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Sounding an Alarm for Hospital-employed CRNAs
This brief paper is intended to highlight some recent observations I have made regarding the disadvantage hospital-employed CRNAs (as opposed to anesthesiologist- or self-employed CRNAs) have in negotiating the new economic realities assaulting their hospital employers. What follows are my opinions and observations, and no one should be deceived into thinking I have any special knowledge. However, there are historical facts and economic realities that need to be illuminated, because ignorance of them is bringing grief to many of our fellows. It would please me greatly if this brief essay were to serve as a starting point for new ideas on how to handle this alarming trend.
Preventing the Hostile Take-over of Your Practice
A recent study in the New England Journal of Medicine failed to live up to researchers expectations, resulting in a greater number of definite intraoperative awareness incidence when using bispectral electroencephalogram monitoring (BIS) in comparison to standard endtidal anesthestic-agent concentration (ETAC).
"We tested the hypothesis that a protocol incorporating the electroencephalogram-derived bispectral index (BIS) is superior to a protocol incorporating standard monitoring of end-tidal anesthetic-agent concentration (ETAC) for the prevention of awareness..."
"There was no difference between the groups with respect to the amount of anesthesia administered or the rate of major postoperative adverse outcomes.