--
________________________________
Elise Goldman
Sent: Friday, 1 February 2008 5:34 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Office Anaesthesia
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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