>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.

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.

There's always someone else. But the radiologist might not be at his/her most efficient doing anesthesia & resuscitation...

No — there is NOT always someone else. And if others present are nurses, aides, radiologists, etc., they are generally of zero help in a crunch.

Pretty sure that at the very least you are not operating the scanner. And the scanner generally nowadays must operate under the plus one staffing model (one certified technologist per scanner plus at least one additional level 2 MRI safety trained staff in the immediate vicinity). So no, you are not "alone".

He said he's been doing that for a long time. Plenty of time for stuff to happen, and security guidelines were not always as they are now.

An anesthesiologist was never operating an MRI scanner at any point in history.

Indeed, but you won't find yourself alone during the MRI. When you're preparing or finishing the case though, the RX tech and the radiologists often suddenly feel a need for a break. Same thing happens everywhere we go: the anesthesiologist comes in, everyone's here. 2 min later, you look around and everybody magically disappeared.

That's never happened anywhere I work unless you're counting being in the control room as "magically disappearing". To be fair I only have 25 years in the field and don't use AI to answer so what do I know.

Look, he might use AI but I'm not. I also have 20 years in the field, and I've lost count of how many times I found myself alone with a risky patient. Yes, oftentimes people are just 10m away. Yes, that's not supposed to happen. But that's often far enough for us anesthesiologists to wish we'd be somewhere else. Perspectives and empathy matter. Try to put yourself in our shoes, sometimes. For the record, I'm the main hybrid MRI OR guy in my hospital, so I work near MRIs most days.

The only way anything you are saying makes sense is if you are counting people being in the control room as not being there. They can see you, they can hear you, you can hear them. You are not "alone" except in an overly dramatic sense. This goes in triplicate for a hybrid system operating today.

The RX bay over here is like 150m^2, serves 6 MRI rooms, has nooks and corners and doubles as the patient waiting bay. Having the tech busy elsewhere while putting people under or waking them up is not a rarity. I agree the security is better for hybrid rooms, as they have their own separate control rooms and techs won't leave when the machine is running. I don't think I'm being dramatic, but you sure seem to have a cozy job if you're allowed to constantly sit around in the control room while anesthesia is under way.

Yeah, I agree that we can find ourselves alone sometimes, although that's not really supposed to happen. For sure, most people usually aren't that useful anyway.