physicians

Health Affairs, 29, no. 8 (2010): 1469-1475
doi: 10.1377/hlthaff.2008.0966
© 2010 by Project HOPE



U.S. Health Care Workforce

No Harm Found When Nurse Anesthetists Work Without Supervision By Physicians

Brian Dulisse1 and Jerry Cromwell2,*

1 Brian Dulisse is a health economist at the Research Triangle Institute, in Waltham, Massachusetts.
2 Jerry Cromwell ([email protected]) is a senior fellow in health economics at the Research Triangle Institute.

In 2001 the Centers for Medicare and Medicaid Services (CMS) allowed states to opt out of the requirement for reimbursement that a surgeon or anesthesiologist oversee the provision of anesthesia by certified registered nurse anesthetists. By 2005, fourteen states had exercised this option. An analysis of Medicare data for 1999–2005 finds no evidence that opting out of the oversight requirement resulted in increased inpatient deaths or complications. Based on our findings, we recommend that CMS allow certified registered nurse anesthetists in every state to work without the supervision of a surgeon or anesthesiologist.

Key Words: Health Economics • Legal/Regulatory Issues • Medicare • Medicine/Clinical Issues • Nurses

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[Aphtalyfe]

No Harm Found When Nurse Anesthetists Work Without Supervision By Physicians

Health Affairs, 29, no. 8 (2010): 1469-1475
doi: 10.1377/hlthaff.2008.0966
© 2010 by Project HOPE



U.S. Health Care Workforce

No Harm Found When Nurse Anesthetists Work Without Supervision By Physicians

Brian Dulisse1 and Jerry Cromwell2,*

1 Brian Dulisse is a health economist at the Research Triangle Institute, in Waltham, Massachusetts.
2 Jerry Cromwell ([email protected]) is a senior fellow in health economics at the Research Triangle Institute.

In 2001 the Centers for Medicare and Medicaid Services (CMS) allowed states to opt out of the requirement for reimbursement that a surgeon or anesthesiologist oversee the provision of anesthesia by certified registered nurse anesthetists. By 2005, fourteen states had exercised this option. An analysis of Medicare data for 1999–2005 finds no evidence that opting out of the oversight requirement resulted in increased inpatient deaths or complications. Based on our findings, we recommend that CMS allow certified registered nurse anesthetists in every state to work without the supervision of a surgeon or anesthesiologist.

Key Words: Health Economics • Legal/Regulatory Issues • Medicare • Medicine/Clinical Issues • Nurses

Anyone have access to the full study?

 

[maceo]

garbage study funded b y the aana. has zero meaning not even worth the paper its printed on.

 

[EMS5]

Does supervision imply... anesthesiology MD directly supervises 2-3 CRNA's, does not work regular cases, and is available in O.R. for airway disasters/critical patients

Anesthesiology MD in O.R., may be on a case, does not supervise CRNA's however is still available for airway disaster/critical patients...

I'm just a bit unclear on what exactly they define as "supervision"...also, no disrespect meant to surgeons, but what business do they have supervising a CRNA? The surgeon's job is to perform surgery, not to maintain airway/anesthesia. Not to mention they don't have the residency training and expertise to supervise CRNA's who have already undergone advanced training in that field...just my fairly uneducated opinion

 

[jbar]

States opting out of having the requirement doesn't mean that the isn't still supervision, just that it isn't required at the state level. The hospitals could still require it, the surgeons could still require it. Also the study is just looking at existing medicare data, not a prospective database intended to detect bad outcomes with changing supervision.

I'd need to see the full study but it looks like garbage from what is here.

 

[mig26x]

all the results went out the window when I read the study is supported or funded by a nurse association.

Is like drug companies and their studies, if the results dont come out with their drug companies on top then they find the drug equal to other but not worse.

 

[Neuronix]

This data can be explained by two statements

Acknowledgments


This research was funded by the American Association of Nurse Anesthetists.

and

the mean number of base units in the anesthesiologist solo group was about a full point higher than in the certified registered nurse anesthetist solo group (p<0.05). This indicates that solo anesthesiologists were performing more complex or difficult procedures than the nurse anesthetist solo group.

Easier cases = less mortality. Duh.

 

[jacketwrestler]

Are there any CRNA-only groups running Level I Trauma centers and teaching-based facilities with ASA 4+ patients? Until then, it's hard to say if they are indeed as safe running the whole show solo.

 

[Therapist4Chnge]

all the results went out the window when I read the study is supported or funded by a nurse association.

Is like drug companies and their studies, if the results dont come out with their drug companies on top then they find the drug equal to other but not worse.

...and yet that is where the vast majority of drug studies come from without change.

I'm definitely skeptical of any research that has funding from an involved party.

 

[jwk]

Are there any CRNA-only groups running Level I Trauma centers and teaching-based facilities with ASA 4+ patients?.

Nope.

 

[bread angel]

Are there any CRNA-only groups running Level I Trauma centers and teaching-based facilities with ASA 4+ patients? Until then, it's hard to say if they are indeed as safe running the whole show solo.

Yes, there are. I am familiar with one in Fresno, CA. Furthermore, in most of the trauma centers, CRNAs work alone, because the anesthesiologists don't want to do the difficult, low paying cases.

The truth is hard to take, sometimes.

 

[bread angel]

Issue one. There are only two sources of funding for any of these projects, the government or private foundations. The government did not wish to do this project years ago, because there was so little anesthesia mortality and morbidity.

Issue two. The ABA (American Board of Anesthesiology) sponsored (paid for) the Silber study that the ASA likes to quote. Funny thing about that study, it was rejected for publication by JAMA and other well regarded peer reviewed journals. Health Affairs is the leading health policy journal in the country and has major credibility among policy makers.

Issue three. The data came from information based on billing codes. If you have some better source for objective research data, please do your own study and see if it will withstand peer review from Health Affairs.

Issue four. Acuity rates have nothing to do with reality. What really happens is that the anesthesiologist pick the healthiest patients with the best insurance.

Perhaps we are seeing a paradigm shift showing that quality care can be done by well educated non-physicians. A word to the wise, my dear physicians...arrogance and a sense of entitlement are not going to get you anywhere. The change is here.

 

[Charles_Carmichael]

Issue two. The ABA (American Board of Anesthesiology) sponsored (paid for) the Silber study that the ASA likes to quote. Funny thing about that study, it was rejected for publication by JAMA and other well regarded peer reviewed journals. Health Affairs is the leading health policy journal in the country and has major credibility among policy makers.

That's poor reasoning. Just because a flawed study was paid for by the ABA doesn't mean the AANA needs to fund its own flawed study. It's like when two kids get into a fight and each one is saying "He started it!" "No, she started it!"

Issue four. Acuity rates have nothing to do with reality. What really happens is that the anesthesiologist pick the healthiest patients with the best insurance.

Didn't this study itself state that anesthesiologists were performing more complex or difficult procedures than CRNAs? So I'm not sure how you can say anesthesiologists pick the healthiest patients with the best insurance when your own (ie. funded by the AANA) study states that CRNAs perform easier/less complex procedures.

As for a better study, if the AANA is so convinced that CRNAs are equivalent to physicians, it shouldn't be that hard for them convince an IRB to do a prospective trial where patients are randomized (no matter how complex the patient is) into the anesthesiologist and CRNA arms. Of course, the CRNAs wouldn't have any physician back-up in case things go wrong. However, this is very unlikely to happen. The same people who'll believe studies saying CRNAs = anesthesiologists will also say that it's unethical to conduct such a study and put patients at potential risk.

 

[Charles_Carmichael]

Issue three. The data came from information based on billing codes. If you have some better source for objective research data, please do your own study and see if it will withstand peer review from Health Affairs.

Genuine question here: Do the billing codes differentiate between complications/mortalities resulting from anesthesia error with that of surgical error or something like that? Just wondering, since if they don't, that adds another confounder that weakens the data.

 

[Denatured]

Interesting MDA post from "Great Z's" blog:

MONDAY, AUGUST 23, 2010

ASA President Defends Anesthesiologists, Feebly
The American Society of Anesthesiologists is losing a public relations war with the nurse anesthetists.* There was that recent AANA sponsored study splashed across the pages of WSJ.com that claimed the care received by MDAs and CRNAs are equivalent.* Then there is this study in the Journal of Nursing Economics that claims the care provided by CRNAs is 25% cheaper than anesthesiologists without affecting the quality. Oy vey! Alexander Hannenberg, MD, president of the ASA, has been a pretty busy guy lately, putting out all these PR fires smoldering around the Society.* He was quickly trotted out to dispute the findings of this latest paper.* But upon reading his defense of anesthesiologists, it is obvious he has little substance to work with.* It reads more like a he said/she said argument.* His line of reasoning wouldn't pass muster in a high school debate class.

In this interview he makes seven points about MDAs vs. CRNAs.* I won't reprint his arguments in their entirety here but you can read his interview in Becker's ASC Review.* I'll just go down the line and give my two cents about why his assertions are weak and almost indefensible.

1. Scope of services provided by MDAs and CRNAs are not equivalent.* Maybe not completely equivalent but in reality they are quite close.* Critical Care Medicine is one field where CRNAs don't practice.* But few anesthesiologists practice CCM either.* Out of around 40,000 anesthesiologists in this country, the American Society of Critical Care Anesthesiologists only counts 563 members.* And that includes resident and medical student memberships.* So for all intents and purposes, MDA and CRNA practice parameters are practically equivalent.* What about Pain Medicine?* Here the ASA is running around the country trying to legislate pain procedures out of CRNAs' hands.* If not for legal obstacles many CRNAs would be in procedure rooms right now doing blocks just like MDAs.

2. Comparison of outcomes invalid. It is true that studies show MDAs take care of sicker patients than CRNAs.* That was also found in the WSJ article.* But the reason for that is most rural hospitals only have CRNAs staffing the ORs.* These small hospitals typically handle more routine cases.* Any complicated cases are transferred to urban tertiary care facilities.* It will be impossible to fully equalize the case complexities between doctors and nurses. Good luck trying to attract anesthesiologists to 75 bed hospitals in the middle of Podunk City, Middle of Nowhere, U.S.A.*

3. CRNAs rarely go "solo" when administering anesthesia. This argument is not going to last much longer.* More and more states are deciding to opt out of Medicare's requirement to have physician supervision over nurse anesthetists.* Regardless, taking care of a surgical patient is a team approach, or at least that's the way it was always taught to me in anesthesiology residency.* Even anesthesiologists don't always decide on the anesthesia "solo". We consult with surgeons when there is a complicated or unusual presentation.in the patient. Together as a team we decide on the anesthesia that will provide the best outcome for the patient. No prima donnas in front of or behind the surgical drapes.

4. Use of CRNAs as solo providers could cost more for Medicare patients. Here Dr. Hannenberg's argument is particularly specious.* He claims that CRNAs would actually cost more because they will order more medical consults than MDAs to "assess co-existing medical conditions." Really Dr. Hannenberg? I've ordered plenty of consultations myself if I felt the patient needed it to get through an operation safely.* Besides, many surgeons prefer to work with CRNAs precisely because they are less likely to delay a case for further medical workup, for better or worse.

5. CRNA and physician compensation are not an apple-to-apple comparison. This is actually a sad indictment against anesthesiologists but alas also true.* A hospital will have to pay nurse anesthetists overtime to work nights and weekends regardless of the number of cases performed, potentially raising their costs.* We smart anesthesiologists are so smug in our superiority that we don't mind sitting around in an uncomfortable doctor's lounge, away from our families, uncompensated, wondering when our next meal ticket will arrive in the emergency room.* There goes another sleepless night on call in the hospital only billing for an appendectomy and a couple of epidurals.

6. Study is unsubstantiated, inaccurate and questionable. Dr. Hannenberg cites a CDC study in 1980 that said comparisons between CRNAs and MDAs are unachievable since the rates of mortality and morbidity from anesthesia are so low.* And they are lower now thirty years later.* Well, it can be argued that if the difference in M&M is so low between the two professions, the nurses must be doing something right.

7. Patients prefer physician anesthesiologists. This maybe true, if the costs were the same.* But how many patients have been surprised by a bill from an anesthesiologist who was not in their insurance network and subsequently disputed or refused the charges? Do you think these people would feel more satisfaction with their hospital and surgeon if they got no anesthesia bill at all because the CRNA administering the anesthesia was an employee of the hospital and thus wouldn't charge the patient separately? Where is the study that shows patients prefer paying extra for an anesthesiologist or anesthesiologist-supervised CRNA vs. a free solo or surgeon-supervised CRNA?* (Free meaning their insurance company pays for it.) Are we afraid to find that people would not want to pay more money to be anesthetized by an MDA or MDA-supervised CRNA? And how much more would patients be willing to pay to have an anesthesiologist instead of a CRNA give the anesthetic?* $1000? $100? $10? Of course it's easy for people to tell researchers they want anesthesiologists present or nearby when the anesthetic is given.* But when they have to reach deep into their own pockets for the privilege I'm willing to bet their stories will change pretty quickly. That type of study involving real money will need to be conducted to prove we are indeed preferred over CRNAs.

As a practicing anesthesiologist, and a proud member of the ASA who contributes to ASAPAC every year, it pains me to have to write these words.* And it really isn't Dr. Hannenberg's fault that his arguments are so anemic.* We anesthesiologists are so busy in our ivory towers trying to understand the molecular basis of lung ventilation in the name of patient safety that we have failed to see the soul of anesthesiology is being hijacked by the nurses.* While the AANA is cranking out multiple papers per year on why they are at least equivalent to MDAs for less cost, we haven't produced a study demonstrating the value of anesthesiologists in today's health care environment.* The nurses only need to prove they provide care as well as doctors to have an advantage, because if all else being equal, the deciding factor will be cost, their ultimate trump card.* If that situation should come to pass, the only way we anesthesiologists can stay gainfully employed is if we lower ourselves to an equivalent salary.* That will indeed be a sad day for anesthesiology.

 

[vegasrocks]

The billing codes can give you some idea of the patients co morbidities, we can bill more (1 unit) for ASA class 3 and 2units for asa4. While the ASA classes are hugely variable the anesthesiologist I work with consistently rates 3 where I rate a 2 (neither is really wrong pure judgment call) so there is some way to at least see what the provider THINKS of the acuity, as well as if it is an emergency (2 units).

By billing codes you can also tell if procedures (nerve blocks, epidurals, art line, central lines etc. etc.) are being done as well.

 

[vegasrocks]

It is not like the AANA said well great lets perform a crappy study it is just that when dealing with something like the M&M of anesthesia you need such huge numbers that retrospective studies (flawed by their nature) are really the only way to go. The fact that the ASA has NOT been able to prove better outcomes and the AANA has (by multiple studies) shows that the preponderance of the evidence supports the AANA's claim.

 

[jwk]

It is not like the AANA said well great lets perform a crappy study

Huh? Are you nuts? That's exactly what they did. Classic proof that you can buy a "study" that "proves" just about anything.

 

[vegasrocks]

Really, you think the leadership of the AANA went out and said, "lets get the worst study we can, that is 100% biased with no applicability", you really think that?
I guess that the AANA must have bought off all of the studies showing equivilence, man the AANa must be the richest most influential group in the medical system.

The point (aside from the top of your head) is that ALL of theses studies are retrospective so someone can always site poor design, etc. etc. The preponderence of the studies and real life evidence argues that the premise is true, can it be proven? no but it is in all likleyhood true.

 

[mig26x]

any study can be manipulated to show better or same results when compare to X or Y. And when that study has the backup from an organization that wants to prove a point for its own monetary gain then you have to be very careful with that study.

 

[vegasrocks]

You are right any study CAN be manipulated, however if there are multiple studies with similar results and these results seem to match the real world then in all probability the studies are accurate.

 

[Charles_Carmichael]

You are right any study CAN be manipulated, however if there are multiple studies with similar results and these results seem to match the real world then in all probability the studies are accurate.

Aren't these multiple studies funded by the AANA? That's like saying that studies a drug company puts out on its own drugs are valid and accurate. Correct me if I'm wrong. I'm not as familiar with literature regarding to CRNAs.

 

[Charles_Carmichael]

Really, you think the leadership of the AANA went out and said, "lets get the worst study we can, that is 100% biased with no applicability", you really think that?
I guess that the AANA must have bought off all of the studies showing equivilence, man the AANa must be the richest most influential group in the medical system.

The AANA leadership may not have literally said "let's do the worst study possible." But they did something close. They have an agenda to push (it's pretty obvious...equivalent scope of practice and reimbursement for CRNAs). So, they went out and said "let's fund a study that will show CRNA = Anesthesiologist no matter what the methods."

So, it's not quite the same as saying "let's do the worst study possible" but when you push heavily towards supporting only one conclusion without regard to experimental design, you're essentially doing the same thing.

 

[vegasrocks]

No not every study is paid for and funded by the AANA. You should however realize that real life (CRNA's being unsupervised) bears out the studies. Any study can be manipulated but if multiple studies match reality then it is quite likley true.

http://bja.oxfordjournals.org/cgi/content/full/93/4/540

Here is a link that reviews several studies most not paid for by the AANA and all except for the one "silber" has borne out the assertion that nurse anesthesia is safe. It also points out the flaws in each study.

 

[tapblock1968]

I note a defining silence when real information VS the antecdote is brought to the table, anyone else have an uninformed OPINION out there?

 

[Consigliere]

Genuine question here: Do the billing codes differentiate between complications/mortalities resulting from anesthesia error with that of surgical error or something like that? Just wondering, since if they don't, that adds another confounder that weakens the data.

No it does not. The study is a joke; as are the CRNA's thinking they can practice independently.

 

[jwk]

I note a defining silence when real information VS the antecdote is brought to the table, anyone else have an uninformed OPINION out there?

What is:

a "defining silence"

an "antecdote"


Why is is that CRNA's don't have the balls to put "CRNA" in their profile, and instead check every other box?

 

[tapblock1968]

1. the need to point out spelling errors is a lame attgempt to avoid the point and we do not check CRNA because there is no box to check for a CRNA.

 

[jwk]

1. the need to point out spelling errors is a lame attgempt to avoid the point and we do not check CRNA because there is no box to check for a CRNA.

And yet somehow I'm able to put "Anesthesiologist Assistant" in my profile.

 

[Denatured]

And yet somehow I'm able to put "Anesthesiologist Assistant" in my profile.

Confrontational individuals gotta streamline the constant setting up of new profiles somehow. I'm sure it gets old after a while.

 

[Coastie]

Sweet. Nurses with minimal training and academic rigor are = or > Physicians with years of training, academic rigor, and greater proven innate intelligence.

You can sign up for a nurse to do your anesthesia solo, but I'll take an anesthesiologist to practice medicine, thanks.

Issue one. There are only two sources of funding for any of these projects, the government or private foundations. The government did not wish to do this project years ago, because there was so little anesthesia mortality and morbidity.

Issue two. The
ABA (American Board of Anesthesiology) sponsored (paid for) the Silber study that the ASA likes to quote. Funny thing about that study, it was rejected for publication by JAMA and other well regarded peer reviewed journals. Health Affairs is the leading health policy journal in the country and has major credibility among policy makers.

Issue three. The data came from information based on billing codes. If you have some better source for objective research data, please do your own study and see if it will withstand peer review from Health Affairs.

Issue four. Acuity rates have nothing to do with reality. What really happens is that the anesthesiologist pick the healthiest patients with the best insurance.

Perhaps we are seeing a paradigm shift showing that quality care can be done by well educated non-physicians. A word to the wise, my dear physicians...arrogance and a sense of entitlement are not going to get you anywhere. The change is here.

 

[ProRealDoc]

No Harm Found When Nurse Anesthetists Work Without Supervision By Physicians

Health Affairs, 29, no. 8 (2010): 1469-1475
doi: 10.1377/hlthaff.2008.0966
© 2010 by Project HOPE



U.S. Health Care Workforce

No Harm Found When Nurse Anesthetists Work Without Supervision By Physicians

Brian Dulisse1 and Jerry Cromwell2,*

1 Brian Dulisse is a health economist at the Research Triangle Institute, in Waltham, Massachusetts.
2 Jerry Cromwell ([email protected]) is a senior fellow in health economics at the Research Triangle Institute.

In 2001 the Centers for Medicare and Medicaid Services (CMS) allowed states to opt out of the requirement for reimbursement that a surgeon or anesthesiologist oversee the provision of anesthesia by certified registered nurse anesthetists. By 2005, fourteen states had exercised this option. An analysis of Medicare data for 1999–2005 finds no evidence that opting out of the oversight requirement resulted in increased inpatient deaths or complications. Based on our findings, we recommend that CMS allow certified registered nurse anesthetists in every state to work without the supervision of a surgeon or anesthesiologist.

Key Words: Health Economics • Legal/Regulatory Issues • Medicare • Medicine/Clinical Issues • Nurses

An enterprising grasshopper found this article written in 1989 by one of the authors of the article above. It shows this guy clearly has a pro-CRNA bias and has been at it for over 2 decades.

http://www.jstor.org/pss/3765294

 

[Volunteer93]

Just a view from a recent patient of anesthesia and someone who is interested in possibly pursing it as a career...when is it set in stone that a specific patient NEEDS an Anesthesiologist vs a CRNA? I've had about 3 surgeries, nothing major but 2/3 times I had an MD and a very experienced one my mother actually knew do it..i had a colonoscopy last year and had a CRNA do my anesthesia...I'm still alive she did a great job, my first thought was "crap this girl can't have half the experience of an MD good thing there's a real surgeon in here when she's playing with diprivan" partly because before she injected the diprivan she explained she was a recent graduate (how i remember this is beyond me) but she did fine (diprivan fentanyl combo, made sure "ketamine" was never considered). I keep reading about MDs bashing CRNAs...it seams like it's just like PAs and MDs..look at it this way..when you buy your groceries do you specify to have the manager bag your groceries? Pretty crude comparison but still...But I'm genuinely looking for an answer so feel free to pick this apart.

 

[avatarftw]

I'm only an MS1, but isn't a colonoscopy a relatively simple procedure? I.E, unlikely to result in loss of life or complications?

Also, good results don't equal good process. Even if everything went well it may have been because of lady luck.

Would you prefer having the person that did 8 years (fellowship, potentially) of training after college or the person that did 2 years?

Just a view from a recent patient of anesthesia and someone who is interested in possibly pursing it as a career...when is it set in stone that a specific patient NEEDS an Anesthesiologist vs a CRNA? I've had about 3 surgeries, nothing major but 2/3 times I had an MD and a very experienced one my mother actually knew do it..i had a colonoscopy last year and had a CRNA do my anesthesia...I'm still alive she did a great job, my first thought was "crap this girl can't have half the experience of an MD good thing there's a real surgeon in here when she's playing with diprivan" partly because before she injected the diprivan she explained she was a recent graduate (how i remember this is beyond me) but she did fine (diprivan fentanyl combo, made sure "ketamine" was never considered). I keep reading about MDs bashing CRNAs...it seams like it's just like PAs and MDs..look at it this way..when you buy your groceries do you specify to have the manager bag your groceries? Pretty crude comparison but still...But I'm genuinely looking for an answer so feel free to pick this apart.

 

[deleted87716]

You didn't have general anesthesia for your colonoscopy. You had conscious sedation.

I'm not even sure why they're using CRNAs for that. Typically, it's done under protocol by the physicians and nurses performing the procedures.

 

[Volunteer93]

You didn't have general anesthesia for your colonoscopy. You had conscious sedation.

I'm not even sure why they're using CRNAs for that. Typically, it's done under protocol by the physicians and nurses performing the procedures.

I didn't think non anesthesia MDs could use propofol..?..

I'm only an MS1, but isn't a colonoscopy a relatively simple procedure? I.E, unlikely to result in loss of life or complications?

Also, good results don't equal good process. Even if everything went well it may have been because of lady luck.

Would you prefer having the person that did 8 years (fellowship, potentially) of training after college or the person that did 2 years?

Probably the person with 8 years but CRNAs still seam to be pretty competent no? Again is there any reason for an MD over a CRNA other than patient request?

 

[deleted87716]

I didn't think non anesthesia MDs could use propofol..?

I have no idea...it's probably facility-dependent.

Diprivan seems like overkill for colonoscopy, anyway. Typically, conscious sedation is done using IV benzos and opioids (e.g., Versed, Fentanyl).

 

[jwk]

You didn't have general anesthesia for your colonoscopy. You had conscious sedation.

I'm not even sure why they're using CRNAs for that. Typically, it's done under protocol by the physicians and nurses performing the procedures.

I didn't think non anesthesia MDs could use propofol..?..


Probably the person with 8 years but CRNAs still seam to be pretty competent no? Again is there any reason for an MD over a CRNA other than patient request?

I have no idea...it's probably facility-dependent.

Diprivan seems like overkill for colonoscopy, anyway. Typically, conscious sedation is done using IV benzos and opioids (e.g., Versed, Fentanyl).

OK, fact check for you non-anesthesia types.

There are a lot of colonoscopies performed with DEEP sedation, using propofol, by anesthetists and anesthesiologists. The use of propofol for this purpose by those untrained in anesthesiology is in direct conflict with the manufacturer's recommendations, and is the subject of much debate.

Some insurance companies are also denying payment for deep sedation - their argument of course is that's it's unnecessary, but the primary reason is of course that they simply don't want to pay for it.

Physicians can (unfortunately) use propofol if they are not trained in anesthesia (like the idiot in the Michael Jackson case). In many states, RN's are prohibited by state law or nursing board regulations from administering propofol except to intubated patients on a ventilator.

 

[Volunteer93]

Physicians can (unfortunately) use propofol if they are not trained in anesthesia (like the idiot in the Michael Jackson case). In many states, RN's are prohibited by state law or nursing board regulations from administering propofol except to intubated patients on a ventilator.

I don't think that's safe...the whole MJ thing happened a week after I had the procedure so I was glad I had a CRNA...if I ever go in for any procededure Im not letting the doc (unless that doc is an anesthesiologist) and some RN give me something there not properly trained to administer...I can drive a car but I cant fly a plane.