Word: anesthesia
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Last year Dr. Ron Miller was in a hospital pre-op unit doing what he has done every week for more than three decades: administering an anesthetic to a patient headed for surgery. Miller served as an anesthesiologist in the Vietnam War and now chairs the department of anesthesia at the University of California, San Francisco, School of Medicine; it's hard to imagine someone with more experience or better credentials. Even so, he was taken by surprise when he gave a low dose of a moderate sedative called midazolam, designed to put the patient into a semiconscious state, somewhere...
...anymore. "What we call outside-the-operating-room anesthesia is exploding," says Dr. Orin Guidry, president of the American Society of Anesthesiologists. It's not that doctors are doing heart bypasses or hip replacements or radical mastectomies on an outpatient basis. "If you're going to take a person apart," says Dr. Warren Zapol, anesthetist in chief at Boston's Massachusetts General Hospital, "you need to control the airways, paralyze the muscles and do things that amateurs don't want...
...published by Dr. Hector Vila, chief of anesthesiology at the University of South Florida's College of Medicine, showed 10 times the risk of death or permanent injury for surgery performed in doctors' offices rather than in ambulatory surgery centers. The difference, Vila concluded, was largely due to lax anesthesia procedures. In an extreme example, he says, "one plastic surgeon had his girlfriend giving the anesthesia. It didn't take long for something...
...wake of that study, Florida has stricter training and certification rules for people administering office-based anesthesia; 21 other states have some sort of guidelines. Some individual health-care systems have created their own tighter rules. And the anesthesiologists' society released new guidelines last fall to help hospitals and clinics establish credentialing processes for nonanesthesiologists who provide sedation...
...common cause of pain on the thumb-side of the wrist. It's a tendon irritation caused by friction. If it continues to be a problem despite pills, therapy, splints and shots there is a small and simple surgical procedure that cures it. I do the operation under local anesthesia, and because there's a tourniquet with a timer on during the case I can tell you how long it takes: about ten minutes. She understood the explanation and opted for the surgery. Then we went next door...