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Comment by bookofjoe | Hacker News Reader

>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.

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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.

> Should piloting a plane solo be outlawed?

Pretty much every civil aviation authority in the world requires two pilots on commercial flights.

Clearly my reference was to non-commercial flights. See: bush pilot in Alaska.

Many bush pilots charge cash to fly people.

And in the age of pretty good long-distance telemetry, I'm sure that 99% of the time there's not much need for the second pilot in a big jet. It's that 1%.

I've never really thought about it, but I guess I'm a little uncomfortable with noncommercial anesthesiologists and I would prefer that they are supervised.

There’s a lot more to commercial aviation than RPT (Regular Public Transport) operations.

Some of those commercial ops include single pilot IFR in Class G, into dirt airstrips at night.

Accreditation is a thing. You don't have to be accredited to practice medicine. But you might want to be if you want insurance or the government to pay you for practicing medicine.

Or get a job. No board certification = no job at good hospitals.

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?

No. I go ahead and do an emergency intubation all by my lonesome.

See also: first responder at countless Code Blues around the hospital (700 beds) where I did just that. On average once a month x 38 years.

>Presumably the patient just dies in that scenario that you are supposedly qualified and prepared for?

P.S. LOVE the snark!

> 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.

To me it reads like anesthesia in the MRI shouldn't be allowed or needs better supervision.

>he's really grateful if someone's there to assist with basic moves while he's trying to control the more pressing matters.

I think they were saying theres literally no one there to help.

>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.

Emblematic of the broken US healthcare system. The guideline creates an easily preventable scenario where the patient is highly likely to die for no real reason.

> To me it reads like anesthesia in the MRI shouldn't be allowed or needs better supervision.

It must certainly be allowed, as it greatly benefits some patients. Believe me, I'd be most happy if I was forbidden to enter MRI rooms.

> I think they were saying theres literally no one there to help.

This might happen quite infrequently, and usually just for a very short time. Problem is that others have their own jobs to do, and sometimes you get unlucky at just the worst time. It's certainly not common that no one's there, and theres almost always someone near. But since you can't leave the patient, it might be that you have to yell for 20-30s before someone notices you're in trouble.

> Emblematic of the broken US healthcare system. The guideline creates an easily preventable scenario where the patient is highly likely to die for no real reason.

I'm not currently practicing in the US. I don't think that's a fair assessment. Guidelines are born in patient blood, and although adaptation is a must deviating from guidelines still remains a bad idea most of the time.

> It must certainly be allowed, as it greatly benefits some patients.

Is this for patients that can’t stay calm? It seems to me there would be plenty of far safer ways to sedate them. Example: some Xanax

many situations: mental illness, transport from ICU, exam during surgery, etc. So no, Xanax isn't enough.

> the patient is highly likely to die for no real reason

Hey now, there's a very good reason for this. The rich people who own the medical insurance company need their third yacht.

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