Talk:Anesthesia

Emergence Phenomenon?

I was redirected to this page from Emergence Phenomenon, but emergence phenomena are not discussed on this page at all! —Preceding unsigned comment added by 72.207.77.105 (talk) 16:42, 18 September 2008 (UTC)

Likewise. Checking the original article's history I found a definition for Emergence Phenomenon as "In medicine, emergence phenomena are reactions experienced by patients during or after awakening from anaesthesia". Perhaps it would be more useful to redirect that page to a link in Wiktionary for this term? Either that, or please include the definition of the term on the Anesthesia page! --Fjb3 (talk) 00:29, 17 May 2009 (UTC)

And same here. It would be helpful if this term was explained. —Robotech_Master (talk) 03:03, 25 August 2009 (UTC)

It's still not mentioned in the page. Even a copy paste of the definition here would be nice in the page. 129.21.75.21 (talk) 20:22, 15 October 2009 (UTC)

I have added a (very) brief section describing emergence phenomena in the general anaesthesia article, which is a more appropriate place for that discussion than in this article IMHO. I have also rewritten the disambiguation page for emergence. I hope this helps. DiverDave (talk) 04:08, 27 December 2010 (UTC)

More vandals.

To those who are now attempting to edit the CRNA section to reflect YOUR politics, (anonymous IPs), it has been mandated by the staff of wiki that no changes are to be made without discussion here and agreement. I am the default protector of the CRNA section in this wiki entry and keep it from being politicized by ASA peons. Please, keep YOUR politics out of my section. Thanks,Mmackinnon (talk) 02:20, 15 June 2009 (UTC)

Editing an article by adding sourced information and removing unsourced information is not vandalism, but good editing. Claiming the article should remain as you left it is ownership, and violates wikipedia policy [[1]]. If you and your sockpuppets are willing to have adult conversations and compromises on language that is one thing, crying vandalism everytime someone adds to an article you believe you own is another. Fuzbaby (talk) 01:27, 16 June 2009 (UTC)

info for fuzbaby

Hello there

First, I am always suspicious (after 3 years) of people who come here making random edits without using the talk page. It suggests ulterior motives. Having said that, here is the reason why your edit is incorrect.

You had edited "CRNAs do not require Anesthesiologist supervision in any state and require surgeon/dentist/podiatrists to sign and approve the chart for medicare billing in all but 16 states. Many states place restrictions on practice, and hospitals often regulate what CRNAs can or can not do."

Here is what was stated previously: "CRNAs do not require Anesthesiologist supervision in any state and only require surgeon/dentist/podiatrists to sign the chart for medicare billing in all but 16 states."

The difference here is significant. First, noone is required to "approve" anything a CRNAs does by law or state law. Hospital policy may be different in each hospital as it IS for all physicians as well. So that statement, which makes the suggestion that CRNAs are somehow limited in comparison, is not needed since it also applies to physicians. In otherwords, it goes without saying. CRNAs are not the same an NPs in that regard. Second, the requirement to sign the chart ONLY exists as a CMS requirement for billing. In every state in the union CRNAs work independently in ASCs like plastic surgery centers, where it is an all cash buisness and CRNAs require noone to sign their chart. There is no "approval" of anything the CRNA does by a physician. This is a misconception.

The actual document says this:

"Thirty-nine states do not have a physician "supervision" requirement for CRNAs in nursing or medical laws or regulations. If clinical "direction" requirements are considered in addition to "supervision," 31 states do not have a physician supervision or direction requirement for CRNAs in nursing or medical laws or regulations. Taking into account state hospital licensing laws or regulations as well, 33 states still do not require physician supervision. Taking into account state hospital licensing laws or regulations, 24 states still do not require physician supervision or direction."

The states which do have some language are left intentionally grey as the expert for anesthesia services is the CRNA and not the operating physician. Case law has proven that in every case, the CRNA working independently (including in supervision states) is 100% liable for the anesthetic and surgeons do not get sued any more often with CRNA only vs MDA only practice. Surgeons carry ZERO additional liability for working with a CRNA.

So the term "supervision" becomes very negative when in reality it means nothing but signing a chart and no actual supervision or direction is required. That is the reason I leave the word out since in reality it has a different meaning that what people would take it as. The reality is this is ONLY about a billing situation.

Comments?Mmackinnon (talk) 18:34, 15 June 2009 (UTC)

Hello, let me start out that users who claim ownership and leave personal attack on personal pages, as you did, are rarely honest, neutral editors.

Second, the source states: "The federal requirement has been that CRNAs must be supervised by a physician. The November 13, 2001 rule allows states to "opt-out" or be "exempted" (the terms are used synonymously in the November 13 rule) from the federal supervision requirement"...further "14 states as of June 2005)

Iowa opted out of the federal supervision requirement in December 2001. Nebraska opted out in February 2002. Idaho opted out in March 2002. Minnesota opted out in April 2002. New Hampshire opted out in June 2002. New Mexico opted out in November 2002. Kansas opted out in March 2003. North Dakota opted out in October 2003. Washington opted out in October 2003. Alaska opted out in October 2003. Oregon opted out in December 2003. Montana opted out in January 2004. (Gov. Judy Martz opted-out; Gov. Brian Schweitzer reversed the opt-out in May 2005, without citing any evidence to justify the decision. Subsequently, after the governor and his staff became more familiar with the reasons justifying the January 2004 opt-out, Gov. Schweitzer restored the opt-out in June 2005. Montana’s opt-out, therefore, is currently in effect.) South Dakota opted out in March 2005. Wisconsin opted out in June 2005." and: "18 states permit CRNAs to practice "independently."" This is not consistent to what is stated in this and other articles on this topic. Fuzbaby (talk) 01:21, 16 June 2009 (UTC)

First, I deleted a post I made out of frustration on your talk page before i actually posted it. However, your attempt at an ad hominem is noted. In anycase, you clearly do not understand the difference between CMS rules for participation in medicare and how they use the terms medical direction and supervision. CRNAs can practice independently in every state in the union this has ALWAYS been true. The CMS rules also state "supervision and medical direction are not comments or direction in relation to scope of practice or control". These are billing terms which explain WHAT and anesthesiologist must do in order to get paid for their participation in the anesthetic (if they are there). Supervision by the operating practitioner involves only them signing an ORDER for anesthesia to be delivered in order for the CRNA to collect 100% physician fee schedule for medicaid. There is no requirement otherwise for 'supervision'. So what you have edited in inaccurate since you suggest supervision as much more than a billing term and that independent practice (billing without someone signing) has anything to do with scope of practice or practice environment. This is simply not the case. Please show me where the term "and approve" is used in that document. Also please explain this statement

"Many states place restrictions on practice, and hospitals often regulate what CRNAs and other midlevel providers can or can not do based on local laws, provider training and experience, and hospital and physician preferences"

I do not fund this in the article either. Moreover, this is also true for every practitioner including physicians. Please show me where it states there is any requirement for "physician preference" as well. I do not find this in the article nor do i find that there is any difference in these requirements for CRNAs as there are for physician requirements. They too have to deal with state laws, hospital policy, local laws, training and experience and hospital preference. Why did you not add this also in the physician section? This seems biased. Please defend these changes. As was agreed to by the moderators previously in this discussion page this is vandalism without proper consensus or discussion.Mmackinnon (talk) 03:18, 16 June 2009 (UTC)

Proposal to split Anesthetic agents to separate article

This article is getting rather long, and to mirror other medical fields on Wikipedia, I propose that the "Anesthetic agents" section be split to its own article. Almost all drug groups have their own articles, separate from the field of medicine that uses the drugs (see {{Major drug groups}}). There used to be an article called Anaesthetic drugs, but it was moved to List of anaesthetic drugs. What I propose is merging the "Anesthetic agents" section of this article with List of anaesthetic drugs, and then moving the article to Anesthetic. Anesthesia/Anesthetic would then parallel the related articles local anesthesia/local anesthetic and general anesthesia/general anesthetic. A {{main}} link to Anesthetic with an overview summary would then be placed in the "Anesthetic agents" section of this article. --Scott Alter 18:08, 20 June 2009 (UTC)

Anyone have any comments? --Scott Alter 00:12, 5 July 2009 (UTC)

Since there were no objections, I completed this split. The article is currently at List of anaesthetic drugs, until an admin deletes Anesthetic so List of anaesthetic drugs can be moved there. --Scott Alter 17:23, 8 September 2009 (UTC)

NYCMD DO NOT DELETE REFERENCES

NYCMD, it is not your place to delete valid references from this article. Nor is it your place to edit the Nurse Anesthesia section because it does not fit your personal opinions. Moreover, lifelinetomodernmedicine.com is an ASA owned website and by definition biased. It isnt a reference, simply a page for ASA agenda. Mmackinnon (talk) 03:03, 11 May 2010 (UTC)

article reassessment

This article has significant problems related to MoS compliance, content (e.g., the prose is riddled with grammatical and spelling errors) and referencing (e.g., the article is nearly devoid of reliable sources). Due to these issues, I have reassessed this article as Start class. There is also a long history of NPOV issues, edit wars, vandalism, and heavy use of edit reversions. This article is greatly in need of attention from expert editors and any other interested editors. Respectfully, DiverDave (talk) 05:30, 10 September 2010 (UTC)

Horace Wells

I think Dr. Horace Wells should be mentioned in this article. He gave an unsuccessful demonstration of laughing gas with a dental patient in MGH and was booed at. But he was a pioneer of anesthesiology also. — Preceding unsigned comment added by 66.30.5.187 (talk) 23:24, 2 October 2011 (UTC)

Types of Anaesthesia

Classification has to be refined to only two broad groups such as 1)General and 2)Regional. Further Regional anesthesia is to be divided into a.Spinal anesthesia, b.Epidural anesthesia, c.Nerve Blocks, d.Bier's Block (IV Regional anesthesia), e.Field block, f.Local infiltration. Dissociative anesthesia is a type of phenomenon caused by specific drug such as ketamine to induce painlessness. It comes under the classification of Total Intravenous anesthesia (TIVA) which is a sub-group under general anaesthesia.Drvijay2000 (talk) 17:13, 22 December 2011 (UTC)

Raymond Lullus?

There is no citation for the section about Raymond Lullus first discovering ether. His wikipedia page makes no mention. Other sources -- including Cordas' wikipedia page -- say it was first synthesized by Valerius Cordas in 1570 when he mixed ethanol and sulfuric acid, calling the result "Sweet Oil of Vitriol."Msalt (talk) 21:52, 26 April 2012 (UTC)

OMFS section

The discussion of OMFS in this detail is WP:UNDUE weight. All surgical residencies, as well as many internal medicine subspecialties, are trained in administering anesthetic medications. However, this is not the place to discuss one specific surgical subspecialty, but to discuss those providers whose primary roles are to provide anesthesia related medciations (such as anesthesiologists, CRNAs, etc). I would not mind a section, appropriately sourced and weight to describe that physicians in general can be trained in administering anesthetics such as critical care physicians, etc., but the section as written was completely UNDUE and reads like an advertisement for the OMFS subspecialty. Yobol (talk) 22:25, 8 July 2012 (UTC)