Unsupervised Certified Nurse Anesthetists (UCRNA) Use Less Propofol (P) and Ancillary Medications Then Supervised Certified Nurse Anesthetists (SCRNA)

Abstract

Endoscopic sedation with P is rapidly becoming the preferred sedating anesthetic due to its quick onset, complete amnesia and rapid resolution. Although debated, most states require P to be administered by anesthesiology-trained personal such as anesthesiologists (AN) or CRNAs. We hypothesize that CRNAs who are working without an onsite AN would sedate less deeply and have relatively less complications then supervised CRNAs. All standard endoscopic procedures for 10 GIs at three ASCs were reviewed from Jan 1, 2008 to Feb 28, 2008. Two of the three centers are staffed by one of three UCRNAs. The third center was staffed by 4 SCRNAs with a supervising AN. Non-standard procedures like EUS, EMR and BARRX were excluded as were dual same day procedures. Patient demographics including age, ASA score, weight and presence of pulmonary disease (PD) were noted. Procedure details including length, P dose and the need for blood pressure controlling (BP) meds like ephedrine, phenylephrine and IV fluids were recorded. Serious complications like aspiration pneumonia, the need for ambu rescue and anesthetic related hospital admissions were compared. 1343 charts were reviewed total. 923 (357 EGD/566 COL) were from SCRNA and 420 (140 EGD/280 COL) were from UCRNA. Age, presence of PD, wt, ASA score and length were similiar between groups. No complications were noted. Significantly more P was used by SCRNA as compared to UCRNA. In addition, SCRNA also used more BP meds. UCRNA used more IV fluids. Conclusion: UCRNA use less P and less bp meds then SCRNA but use more IV fluids. Tabled 1 EGD (n) length (min) Age ASA Wt(lbs) PD P dose (mg) BP meds IV fluids SCRNA 357 13.0 57 2.5 184 120 (34%) 226 3 (0.8%) 0 (0%) UCRNA 140 11.3 57 2 182 53 (38%) 183 1 (0.7%) 6 (4.2%) ∗∗ p<.05 COLON SCRNA 566 19.0 58 2 183 159 (28%) 249 58 (10%) 15 (3%) UCRNA 280 19.3 58 2 187 110 (39%) 224 4 (1.4%) 19 (7%) ∗∗ p<.05 Open table in a new tab