Wednesday, December 15, 2010

"Sedation Gravy Train" Over?

One of my readers sent me this link along with this comment;  FDA Reconsiders Approval of Personalized Sedation System 

 I was reading an article on Nurse Anesthesia ,  and came across an interesting comment made by "stanman1968" (CRNA).  He actually thinks the "sedation gravy train"  will end soon !  Maybe I'm reading too much into his comment ( or maybe it's just wishful thinking !),  but are anesthesia providers actually starting to realize how much Versed is over-used,  or starting to see too many bad reactions ?  Let me know what you think."
Here's the quote referenced...  I actually respect Stanman to a certain degree, so I am not slamming him in any way shape or form.  I am grateful that he seems to agree with me about sedation being a "gravy train."
"The truth is that the sedation gravy train WILL end and sooner then later, I do a lot of it right now but I do not think it is a viable career choice for the long hall."

I actually do have an opinion on this!  Surprise surprise!  This thread was started by CRNA's who take exception to their job being automated, just like anybody else whose job is on the chopping block because of automation.  Ask farm workers and manufacturers of any kind of goods how much they like being in the unemployment line because of computer robotics, machinery etc. doing that job better, faster and more efficiently than humans can... 

What do *I* think about replacing a bunch of arrogant, overpaid CRNA's with a machine?  BRING IT ON!  But Jackie, you say "Don't you want the human touch, the ability for your CRNA to save your life if things go wrong with the machine?"  NOT ON YOUR LIFE!  At least the machine won't be trying to second guess me.  The machine isn't going to decide unilaterally that IT "knows what's best" is it?  No it's not.  A machine isn't an egotistical miscreant intent on imposing its will upon me is it?  No its not!  There is no humanity in (most) CRNA's that I can detect.   Why would I miss what I never had?  As for some fool needing to ram a tube down my throat as one poster on nurse-anesthesia says, (scuse me "intubate") well, that's what alarm bells are for.  They have them all over the place in the hospital, let alone in a surgical suite!  They are there to summon the help.  Just like a maid's bell.  Either I or the machine rings, you come running.  That's as it should be.  A machine is better, safer and less expensive that a CRNA, at least the one *I* had.  I want a machine to administer Fentanyl only to me, at my direction, and I want that "anesthesiologist" to "supervise" the machine instead of a nasty little CRNA.  Get it?  I had a machine in the hospital that allowed me to administer the dosage of pain killer (Morphine at the time) that I needed.  It was very effective and *I* had absolutely NO PROBLEM with my machine. 

Obviously I am looking askance at Propofol as well.  That's because "sedation" as practiced doesn't mean being in a serene state of mind.  It means becoming a mindless zombie whose life revolves around making their torturers happy.   I am NOT interested in sedation in any form!  Fentanyl as pain killer AND sedative works great.  It just makes the CRNA's job harder because they can't treat you like dead meat.  You'll REMEMBER IT!

To address my reader's hopefulness about the "Sedation Gravy Train" being over...  This is what *I* get out of it.  CRNA's are on their way out as it pertains to sedation and paying the OUTRAGEOUS FEES to these nurses to slam patients with Versed (and/or Propofol) whether they want it or not.  I hope this is true.  The machine in question dispenses Propofol only as far as I can gather and not Versed... (or Fentanyl)  As health care gets more and more expensive, due in part to NURSES making 6 figures for abusing their patients trust, I imagine that less and less trained people will be allowed to do sedation AND automation will take the place of those marginally skilled people, relegating them to computer technicians.  Good.  I hope that health insurance companies will take a good hard look at Versed and decide not to pay for it at all.  All it does is create a "sedation gravy train" for CRNA's and is unnecessary and actually harmful to patients. As I've said before FOLLOW THE MONEY!  It appears that I am vindicated about the Versed use.

You know my view of the FDA, as I have not been shy about what *I* think about them.  Their latest ruling in favor of injectable Versed solidifies my absolute CONTEMPT for this wholly owned subsidiary of pharmaceutical companies.  They are remiss in their primary duty and that is the SAFETY OF PATIENTS.  Here's a quote from an SRNA (student registered nurse anesthetist) SuccsDrugs&Rocuron;   
"would love to see a "virtual jaw thrust" or a robot intubator~
can u imagine the insane cluster f*ck when the apneic pt starts to code, and no one is there to
handle the code & intubate the pt, there is no positive pressure/ambu-bags in room,
unfortunately, must be a ton of money $$$$ smoozing the FDA officials from the GI doc groups~
oh well, after the first person dies (and they will) maybe things will go back to a safe anesthetic delivered by CRNAs."

When my dear readers recover from their hysterical laughter over this one, here's what I see.  An undereducated person without a grasp of the English language postulating on things they know nothing about.  You may quote me.  First of all there is undoubtedly an alarm which sounds off if the machine detects over sedation.  (It says so, if you can read the other posts on the thread)  There are LAWS AND REGULATIONS about what MUST be in the room where this "sedation" is being practiced.  That would include those 'missing' "positive pressure/ambu-bags" and personnel trained in airway management.  IT'S THE LAW!  Since when are sedated patients left alone in rooms, self medicating,  without anybody there and without the required by law resuscitation devices?  It's illegal to do so.  Any patient who is being anesthetized, (sedated if you will) must be monitored by a person trained in airway management and whose duties are solely devoted to the patient.  There are heart monitor leads, oxygen saturation apparatus etc.  I'm not a trained medical person and I know that! 

Here's the part that really slays me!  "...must be a ton of money $$$$ smoozing the FDA officials from the GI doc groups..."  How does it feel when the shoe is on the other foot?  Where were all of you people when patients started to complain about Versed?  Where were all those CRNA's who want that "safe" anesthesia, delivered by themselves, when the Police were allowed to inject people with Versed and without a CRNA?  (just an EMT)  The only reason you people even still have Versed in the face of all the complaints, deaths and disorders from it,  is because the FDA was bought off by those same GI docs and others like YOU and pharma who love this drug no matter how bad it is for patients!  It's your own fault that people are looking into ways to DECREASE the cost of health care!  You people (CRNA's) are the ones on the "sedation gravy train" gobbling up health care dollars and demanding more and more money for a job apparently best left up to a machine!   

We need a new type of nurse.  An ARN.  That would be an Airway Registered Nurse.  (Aren't most nurses trained in airway management and how to handle a coding patient?)  Then nursey nurse's whites won't turn yellow at all.  (from another post same place)  By the way, what a pompous, overbearing, disgusting way to describe a fellow professional nurse.  Shame on you!

Another quote from an SRNA "Volatile" (gotta wonder about the name choice, is this a personality trait or an allusion to anesthesia gasses?) showing that patients aren't the only ones who bear the brunt of the megalomania of anesthesia nurses...  "This is stupid! The GI docs pushing this are STUPID and should be ashamed of themselves. I cant imagine endo nurses managing a propofol drip on any given patient, much less leaving it to a machine. Wow."  So, not only are patients stupid, but also the FDA, endo nurses, nurses who wear white uniforms, AND GI Docs.  Welcome to my world.

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