RMV->)The problem with this whole practice of allowing RNs to "practice anesthesia" all stemmed from reimbursement issues, not improving patient care. The idea that we were somehow saving money made it alright. CRNAs have 27 months of anesthesia training after a BSN. I think it is ridiculous to think that RNs can take a weekend class and be proficient in airway management. ACLS does not provide you with the hours of practice needed to intubate without fail. At our facility and others like it, we would not have any backup from anesthesia. We have elected to provide safe, quality care even for such cases as GI and cataracts.
"RNs Pushing Propofol" (July, page 24). I was glad to see this issue brought to print. At my facility, we do not have RNs doing the IV conscious sedation. We are a rural critical access hospital with one CRNA taking call 24/7. If he is not scheduled to provide MAC for cases, he would not be in the building. I am not comfortable to say we could always and without fail rescue a patient from too much Versed/Demerol. I have a friend who works in endoscopy at our neighboring facility (250 beds). I hear about the horror stories on an almost daily basis. A gentleman from our community died during a bone marrow biopsy at an office in St. Louis. It is not a safe practice. I am probably more conservative than most of your readers. We need to be fighting the battle to get reimbursement for CRNAs to do these procedures. I guarantee there have been a number of sentinel events since this practice became common. I certainly am speaking from a rural hospital point of view. We have to be "jacks-of-all-trades" as it is. To add this responsibility is unreasonable with limited or no backup and no room for error.
Melanie Koch, RN, BSN
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I am truly thankful that you published an article with such fairness and truth. Having practiced as a CRNA for more than 23 years, I have seen quite a few changes in the field of anesthesia and some of them were not for the better. I have no bias against nurses (I am still licensed as one), but I do have a problem with patients receiving care from individuals who may be familiar with the administration of certain medications, yet do not fully understand the potential side effects or how to deal with them. ACLS certification is very beneficial for anyone in the healthcare profession, but the pharmacology and physiological effects of drugs are not even addressed in length at these courses.
We CRNAs have our hands full making sure that "anesthesia assistants" being backed by anesthesiologists in some areas don't compromise patient care by administering medications without proper medical training to understand all aspects of anesthesia care. Enough said. I thoroughly enjoyed the article and will show it to as many of my colleagues as I can. Thank you.
Donald P. Randolph, PhD, CRNA
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I have had physicians approach me on this issue wanting my advice on RNs pushing propofol to patients undergoing conscious sedation. So far, my advice has been to avoid it without anesthesia involvement.
My reasoning is it is easy to lose an airway with this drug and there is no reversal agent for it. When administered properly, the patients usually do wonderfully, waking up faster and feeling better. But, as with all potent medications, its effects are highly variable from patient to patient.
Propofol can cause hypotension and hypoxia quickly, not a good combination for anyone to deal with, especially those not experienced in dealing with these kinds of problems. I have a high degree of confidence in my RN colleagues but this may be too much to expect from people not trained to meet all the challenges of anesthesia pharmaceutical care. However, I try to keep and open mind and am eager to hear opposing views.
Eric Beechly, CRNA, MS
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Thank you for running this article on such an important and sensitive topic.
Steven Stein, MD
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The very interesting and thought-provoking article solidified my feelings that unless you are trained in anesthesia (physician or CRNA), you should not be administering potentially dangerous drugs - no matter how rapid the off-set of the medication is. Judgment is very important, and that only comes from training and practice.
Michael A. Belinson, MD
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