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Doctors and Nurses

Page: http://healingfireisland.com/doctors-and-nurses/
Healing Fire Island ~ Doctors and Nurses

passing gas

In the operating room there are teams that deliver care to patients which are organized to make the surgical experience efficient and pleasant for all involved. There is an anesthesiologist or a nurse anesthetist who is supervised by an anesthesiologist or a surgeon. The surgeon obviously does the operation along with an assistant who might be a physician’s assistant or a surgical tech. There is a circulating nurse who assists the anesthesiologist or nurse anesthetist as needed. Sometimes there is more than one surgical tech or more than one surgeon if the case is complex or very serious.

When the case is getting started the patient is brought into the room by the nurse anesthetist (CRNA) and the circulating nurse and put on the table. The monitors are placed and oxygen is placed over the patient’s nose or nose and mouth, depending on the type of anesthesia they are expecting to have. When it is time to start the anesthetic, a sedative is administered and the anesthesiologist is called to the room if necessary and the actual anesthetic is started. Sometimes it is general anesthesia which would involve injecting a series of drugs into the IV line and watching and verifying the patient’s airway and ability to ventilate their lungs. All the while the patient’s vital signs are monitored closely.

If the anesthetic is a regional such as a spinal, epidural, or nerve block, the block is started while a sedative is injected and the vital signs are watched. The patient is observed and questions are asked to determine the effects of the local anesthetics injected to determine the level of anesthetic as the local is given. The anesthetist or anesthesiologist is careful to avoid overdose or complications while attempting to achieve an anesthetic level appropriate for the planned procedure. All is done is a time-sensitive manner while the surgeon is pacing in the substerile room next door.

After the anesthetic is completed and the patient is stable, the nursing staff preps and drapes the patient and the surgeon is called to scrub and get gowned and gloved. They then localize the incision site, verify that the patient is indeed under anesthesia and make incision. The anesthesiologist notes the time of surgery and all agree on the specific time of start. Billing all depends on the time of the case, and all times must agree on the nursing and anesthesia documents.

During the surgery, the anesthesia staff watch vital signs, fluids administered, bleeding and urine collected. Other fluids monitored might include stomach contents suctioned with a nasogastric tube. These fluids influence IV fluid amounts administered and the decisions made to give blood or blood products during surgery. They also monitor temperature and muscle relaxation, and the total amounts of drugs given. When the surgeon puts in the final suture and places the last dressing on the patient, that is when the case is considered over, and the time is then recorded as the end of surgery.

The anesthesiologist then will turn off the anesthesia gas, reverse the muscle relaxant if used, and suction the stomach in anticipation of removing the airway which was used to ventilate the patient. If a block was used, the end of surgery requires very little action except for cessation of any sedation medication. The patient is moved to recovery when stable and report is given to the nurse who will be taking the patient from the team.

A CRNA is a nurse with a masters level education. She or he is a registered nurse with critical care experience and special training in anesthesia. The difference between a CRNA and an anesthesiologist is that an anesthesiologist is a physician who has attended a full four-year college and then gone on to medical school and residency specializing in anesthesia. They graduate with and MD degree, four years of college, four years of med school, and four years of residency. Specialty within anesthesiology such as cardiac or pediatric or pain management could also take extra fellowship training. MDAs (MD anesthesiologist) often carry the same intraop activities as CRNAs, however the preop and postop responsibilities usually are managed by the MDAs in mixed groups where the MDAs supervise the nurses in the OR and the MDAs run the schedule and make rounds and do consults.

I have worked with many talented and dedicated CRNAs and am happy to endorse their role in our practice! I write this merely to help my reader understand the difference as it has often been a source of confusion.  I hope you find this interesting, because most of you would not have any idea what happens once you enter the OR!

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