Specifically asking for an Anesthesiologist

[MikMik6]

Hey guys! I have an ortho procedure coming up. I was wondering if it was professional and reasonable to ask whether or not I can specifically ask for an anesthesiologist and not a CRNA for my upcoming case?

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[chessknt]

Hey guys! I have an ortho procedure coming up. I was wondering if it was professional and reasonable to ask whether or not I can specifically ask for an anesthesiologist and not a CRNA for my upcoming case?

You can ask but what are you going to do if they say they can’t guarantee that?

I had a procedure done and when I asked if there was a physician anesthesiologist backup I was told no so I cancelled it and rescheduled it at a hospital where I knew there was a backup available.

 

[MikMik6]

You can ask but what are you going to do if they say they can’t guarantee that?

I had a procedure done and when I asked if there was a physician anesthesiologist backup I was told no so I cancelled it and rescheduled it at a hospital where I knew there was a backup available.

Meaning a CRNA would be the primary with an attending on back up?

 

[chessknt]

Meaning a CRNA would be the primary with an attending on back up?

It was a moderate sedation being done by the proceduralist but I didn’t trust them to manage complications of the sedation if there were any. They have a endo center but no anesthesia staff around. I’m pretty sure they’ve never hd to deal with an emergency though because none of them know how to intubate and probably don’t even know how to reverse the sedatives they are giving. At least in the hospita there is an anesthesiologist 12 feet away if there is an emergency.

 

[MikMik6]

The hospital I'm doing the procedure has multiple CRNAs staffed with a single attending supervising 3-4 procedures at a time. I'm just concerned if there's any complication, he won't nearby. So I think I'll just strictly ask for an attending. If not, then I'll cancel the procedure.

 

[MikMik6]

I only ask because I came across this article and it was horrific and I don't want a CRNA to lay a hand on me.

'Like torture' | St. Louis man says he was awake, unable to speak or move during surgery

Imagine going under the knife and actually feeling the pain. Matt Caswell says it happened to him, and now he's filing a lawsuit against Washington University, the anesthesiologist, and the

www.kctv5.com

 

[GassYous]

I would ask for it. That's what I would expect for my family and for myself

 

[coffeebythelake]

I only ask because I came across this article and it was horrific and I don't want a CRNA to lay a hand on me.

'Like torture' | St. Louis man says he was awake, unable to speak or move during surgery

Imagine going under the knife and actually feeling the pain. Matt Caswell says it happened to him, and now he's filing a lawsuit against Washington University, the anesthesiologist, and the

www.kctv5.com

Re: the awareness-under-general anesthesia case you linked... I would say that something like this is extremely unusual and an error that could happen regardless of training.

While I don't want to dissuade you from your decision to choose physician-only for your anesthetic, it might be difficult to organize depending on your geographic location and especially on short notice. You should call the hospital's anesthesiology department and inquire if this can be arranged. I believe that the ACT model (anesthesiologist directing CRNAs) is safe, although the better the staffing ratio the more attention the anesthesiologist can have to you intraoperatively. Not all ACT models are 1:3 or 1:4, there are places where 1:2 is more common. I wouldn't go with an independent CRNA.

Since you mentioned getting an orthopedic surgery, it is worth mentioning that many of them can be performed with block + sedation. That would preclude the use of muscle relaxants.

 

[Urzuz]

Since you mentioned getting an orthopedic surgery, it is worth mentioning that many of them can be performed with block + sedation. That would preclude the use of muscle relaxants.

For what it’s worth, in an ACT practice, I would be much more terrified to undergo a surgery with block+sedation than a general anesthetic. I would be way more concerned that the CRNAssassin isn’t able to recognize/treat hypoventilation, or if I involuntarily move they may just crank up the propofol infusion.

I would feel much safer with an ETT in my throat if a CRNAssassin is the one sitting my case. Of course, MD-only is the way to go in any situation…

 

[anaesthetic]

In our practice, we solo and supervise, so we often get requests for physician only cases or cardiac anesthesiologists for LVADs/cardiac cripples. I’ve seen patients wait around for hours for an anesthesiologist to become available before being anesthetized, and even though we have decent CRNAs, I don’t blame the patient at all. It’s hard to be in four places at once.

Re: the awareness article, I always lay eyes on the ETCO2, most recent vitals post-induction, and the vaporizer before leaving the room, doubly so after reading about that. I’ve turned on the vaporizer for the CRNA 2-3 times this past year because of this routine.

 

[nimbus]

We honor patient requests all the time. I’ve also asked for a specific anesthesiologist (based on the recommendations of colleagues who trained there) at an academic place and my request was honored. It’s no different than choosing your surgeon.

 

[jwk]

You’re certainly within your rights to request an MD and cancel the procedure if one isn’t available. In an ACT practice, you should make that request known WAY ahead of time. We are a true medical direction practice - docs do all the blocks, and are present as reqd according to TEFRA. Our anesthetists do >99% of our cases but every one is medically directed with the personal involvement of an anesthesiologist. It is rare in our practice that docs do cases. I don’t make that decision. That’s just the way our practice operates.

One thing to consider that many don’t - sure I want a competent anesthetist (or doc) doing my anesthesia. But I also want the person that’s in the OR doing cases every day, who knows the surgeon, who knows his preferences in the OR, AND knows where everything is in the carts - drugs, equipment, etc., and can do the case and keep track of it with our EMR. That’s not going to be the doc that does a room 2-3 times a year.

 

[nimbus]

But I also want the person that’s in the OR doing cases every day, who knows the surgeon, who knows his preferences in the OR, AND knows where everything is in the carts - drugs, equipment, etc., and can do the case and keep track of it with our EMR. That’s not going to be the doc that does a room 2-3 times a year.

If the attending anesthesiologist doesn’t know this basic stuff, I don’t want my care there. I’d prefer someone who works with the surgeon on a regular basis, preferably for >10 years. Guess what I’m saying is I don’t want any doc who does a room 2-3x/year. How can that possibly be good?

 

[MikMik6]

If the attending anesthesiologist doesn’t know this basic stuff, I don’t want my care there. I’d prefer someone who works with the surgeon on a regular basis, preferably for >10 years. Guess what I’m saying is I don’t want any doc who does a room 2-3x/year. How can that possibly be good?

This is exactly who I’d prefer as well. I just want to mitigate any and all possible intraoperative complications related to anesthesia by having someone who is appropriately credentialed.

 

[vector2]

. Guess what I’m saying

I'm mostly on the same page as you, but for the sake of argument, what is the relative importance of the basic stuff jwk was referring to when working in an ACT practice (carts, slickness with the EMR, etc)? Even though I supervise, I make it a point to know where everything is and how everything works. In part because it lets the nurses know I can definitely do everything they do, but not vice versa. However, some of my colleagues don't.

On the critical care side, I know some intensivists who could definitely treat your vtach storm with amiodarome and lidocaine gtts, and who could then drop a transvenous pacer if you went into symptomatic bradycardia......but they don't know the code to the supply room where the pacer boxes are kept or how to troubleshoot a beeping alaris pump. Does that change your opinion of an intensivist if they don't know that "basic" stuff?

 

[Gaseous Clay]

It was a moderate sedation being done by the proceduralist but I didn’t trust them to manage complications of the sedation if there were any. They have a endo center but no anesthesia staff around. I’m pretty sure they’ve never hd to deal with an emergency though because none of them know how to intubate and probably don’t even know how to reverse the sedatives they are giving. At least in the hospita there is an anesthesiologist 12 feet away if there is an emergency.

Amen to that, wise decision on your part.

 

[coffeebythelake]

We honor patient requests all the time. I’ve also asked for a specific anesthesiologist (based on the recommendations of colleagues who trained there) at an academic place and my request was honored. It’s no different than choosing your surgeon.

Our practice used to be like this as well. Now with covid and severe staffing shortages I don't know if it is so easy to do.