I’m not sure but I believe so.
Put IR department does most things under local and nursing sedation. I agree with your impression that most of these can be done with MAC and with local and nursing sedation unless sick patient or high BMI etc, but it does depend on the IR doc and staff.
Ditto.. if they call it’s almost always appropriate and necessary.
I never meant they are dumb procedures. I meant the anesthesia for them is dumb. For angiograms we basically give 25-50 of fentanyl. The surgeons probably utilize anesthesia so they can have less liability or bill more themselfes. anesthesia services for all of these are often times unnecessary. A surgeon can administer versed and fentanyl and the patient will have virtually the same experience. Of course if it’s a large BMI patient or a critically ill patient then Its understandable. When you have to cover many different services and are short staffed then yes it can be a problem.
I have had cases where the IR doc couldn’t get it with his fluoro for 30 min and I went in and got the LP in a few minutes myself.
I'll take the propofol for mine, please and thank you.
“A total of 118,004 colonoscopies were performed during the study period, with 48 perforations (0.041% or 4.1 per 10,000). Overall, the use of propofol was associated with a 2.5 times increased rate of perforation (6.9 vs 2.7 per 10,000; p = 0.0015). Similarly, in patients undergoing therapeutic colonoscopies, there was a 3.4-times increased risk of perforation associated with the use of propofol (8.7 vs 2.6 per 10,000; p = 0.0016).”
Majority of patients get said procedures with no anesthesia or with versed and fentanyl. No my issue is not providing anesthesia for them obviously. It just feels like an unnecessary use of our skill and time when it can be done with a nurse or even the surgeon themselfes providing sedation
I don’t think your info is accurate. From what I recall many European nations and the Netherlands have a similarly high rate of epidural use for labor as the US.
I think a little self-introspection would come in handy here and not just ad-hominem attacks. Cost is increased (negative for "society", positive for us) and patient satisfaction is increased (marginally positive for the patient compared to nursing sedation) but we need to look at this from a resource utilization perspective. It's hard to be objective when there is a conflict of interest. Anesthesia for (most) cosmetic plastic surgery cases falls into this category but at that point the anesthesiologist/CRNA has come to terms with their motivation (which is fine). If "society" (Medicare, Medicare advantage, etc.) is going to help pay for the anesthesia we should look at certain cases from a macro cost/benefit perspective. If someone has to work post-call to staff one of these cases, then you could also add the cost of physician and group burnout (even if the parties involved get compensated and everyone wants to make the anesthesia group, proceduralist, hospital and patient happy). The (possible) slightly increased risk of procedural complication from deep sedation should also play a role in the calculation but I think the other issues weigh more heavily. If the OP was suddenly paid a million dollars for his services, I'm sure he/she would be ecstatic but that doesn't answer whether the service was appropriate to begin with. Those type of decisions need to be on a case-by-case basis. Our proceduralists typically handle their own sedation for most cases in pain clinic, IR and GI and we are involved with the "bigger" cases (lung/kidney/liver ablations, rare MRI for special needs patients, ERCPs etc.). If we wanted to have an honest conversation about the breakdown of anesthesia necessity for these "bigger" cases then I think that is reasonable as well. Honestly, this discussion could also extend to unnecessary surgeries as well but that should be its own thread.
Those peeps who know when I post. I don’t lie or mislead.
I had multiple similar scenarios during residency. Large Amish population. Consistently saw ladies that were G10P10 or higher. Some decided they just wanted to see what it was like for their last planned delivery. After placement almost all of them wished they had gotten them for all their others.
My point is in the USA. We do things in healthcare way more than other first world countries.
She must be really good with local anesthesia. Some of our surgeons operate like they've never heard of it.
Fair enough. I was thinking of Sweden, which actually had a very high rate of epidural use. In fact, many European countries has a high epidural usage rate, I do find it strange that the Netherlands has an extremely low rate.
Typically, it involves a patient with dysphagia needing a NG/Keofeed for enteral access i.e. feeds, meds, etc. The story is often: bedside nurse tried, other bedside nurse tried, charge nurse tried, primary team requested anesthesia to place NG tube. When we somehow get suckered into this, the first move is to try it yourself without anesthesia but the patient has often been told that they will be put to sleep for this after so many tries so some patients just aren't interested in trying too hard.
Yep, TTEs. "Patient does not tolerate pressure from probe." "Patient anxious about results and will not hold still with prior attempts."
AH - there's your problem. This is a surgeon/hospitalist or even radiology issue, not anesthesia. We don't place NG tubes unless it's intra-op.
