Re: Office Anaesthesia
From: Kim Elise Goldman (goldman@calweb.com)
Thu Jan 31 11:31:17 2008
Entonox is nitrous oxide.
CRNA's have to be supervised by an anesthesiologist if only remotely.
LIke many fertility centers there will be a cost for these services.
And in order to administer in office conscious sedation or general
anesthesia once again you need resuscitative equipment and appropriate
monitoring equipment, permits, etc.
The real question is whether the additional expense for both you and
the patient is worth the cost.
Is this a procedure you will do often enough to warrant the additional
costs in time, money and personnel.
Obviously it is in my profession - I have a full OR in my office.
Obviously it is for our local fertility clinics - they keep their in
office procedures suite busy every day.
For a general OB-GYN office to do one procedure that procedure would
have to be a large portion of your business to warrant the work
necessary to set it up properly.
Just my two cents.
KEG
On Jan 31, 2008, at 12:58 PM, Andrew Folley wrote:
> Thanks everyone. Sounds like Nitrous may not be the best way to
> go. I will check on Entonox steve. I may have to see about having
> one of the hospital CRNAs come in and do something extra IV such as
> versed or Propothol??
>
> Date: Thu, 31 Jan 2008 02:29:52 -0600
> From: Stephen.Raymond@dhhs.tas.gov.au
> To: ob-gyn-l@mail.obgyn.net
> Subject: RE: Office Anaesthesia
>
> It may be a British thing, but Entonox would be a very reasonable
> idea for short office procedures such as Novasure. Is it available
> in the States?
>
> Steve
>
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> Kim E. Goldman
> Sent: Thursday, 31 January 2008 3:08 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Office Anesthesia
>
> As a board certified oral and maxillofacial surgeon I need to chime
> in here and say, though it is not complicated you do need proper
> training to use nitrous, there are some contraindications, and no
> one should ever deliver nitrous with a system that doesn't have a
> fail safe valve preventing "blue gassing" someone (giving 100%
> nitrous). In addition you should have appropriate monitoring
> equipment (pulse oximetry) and equipment for resuscitation
> including the ability to deliver 100% 2 via face mask. Also you need
> a closed system with evacuation of the wasted nitrous, med gas line
> approval by the state in most states and there are OSHA and other
> regulations regarding what the facility must have to administer
> nitrous.
>
> There are also state licensure laws for the delivery of nitrous
> (varies from state to state) and for conscious sedation and for
> general anesthesia as well as a national board for dental anesthesia.
>
> Kim
> On Jan 30, 2008, at 9:14 PM, R. Daniel Braun wrote:
>
> Check with your insurance carrier and do an anesthesia residency.
> Look out for aspiration, make sure your oxygen tank doesn't run out
> in the middle of the procedure, and know how to do a Nitrous washout
> before you start doing this. When I was a resident, we gave nitrous
> to our attendings patients for deliveries. We had an aspiration
> pneumonia, we had one lady turn blue because the O2 tank ran out and
> there was no valve in the room to open another tank. (I took the
> mask off and let her breathe room air. Luckily she was able to get
> by that way and didn't have problems from all the nitrous still in
> her system.
>
> I always wondered how those dentists got away with it.
>
> Dan
> On Jan 30, 2008 5:54 PM, Andrew Folley <agfolley@hotmail.com> wrote:
> Has anyone ever used Nitrous Oxide for office anesthesia???
> Dentists use it or use to use it frequently. I have had no luck in
> eliminating the severe intense pain of the office Novasure which
> occurs during the 1-2 minutes of ablation. I thought the Nitrous
> Oxide might be a good solution???
>
> --
> R. Daniel Braun, MD FACOG(L) CMT
> Professor Emeritus
> Dept. of Obstetrics and Gynecology
> Indiana U. School of Medicine
>
> R. Daniel Braun
>
> "Science without Religion is LAME; Religion without Science is
> BLIND"
> Einstein 1941
>
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