Sunday 26 December 2010

Risk and complication of anesthesia

Anesthesia - Risks and Complications

Although all types of anesthesia involve some risk, major side effects and complications from anesthesia are uncommon. Your specific risks depend on your health, the type of anesthesia used, and your response to anesthesia.

Personal risk factors

Your age may be a risk factor. In general, the risks associated with anesthesia and surgery increase in older people.

Certain medical conditions, such as heart, circulation, or nervous system problems, increase your risk of complications from anesthesia.

Some medicines can raise your risk of problems too. Make a list of all the prescription and over-the-counter medicines you take. And share your list with your doctors.

If you smoke, drink alcohol, or use illegal drugs, you may be more likely to have problems from anesthesia. It's important that you are honest when you talk with your surgeon and anesthesia specialist.

 

Monday 20 December 2010

Anesthesia specialists, anesthesiologist and Anesthetist definition

Anesthesia specialists

Anesthesia specialists are responsible for making informed medical decisions to provide comfort and maintain vital life functions while you are receiving anesthesia and in recovery.
Anesthesia specialists include anesthesiologists and qualified nurse or dental anesthetists.

Anesthesiologist

Anesthesiologists are medical doctors who, after obtaining their medical degree and completing their internship, complete an additional 3 years of specialized training in an accredited anesthesiology residency program. They are certified by the American Board of Anesthesiology. As medical doctors, they have a wide range of knowledge about medications, medical care for diseases, how the human body works, and how it responds to the stress of surgery.

Anesthetist

Most anesthetists are nurses who have graduated from an accredited nurse anesthetist program and who have been certified by the American Association of Nurse Anesthetists to become a certified registered nurse anesthetist (CRNA). Nurse anesthetists are advanced practice nurses with specialized skills in anesthesia administration. A nurse anesthetist is usually supervised by an anesthesiologist or a surgeon, although law and practice may vary by state.

 

Wednesday 8 December 2010

ANESTHESIOLOGIST DIRECTED ANESTHESIA

Medical direction may apply to a single anesthesia service furnished by a CRNA or up to four
concurrent anesthesia services. A physician who is directing the administration of anesthesia to four
surgical members is not expected to be involved routinely in furnishing any additional services to other
members. Addressing an emergency of short duration in the immediate area, administering an
epidural or caudal anesthetic to ease labor pain, or periodic rather than continual monitoring of an
obstetrical member would not substantially diminish the physician’s capacity to direct the CRNA
services.

The medical directing anesthesiologist must document in the member’s medical record that all
medical direction requirements have been met, including:

• Perform the pre-anesthetic examination and evaluation

• Prescribe the anesthesia plan


• Participate personally in the most demanding aspects of the anesthesia plan, including, if
applicable, induction and emergence

• Ensure a qualified individual performs any procedure in the anesthesia plan he/she does not
perform personally

• Monitor the course of anesthesia administration at frequent intervals

• Remain physically present and available for immediate diagnosis and treatment of emergency
that may develop

• Provide indicated post-anesthesia care.

A physician may appropriately receive members entering the operating suite for the next surgery while
directing concurrent anesthesia procedures. However, checking or discharging members in the
recovery room and handling scheduling matters are not compatible with reimbursement to the
physician for directing concurrent anesthesia procedures.

Thursday 2 December 2010

PCA - Patient Controlled Analgesia

Patient Controlled Analgesia

Patient controlled analgesia (PCA) services are reimbursable when they are
administered by an anesthesiologist and are performed for the control of postoperative
pain. A separately identifiable physician-recipient encounter should
be reflected in the medical record documentation. PCA pumps are usually
administered through an intravenous (IV) line or the PCA pump is connected
to an epidural catheter line.

Daily management of a PCA pump through an IV line is disallowed. When an
anesthesiologist provides the management of the PCA pump through an IV
line, the anesthesiologist will be allowed a total of four units and will be
considered a global payment for the management regardless of the number of
days the recipient remains on the pump. Use procedure code 90784 for daily
hospital management of intravenous patient-controlled analgesia.

The anesthesiologist should use the appropriate procedure code(s) when
filing claims for a single injection or for an injection including catheter
placement (epidural, subarachnoid, cervical, thoracic, lumbar, or sacral) when
the PCA pump is connected to an epidural line. Placement of the epidural
catheter and daily management of a subarachnoid or epidural catheter is not
reimbursable on the same date of service. Daily management of a
subarachnoid or epidural catheter is reimbursable on subsequent days.

Delivery of pain medication through intermittent injections, a regular infusion,
or by a PCA pump is included in the management of an epidural line whether
a registered nurse or a physician administers it. Additional units for a PCA
pump that is connected to an epidural line is not separately reimbursable.
The global surgical reimbursement fee to the surgeon includes the
management of a PCA pump for post-operative pain control and is not a
separately reimbursable item. Similarly, a physician’s global medical service
reimbursement includes the management of a PCA pump for recipients with
chronic pain control or terminal cancer and is not separately reimbursable.