Anestheisiology question

Do doctors really walk around the hospital with a bandolier of fully-cocked syringes like this? (Photo is about 2 pages down in the post)

It would not be common. It would be in a specialized ward perhaps.

I am not clear if he was working in a poorer state hospital or a better psych hospital probably the former.

He probably was working in the VA. The quality of the VA is up and down and not the same from hospital to hospital. We do not know the quality of such care. It could be necessary. It could be brutally unnecessary. We do not know if the vets are an extreme group of patients.

When I went for my colonoscopy earlier this summer the procedure was done in a specialized building with beds lined up patients waiting to have the job done. The anesthesiologist visited me right away. He was unarmed so to speak even though he had several patients to see per day. Of course, his tools were in the theater.

Sedating people makes sense. The use of sedation frequently over time would be very worrisome.

The name tag on the guy’s belt says he’s at the VCU Medical Center in Richmond VA. A large academic medical center.

My 10-year colonoscopy is coming up in about 6-months. I got my first one shortly after Obamacare was up and running and I could get it for free.

At the time insurance companies were trying to screw people out of their “free colonoscopy” by saying that the colonoscopy only covered “the scope” and if they snipped any polyps, that was extra. Then they said that any pathology studies on the polyps was extra. Finally the Labor Dept moved in and told the insurers that a “colonoscopy” included everything you expected it to, including any anesthesiology services required.

So when I scheduled the colonoscopy, I asked them, “How do I make sure that the anesthesiologist is in network and I don’t get screwed.” Answer, “For low risk patients, they just used a sedation machine operated by a nurse, so you weren’t going to get a bill from an anesthesiologist”. Smooth sailing.

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The VCU is actually a very important hospital.

No. However, it is common practice that before the first case of the day to mix up a batch of “emergency meds” so they are read to go if needed. Don’t want something bad happening and you be in a rush trying to draw up a syringe and some of the drugs needing to be diluted and you screw up the dilution because “hurry up the patient is crashing”. Most people I worked with just wrapped up the syringes in a towel and kept them on their anesthesia cart for the day.

As far as a “sedation machine” watched by a nurse, works great till it doesn’t work great. Seen too many stories of doctors/surgeons doing stuff in their office/procedure room and next thing you know they are calling a code and bringing in the body bag.

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THIS :point_up_2::point_up_2::point_up_2:

Not a tremendously common occurrence…but devastating when it happens. The joke about anaesthesiology always used to be that it was 90% boredom and 10% panic. I oftentimes remarked that it took a fair bit of knowledge, skill and expertise to maintain that 90%.

Not everyone agreed.

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One of my retired doctor friends overhead a senior discussion regarding how important it was to carefully check out and choose your surgeon and responded

“Your surgeon’s skill has a significant but not overwhelming effect on the outcome of a procedure, but your anesthesiologist, mostly unnoticed, can all too easily kill or save you.”

david fb

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Depends on your risk. Presumably we’d all be safer if we had a cardiologist following us around with a defibrillation machine, but it wouldn’t be money well spent in most cases.

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They do the best they can with AEDs (Automatic Electric Defribrulators) located/available wherever deemed reasonable.

Is this “sedation machine” the tech used for “sedation dentistry”?

I now, voluntarily choose sedation dentistry!
:sun_with_face:
ralph

The machine they used in my 2014 colonoscopy was made by Sedasys. It was just an IV pump. They didn’t put a mask with gas over my mouth.

I understand that the Anesthesiology Society lobbied against Johnson & Johnson (owners of Sedasys) over the use of the product, since it was a threat to business. They were successful in getting insurance companies to not pay for it and Johnson & Johnson eventually shut Sedasys down.

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Why would you be sedated for a colonoscopy? It is one of the greatest experiences, watching the procedure - I look forward to this every 5 years! My first one I had asked the doctor if I could get a copy of the video - he responded with ‘please shut up, I’m trying to work here’! I probably had been babbling on for a bit.

JimA

My entire career I’ve heard of thousands of threats about being replaced by a robot. Was never worried. Every so often some “machine” would come in for a “test run” and I’d immediately find significant holes in the programming. And on very basic stuff such as interpreting vital signs.

The reason the ASA fought it, the whole slippery slope that I’ve seen way too many times throughout my career, people start doing more and more things without proper supervision and safety. Knew one arrogant ENT surgeon that thought he could do his own sedation in his office for minor procedures. Worked great until he killed a completely healthy 30 year old.

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One of our anaesthiology professors at dental school would oftentimes comment that, back in his early days, he’d quote his fees in guineas (a pound and a shilling…old money) The X shillings to put them to sleep and the X £s to wake em back up with all their marbles. He also stated, quite forcefully, that part of his job was to convince us buggers to never, ever work as operator-anaesthetists. He’d done his job with me, at least.

My first gig as an associate after residency was in a practice where the principal…and presumably associates before me … used I.V. valium for dental work (totally “legit” at the time) For the handful of patients who requested it, I explained the rationale of why I did not use it…and a good many saw the sense. So didn’t (“Well, I’ve never heard of that”…:thinking:) and one woman who asked point blank what about “the customer is always right?”. Srsly!

I’m not that slick with quick thinking but I guess the incongruity of the comment stirred something as, quick as a flash, I replied that, “when the customer knows enough to actually be always right, they don’t generally find themselves in a dentist’s with a mouthful of cavities making requests such as she did”. Worked a treat as she got up and left.

I filed it away as a useful turn of phrase (to be used judiciously, of course)

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It all depends on the risk.

I’ve told this story before.

Eight or nine years ago, I saw a plastic surgeon to get a small weight implanted in my eyelid. My eyelid wasn’t fully closing when I blinked, and there was an area in the middle or my cornea that was getting dried out. The weight would help the eye fully close.

The procedure was to make a 1/4" to 3/8" incision in my eyelid. Slip the weight under the skin and hold it in place with a stitch. Then close the wound. But the insurance company wouldn’t pay for it if the procedure was done in the office. It had to be done in the hospital. I said fine, but I don’t want to be sedated for something this simple. Do it under local anesthetic. Surgeon said OK.

Then about a week before the surgery, I get a call from “Anesthesiology Services” at the hospital. I say, “Why am I talking to you? Doesn’t the surgical order say this is being done under local anesthetic? The woman confirms that it does, but an Anesthesiologist still has to be there in case something goes wrong”. I say, “It’s a 1/4” incision. What could go wrong? Are you going to set me on fire? I’m not going to pay an Anesthesiologist to stand there as a spectator." So then she asks me how I’m going to get home from the surgery. I tell her, “I driving myself home. It’s a 1/4” incision and I’m not getting any sedation or anesthesia." She says, “We’re not going to let you do that.” I said fine. I’ll call my surgeon and cancel the procedure and get the work done elsewhere.

Of course, when I called the surgeon’s office to cancel the procedure, they went nuts. “Oh no, you don’t have to do that. We’ll fix the problem with Anesthesia.” So they called back the next day and said they’d make my case the last one of the day, and dismiss the Anesthesiologist beforehand. So I drove to the hospital at about 2 PM and drove myself home by 4 PM, eliminating the inconvenience being imposed by “Anesthesiology Services”.

About a month later I got the hospital bill which included a $1,800 charge for
“Anesthesiology Services”. I immediately called the insurance company and told them I didn’t get any anesthesia, and they shouldn’t pay that. The clerk told me that their contract with the hospital required them to pay for “Anesthesiology Services” whether the patient gets anesthesia or not. I didn’t get a bill from an Anesthesiologist.

And people wonder why health care is so expensive.

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I bet that, should a wayward child have run out unexpectedly and made its way under the wheels of your car… or anyone else having a similar procedure done… and with as many compromises to standard procedre (assuming that to be the case) I bet things would’ve been a bot different. Forget the minimal nature of the procedure, some enterprising legal hack would’ve been able to make a cast iron and indefensible case to gua-RON-tee a multi-million dollar lawsuit.

Might well have already happened … which was why the apparently unnecessary palver…and is one more reason why healthcare is expensive

That’s fine. I have a big liability insurance policy to cover that kind of multi-million dollar risk. But I refuse to be price gouged on health care.

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We had a big scandal here in the Portland suburb where I live a few years ago. A dentist called in an anesthesiologist to sedate an autistic 4-yr-old who wouldn’t sit still in the chair, and they ended up killing him. Dosage of the drug used was too high.

It’s not clear to me that there’s any added safety in having an anesthesiologist in attendance as a spectator. I have a high tolerance for pain, and avoid sedation whenever possible. {{ LOL }}

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There are cases of the patient’s wishes being damned. To fail to see such a case is tantamount to malpractice.

I wish school teachers could let the parents know when to stop the crap.

It matters a great deal or there would be even more horrible deaths.