Your Anesthesia Questions - Continued

Question: Do anesthesiologists carry malpractice insurance?
Anesthesiologists (MDAs – medical doctors of anesthesia) are doctors who specialize in anesthesia. CRNAs are nurses who specialize in anesthesia. This is confusing to patients, and I should do a whole post on it. Here’s the mini version: I’m a nurse with a masters degree, not a doctor with a specialty. I work in a hospital that has a “team model.” My attending anesthesiologist does the pre-op assessment (usually while I’m in the previous case), and he’s present for the induction (where we put the patient to sleep and secure the airway) in case I need an extra set of hands or a second opinion. On a normal day, he just stands there and looks pretty. Then he’s gone for the rest of the case. He only comes back if I call him because I want advice or because I need to go to the bathroom (and sometimes not even then!). The MDA’s also do their own cases some days; they don’t always supervise. In addition, many hospitals have only CRNAs or only MDAs. There are many different practice models.
Nurse anesthetists have been around in some form since the American Civil War. My granddaddy was a nurse anesthetist. A number of studies have been conducted on quality of care. They all indicate that you get equal quality care whether you’re anesthetized by a CRNA or an MDA. We get the same training in anesthesia. However, medical doctors are qualified to do things like mange home mediations for pain, high blood pressure, and other co-morbidities. CRNAs don’t do that. We are perioperative specialists.
Sorry for the tangent. You asked whether MDAs carry malpractice. I’m sure they do, but I don’t know how it’s set up, because I am not an MDA. I am insured through the anesthesia group that employs me. If I took a 1099 job, I’d have to buy my own malpractice insurance. One way or the other, you’ve gotta have it. Anesthesia is a high law-suite area. It comes with the territory.
Question: Have you ever used your knowledge of anesthesia in writing fiction? (I suspect so, looking at poisons in Panamindorah)
Sure. Most often, I use basic medical knowledge to make injuries or medical events realistic. I could do a whole blog on silly medical scenes in fiction. :) My only story that directly related to anesthesia was “Blood of the Dawn,” and I’ve hidden that story because it’s got such huge spoilers for Walk Upon High. Sometimes, my medical background probably gets in the way. My characters are too right too often. They should probably believe more nonsense about health and injury.
Question: Know this sounds odd, but any truth to redheads being more resistant to certain anesthetics?
Not a silly question at all. There have been multiple studies on this. As far as I know, it’s inconclusive. Some anesthetists believe that redheads need more drug, and some do not. I have no strong opinion about it.
Question: Why do they give you that horrendous anti-nausea shooter before anesthesia when it just makes you sick to your stomach?
I had to quiz the questioner about this, since our antiemetics are generally given after the patient is asleep through the IV. I guessed that her surgery was a c-section, and I was right. C-sections are considered a full stomach, they are more likely to vomit, even if you do everything right. Consequently, they routinely get bicitra before the case. It’s 30 ml of nasty-tasting liquid that decreases the acidity of your stomach contents. It does not prevent nausea. However, if the patient does vomit and aspirate, they are less likely to get pneumonia, because there will be less damage to their lungs because the vomit is less acidic. Make sense?
Question: Do people really say weird stuff/ reveal secrets as they go under?
Not usually. They usually behave as they normally would; they just don’t remember it later. Often, they say the same things over and over because they forget what they just said. On the other hand, propofol is a mild aphrodisiac, and some people get aggressively flirtatious during a sedation. When that happens, you just deepen them, and they start snoring.
Question: I don't know anything about anesthesia except that the anesthesiologist on Greys Anatomy did crossword puzzles. Do you do puzzles?
During long cases, you sometimes have a period where you’re just monitoring the patient, charting, and nothing else is happening. During that time, many of us read something. Studies indicate that  you’re actually more alert for problems when you’re switching your attention between a book and the monitor, as opposed to just staring for hours at the monitor. Light reading keeps you awake. I typically read either my Kindle or articles from Google FeedReader on my Phone. iPhones have become the overwhelming source of reading during anesthesia cases in the hospital where I work. People hardly ever carry magazines or newspapers anymore.
Question: How do perfusionists fit into the whole surgery/anesthesia thing?
Perfusionists run the heart/lung bypass machine. This is used for coronary artery surgery, heart transplant, and lung transplant. In very specific situations, you can also crash on bypass to save someone’s life in an emergency/trauma situation. The bypass machine is a delicate instrument with rules all it’s own. A perfusionist is trained to run that machine. CRNAs and MDAs don’t do that. During a cardiac case, the dangerous time (for us) is going on bypass and coming off bypass. When the patient is actually on bypass, there isn’t a lot for us to do.
Question: Why did I see the spirit of Odin when I went under anesthetics for my operation? Or was it Loki?
That was actually the spirit of Silveo. He is annoyed that you didn’t recognize him.
Question: I am curious about training for anesthetists. In vet med, we get a DVM then do a residency to be an anesthesia specialist. But as general practitioners we anesthetize patients and our techs are often doing a lot of monitoring.
To become a CRNA, you need a 4 year nursing degree with a few extra sciences/maths. Then you need to work for 1-5 years in the ICU. Then you need to get into an anesthesia program. These programs are competitive, and you need high grades. They take only the cream of the ICU nurses. Once you get into a program, you will spend 2.5-3 years getting a masters in anesthesia. This may involve living all over the country at different clinical sites. You say good bye to your family before you start. That’s what everyone needs to become a CRNA.
In addition, I personally have a pre-medical background. My first degree was biology. I was pre-vet. I ended up with a biology degree, a chemistry minor, a minor’s worth of other classes (physics, calculus, statistics), and I was 9 hours short of a English degree. I got into Purdue veterinary school and spent a semester there. I left (for reasons beyond the scope of this question), cast about for a while, got half a literature masters, did some teaching. Then I went into nursing. So, I have more than the minimal requirements. For the difference between MDAs (anesthesiologists) and CRNAs (nurse anesthetists), see my answer to the first question in this post.