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What you should know about anesthesia care teams

Do you expect an anesthesiologist to be in the operating or procedure room while you're under general anesthesia?

When preparing for a surgery involving general anesthesia, it’s important to understand the type of anesthesia provider who will be handling this important aspect of your care.

Anesthesiologists are experts in the administration and management of anesthetic medications, as well as critical care. The advanced training in critical care medicine comes into play when there’s an unexpected complication during anesthesia care or surgery.

These days, anesthesia care teams provide most general anesthesia care. Medicare and insurance companies have driven this transition because of the cost-effectiveness of using less-trained non-physician anesthesia providers to handle the bulk of the care.

The American Society of Anesthesiologists considers the head of any anesthesia care team to be an anesthesiologist physician. In Texas, that’s still the case. In other states, though, lobbyists for certified registered nurse anesthetists (CRNAs) have convinced legislatures to enact laws allowing them to practice independently. This article will focus on what to expect in an anesthesiologist-led anesthesia team.

In my mind, the word team conjures up the idea of players engaged in one game. When I used to play basketball, our team only played against one opponent on one basketball court at any given time. Anesthesia teams operate differently.

To continue the basketball analogy, the captain of the team—the anesthesiologist—is leading four, five, or more separate teams in four separate games on four separate courts all at once.

It’s easy to see the frightening possibilities in this set up. If the anesthesiologist is urgently or emergently needed in more than one place once, someone suffers. Someone may sustain a serious brain injury. Someone may die.

Interestingly, the total number of patients that an anesthesiologist may handle it once is defined by billing criteria, rather than evidence-based medicine or patient safety. When there’s an anesthesia team involved, there are two different models for anesthesiologist involvement.

Under the medical direction model, an anesthesiologist is allowed to be involved in up to four anesthesia procedures or surgeries going on at the same exact time, with a CRNA nurse anesthetist in four different operating rooms. To bill and function under this model, the anesthesiologist must fulfill several responsibilities, including:

• Perform a pre-anesthesia examination, which includes assessing the patient, identifying, and addressing risks, and prescribing the anesthesia plan.

• Be physically present in the operating room when the patient is put to sleep (induction), woke up (emergence), and the most physically demanding procedures and anesthesia plan.

• Monitor the course of anesthesia at frequent intervals.

• Remain physically present and immediately available when there’s an emergency.

Under the medical supervision model, and anesthesiologist is allowed to be involved in five or more concurrent anesthesia procedures or surgeries, with a CRNA nurse anesthetist in each of many different operating rooms. In this anesthesia team model, the medical doctor anesthesiologist is required to fulfill all of the requirements discussed above for medical direction.

One of my concerns about anesthesia teams is that patients are often not fully informed about who will be managing the anesthetic portion of the care in the operating room after they are put to sleep.

Typically, an anesthesiologist physician will come and meet the patient in a pre-procedure room, conduct an exam in interview, and go over the procedure. It’s usually during this meeting that the informed consent paperwork gets signed, which allows the anesthesia team to provide care.

From my experience in handling many anesthesia medical malpractice cases, there is some important information that’s frequently conspicuously missing doing this conversation. Of course, it’s the fact that the anesthesiologist will be conspicuously missing from the operating room during most of the anesthesia and surgical care. Instead, this will be left up to a CRNA nurse anesthetist. In many cases, I think it’s a classic bait and switch.

Before signing informed consent paperwork with an anesthesiologist for surgery, there are some critical questions to ask. Before signing on the dotted line, make sure that you’re comfortable with all the answers.

• Who are all the members of the anesthesia team?

• Will the anesthesiologist physician be in the operating or procedure room during the entire case?

• If not, will the anesthesiologist be medically directing or medically supervising your case?

• How many other cases will anesthesiologist be medically directing or medically supervising at the same time is yours?

• How close are the other operating or procedure rooms to yours?

• Will the anesthesiologist be in your operating or procedure room when you are put to sleep and woken up from anesthesia?

• What is the training and experience of the CRNA who will be handling your care?

• How long has the CRNA been licensed?

• Is a crash cart located in your operating or procedure room?

• If you’re a patient with possible or confirmed obstructive sleep apnea, what is the plan for dealing with that? Is a difficult airway cart in your operating or procedure room?

Here at Painter Law Firm, we’ve handled multiple cases with anesthesia care was bungled, leaving patients with permanent brain injuries were leading to wrongful death.

If you’ve been seriously injured because of poor anesthesia care in Texas, then contact an experienced, top-rated Houston, Texas medical malpractice lawyer for help in evaluating your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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