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>1. I had to anesthetize the patient in the sub-basement, two floors below the main OR — where there were always other anesthesiologists able to help in an emer

>1. I had to anesthetize the patient in the sub-basement, two floors below the main OR — where there were always other anesthesiologists able to help in an emergency. In the MRI suite, no one could hear my silent screams if I got in trouble nor were there knowledgeable extra hands to, for example, squeeze the breathing bag if I needed to prepare for an emergency intubation. You are allowed to put patients under general with no one else present? That doesn't seem like it should be possible

rscho 1y ago
There's always someone else. But the radiologist might not be at his/her most efficient doing anesthesia & resuscitation...
- bookofjoe 1y ago
  No — there is NOT always someone else. And if others present are nurses, aides, radiologists, etc., they are generally of zero help in a crunch.
  - fluidcruft 1y ago
    Pretty sure that at the very least you are not operating the scanner. And the scanner generally nowadays must operate under the plus one staffing model (one certified technologist per scanner plus at least one additional level 2 MRI safety trained staff in the immediate vicinity). So no, you are not "alone".
    - rscho 1y ago
      He said he's been doing that for a long time. Plenty of time for stuff to happen, and security guidelines were not always as they are now.
      - fluidcruft 1y ago
        An anesthesiologist was never operating an MRI scanner at any point in history.
        rscho 1y ago
        Indeed, but you won't find yourself alone during the MRI. When you're preparing or finishing the case though, the RX tech and the radiologists often suddenly feel a need for a break. Same thing happens everywhere we go: the anesthesiologist comes in, everyone's here. 2 min later, you look around and everybody magically disappeared.
        fluidcruft 1y ago
        That's never happened anywhere I work unless you're counting being in the control room as "magically disappearing". To be fair I only have 25 years in the field and don't use AI to answer so what do I know.
        rscho 1y ago
        Look, he might use AI but I'm not. I also have 20 years in the field, and I've lost count of how many times I found myself alone with a risky patient. Yes, oftentimes people are just 10m away. Yes, that's not supposed to happen. But that's often far enough for us anesthesiologists to wish we'd be somewhere else. Perspectives and empathy matter. Try to put yourself in our shoes, sometimes. For the record, I'm the main hybrid MRI OR guy in my hospital, so I work near MRIs most days.
        fluidcruft 1y ago
        The only way anything you are saying makes sense is if you are counting people being in the control room as not being there. They can see you, they can hear you, you can hear them. You are not "alone" except in an overly dramatic sense. This goes in triplicate for a hybrid system operating today.
  - rscho 1y ago
    Yeah, I agree that we can find ourselves alone sometimes, although that's not really supposed to happen. For sure, most people usually aren't that useful anyway.
bookofjoe 1y ago
>You are allowed to put patients under general with no one else present? That doesn't seem like it should be possible Every day in ORs around the world manuy thousands of anesthesiologists — and CRNAs where approved — put patients under general with no one else present. Are you proposing that two anesthesiologists be assigned per patient, like scheduled airlines? Should piloting a plane solo be outlawed? If, after three years of residency and roughly 1,500 cases done under supervision, many more done without supervision, a written examination, and an oral examination, you aren't qualified to administer a general anesthetic solo, then you have NO business giving general anesthesia no matter how many other qualified or unqualified others are present.
- rscho 1y ago
  I agree you should be able to provide solo, but there is also substantial evidence supporting the addition of a CRNA to make anesthesia teams, that are safer (and even more expensive) than either CRNA or MD operating alone. In many countries, teams are the standard of care.
- vonneumannstan 1y ago
  Im sorry but how does this possibly jive with what you literally just said? > In the MRI suite, no one could hear my silent screams if I got in trouble nor were there knowledgeable extra hands to, for example, squeeze the breathing bag if I needed to prepare for an emergency intubation. Presumably the patient just dies in that scenario that you are supposedly qualified and prepared for?
  - rscho 1y ago
    > Presumably the patient just dies in that scenario that you are supposedly qualified and prepared for? Yeah, can happen. That doesn't mean you did something wrong. Sometimes (very rarely), shit happens even though you've planned it all according to guidelines. What he's saying is that when shit hits the fan, he's really grateful if someone's there to assist with basic moves while he's trying to control the more pressing matters. I can relate.

rscho 1y ago

There's always someone else. But the radiologist might not be at his/her most efficient doing anesthesia & resuscitation...

bookofjoe 1y ago
No — there is NOT always someone else. And if others present are nurses, aides, radiologists, etc., they are generally of zero help in a crunch.
- fluidcruft 1y ago
  Pretty sure that at the very least you are not operating the scanner. And the scanner generally nowadays must operate under the plus one staffing model (one certified technologist per scanner plus at least one additional level 2 MRI safety trained staff in the immediate vicinity). So no, you are not "alone".
  - rscho 1y ago
    He said he's been doing that for a long time. Plenty of time for stuff to happen, and security guidelines were not always as they are now.
    - fluidcruft 1y ago
      An anesthesiologist was never operating an MRI scanner at any point in history.
      - rscho 1y ago
        Indeed, but you won't find yourself alone during the MRI. When you're preparing or finishing the case though, the RX tech and the radiologists often suddenly feel a need for a break. Same thing happens everywhere we go: the anesthesiologist comes in, everyone's here. 2 min later, you look around and everybody magically disappeared.
        fluidcruft 1y ago
        That's never happened anywhere I work unless you're counting being in the control room as "magically disappearing". To be fair I only have 25 years in the field and don't use AI to answer so what do I know.
        rscho 1y ago
        Look, he might use AI but I'm not. I also have 20 years in the field, and I've lost count of how many times I found myself alone with a risky patient. Yes, oftentimes people are just 10m away. Yes, that's not supposed to happen. But that's often far enough for us anesthesiologists to wish we'd be somewhere else. Perspectives and empathy matter. Try to put yourself in our shoes, sometimes. For the record, I'm the main hybrid MRI OR guy in my hospital, so I work near MRIs most days.
        fluidcruft 1y ago
        The only way anything you are saying makes sense is if you are counting people being in the control room as not being there. They can see you, they can hear you, you can hear them. You are not "alone" except in an overly dramatic sense. This goes in triplicate for a hybrid system operating today.
- rscho 1y ago
  Yeah, I agree that we can find ourselves alone sometimes, although that's not really supposed to happen. For sure, most people usually aren't that useful anyway.

bookofjoe 1y ago

>You are allowed to put patients under general with no one else present? That doesn't seem like it should be possible Every day in ORs around the world manuy thousands of anesthesiologists — and CRNAs where approved — put patients under general with no one else present. Are you proposing that two anesthesiologists be assigned per patient, like scheduled airlines? Should piloting a plane solo be outlawed? If, after three years of residency and roughly 1,500 cases done under supervision, many more done without supervision, a written examination, and an oral examination, you aren't qualified to administer a general anesthetic solo, then you have NO business giving general anesthesia no matter how many other qualified or unqualified others are present.

rscho 1y ago
I agree you should be able to provide solo, but there is also substantial evidence supporting the addition of a CRNA to make anesthesia teams, that are safer (and even more expensive) than either CRNA or MD operating alone. In many countries, teams are the standard of care.
vonneumannstan 1y ago
Im sorry but how does this possibly jive with what you literally just said? > In the MRI suite, no one could hear my silent screams if I got in trouble nor were there knowledgeable extra hands to, for example, squeeze the breathing bag if I needed to prepare for an emergency intubation. Presumably the patient just dies in that scenario that you are supposedly qualified and prepared for?
- rscho 1y ago
  > Presumably the patient just dies in that scenario that you are supposedly qualified and prepared for? Yeah, can happen. That doesn't mean you did something wrong. Sometimes (very rarely), shit happens even though you've planned it all according to guidelines. What he's saying is that when shit hits the fan, he's really grateful if someone's there to assist with basic moves while he's trying to control the more pressing matters. I can relate.