Expert: JM Starkman, MD - 10/4/2010

Question
Is this standard procedure?  To have an RN, not even a CRNA, administer conscious sedation?  I especially ask because this endoscopy center advised me they did not use CRNAs and now I see their employment advertisement below.  

_____________  is  looking  for  a  skilled  RN  to  obtain  patient  history,  get  informed  consent,  prepare  patients  for  procedures, circulate  in  procedure  room  and  administer  conscious  sedation.  Recover  patients,  give  discharge  instructions  and  cross  -  train  for  all  areas.  Must  be  a  team  player  with  current  (state)license,  ACLS  and  have  or  obtain  good  IV  skills.

The center had an anesthesiologist and informed me they used propofol which I had before under the name diprovan so I was comfortable with that situation. (They seemed proud of this, stating they used the ‘Michael Jackson drug’.  Personally, I thought that might not be great advertising or reassuring to everyone – since he’s DEAD.)

Other than BP spikes during sedation, I have only had issues with general anesthesia in the past: the first time over 30 years ago being ‘out’ 6 or 8 hours vs. 30-45 mins, waking up maxed out on anti-nausea meds and receiving a large extra invoice for ‘recovery room complications’ to add insult to injury (not that you need to know that); the 2nd time a year later I woke up in the OR – a mildly amusing experience that not everyone gets to have unless they are a medical professional; a little disconcerting at 1st when no one seemed to notice my eyes were open, but I trusted my entire team, the guy behind me was diligently monitoring his equipment – as he should be, I was being sutured closed, and it was obvious that anesthesiologist was a good listener since my main request was ‘please do not put my brain to sleep any longer than medically necessary’.

In any case, due to the above I always prefer to use a 1-1 anesthesiologist.  The past 3 times I have been sedated, the anesthesiologist has even been the one to start my IV line.  This last time, I did have to request this numerous times before the staff spoke to him.  However, afterwards I did have the concern if he actually remained in the room.

The reason I had the concern was that once in the procedure room two nurses showed up right before the sedation process.  I will confess to having a panic attack on the table.  The nurse informed me of this and stated I’d be fine as soon as the dr started the drug, so I had to assume he was there.   I thought he probably already had started the drug and in those few brief seconds before one goes out, I was panicked.  This was due to a little PTSD thing I have going on pertaining to drugs (not limited to the situations listed above; I'll spare you the details).  Because of this, in my mind I NEED to be able to see and hear the person I agreed to sedate me and know when they start the drug.  That this did not happen was partly, or entirely, my fault since I failed to inform the anesthesiologist of this due to the conversations centering on the issues of starting my IV (although drs generally inform the patient when they start the anesthesia).  In any case, I panicked because – to put it bluntly - I thought ‘who are all these new players and where the &*#* is my guy’, so it didn’t matter how much that nurse cranked up the oxygen I was still going to feel like I couldn’t breathe.  Had I been able to look into his eyes and hear his voice and know when the drug was first being run, my BP probably would still spike, but I wouldn’t have been crawling off the table.

Afterward, I called the center and asked the staff again if they used CRNAs and they stated they did not, only RNs.  I did not take this to mean that they had RNs administering anesthesia, supervised or not.  I didn’t ask them if the anesthesiologist remains in the room the entire time.  It was after the fact, and I think I didn’t want to hear the answer may have been no.  Along with the front desk and RN check in staff, I found the anesthesiologist to be the most compassionate and professional staff there.

Apologies for the length of this.  At present, I am home sick and was job hunting online when I came across this ad and became curious…then annoyed.  There is actually a question at the top and I was hoping to hear your candid opinion.  Thanks in advance for your time.  Best regards.

Answer
It sounds like the people running this endoscopy center are gargantuan morons.....geez!.....y.ou've certainly got it right: the whole point about Michael Jackson and his tragic death is that an anesthetic was being administered by a NON-ANESTHESIOLOGIST!  And now this place is effectively bragging about same.

Find a new surgery/endoscopy center and a new gastroenterologist to go with it.  If your current GI can cannot evaluate an unsafe and substandard situation that you describe he's probably cutting a lot of other corners as well.