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I was redirected to this page from Emergence Phenomenon, but emergence phenomena are not discussed on this page at all! —Preceding unsigned comment added by 72.207.77.105 ( talk) 16:42, 18 September 2008 (UTC)
Likewise. Checking the original article's history I found a definition for Emergence Phenomenon as "In medicine, emergence phenomena are reactions experienced by patients during or after awakening from anaesthesia". Perhaps it would be more useful to redirect that page to a link in Wiktionary for this term? Either that, or please include the definition of the term on the Anesthesia page! -- Fjb3 ( talk) 00:29, 17 May 2009 (UTC)
To those who are now attempting to edit the CRNA section to reflect YOUR politics, (anonymous IPs), it has been mandated by the staff of wiki that no changes are to be made without discussion here and agreement. I am the default protector of the CRNA section in this wiki entry and keep it from being politicized by ASA peons. Please, keep YOUR politics out of my section. Thanks, Mmackinnon ( talk) 02:20, 15 June 2009 (UTC)
Hello there
First, I am always suspicious (after 3 years) of people who come here making random edits without using the talk page. It suggests ulterior motives. Having said that, here is the reason why your edit is incorrect.
You had edited "CRNAs do not require Anesthesiologist supervision in any state and require surgeon/dentist/podiatrists to sign and approve the chart for medicare billing in all but 16 states. Many states place restrictions on practice, and hospitals often regulate what CRNAs can or can not do."
Here is what was stated previously: "CRNAs do not require Anesthesiologist supervision in any state and only require surgeon/dentist/podiatrists to sign the chart for medicare billing in all but 16 states."
The difference here is significant. First, noone is required to "approve" anything a CRNAs does by law or state law. Hospital policy may be different in each hospital as it IS for all physicians as well. So that statement, which makes the suggestion that CRNAs are somehow limited in comparison, is not needed since it also applies to physicians. In otherwords, it goes without saying. CRNAs are not the same an NPs in that regard. Second, the requirement to sign the chart ONLY exists as a CMS requirement for billing. In every state in the union CRNAs work independently in ASCs like plastic surgery centers, where it is an all cash buisness and CRNAs require noone to sign their chart. There is no "approval" of anything the CRNA does by a physician. This is a misconception.
The actual document says this:
"Thirty-nine states do not have a physician "supervision" requirement for CRNAs in nursing or medical laws or regulations. If clinical "direction" requirements are considered in addition to "supervision," 31 states do not have a physician supervision or direction requirement for CRNAs in nursing or medical laws or regulations. Taking into account state hospital licensing laws or regulations as well, 33 states still do not require physician supervision. Taking into account state hospital licensing laws or regulations, 24 states still do not require physician supervision or direction."
The states which do have some language are left intentionally grey as the expert for anesthesia services is the CRNA and not the operating physician. Case law has proven that in every case, the CRNA working independently (including in supervision states) is 100% liable for the anesthetic and surgeons do not get sued any more often with CRNA only vs MDA only practice. Surgeons carry ZERO additional liability for working with a CRNA.
So the term "supervision" becomes very negative when in reality it means nothing but signing a chart and no actual supervision or direction is required. That is the reason I leave the word out since in reality it has a different meaning that what people would take it as. The reality is this is ONLY about a billing situation.
Comments? Mmackinnon ( talk) 18:34, 15 June 2009 (UTC)
Second, the source states: "The federal requirement has been that CRNAs must be supervised by a physician. The November 13, 2001 rule allows states to "opt-out" or be "exempted" (the terms are used synonymously in the November 13 rule) from the federal supervision requirement"...further "14 states as of June 2005)
Iowa opted out of the federal supervision requirement in December 2001. Nebraska opted out in February 2002. Idaho opted out in March 2002. Minnesota opted out in April 2002. New Hampshire opted out in June 2002. New Mexico opted out in November 2002. Kansas opted out in March 2003. North Dakota opted out in October 2003. Washington opted out in October 2003. Alaska opted out in October 2003. Oregon opted out in December 2003. Montana opted out in January 2004. (Gov. Judy Martz opted-out; Gov. Brian Schweitzer reversed the opt-out in May 2005, without citing any evidence to justify the decision. Subsequently, after the governor and his staff became more familiar with the reasons justifying the January 2004 opt-out, Gov. Schweitzer restored the opt-out in June 2005. Montana’s opt-out, therefore, is currently in effect.) South Dakota opted out in March 2005. Wisconsin opted out in June 2005." and: "18 states permit CRNAs to practice "independently."" This is not consistent to what is stated in this and other articles on this topic. Fuzbaby ( talk) 01:21, 16 June 2009 (UTC)
"Many states place restrictions on practice, and hospitals often regulate what CRNAs and other midlevel providers can or can not do based on local laws, provider training and experience, and hospital and physician preferences"
This article is getting rather long, and to mirror other medical fields on Wikipedia, I propose that the "Anesthetic agents" section be split to its own article. Almost all drug groups have their own articles, separate from the field of medicine that uses the drugs (see {{ Major drug groups}}). There used to be an article called Anaesthetic drugs, but it was moved to List of anaesthetic drugs. What I propose is merging the "Anesthetic agents" section of this article with List of anaesthetic drugs, and then moving the article to Anesthetic. Anesthesia/ Anesthetic would then parallel the related articles local anesthesia/ local anesthetic and general anesthesia/ general anesthetic. A {{ main}} link to Anesthetic with an overview summary would then be placed in the "Anesthetic agents" section of this article. -- Scott Alter 18:08, 20 June 2009 (UTC)
Since there were no objections, I completed this split. The article is currently at List of anaesthetic drugs, until an admin deletes Anesthetic so List of anaesthetic drugs can be moved there. -- Scott Alter 17:23, 8 September 2009 (UTC)
NYCMD, it is not your place to delete valid references from this article. Nor is it your place to edit the Nurse Anesthesia section because it does not fit your personal opinions. Moreover, lifelinetomodernmedicine.com is an ASA owned website and by definition biased. It isnt a reference, simply a page for ASA agenda. Mmackinnon ( talk) 03:03, 11 May 2010 (UTC)
This article has significant problems related to MoS compliance, content (e.g., the prose is riddled with grammatical and spelling errors) and referencing (e.g., the article is nearly devoid of reliable sources). Due to these issues, I have reassessed this article as Start class. There is also a long history of NPOV issues, edit wars, vandalism, and heavy use of edit reversions. This article is greatly in need of attention from expert editors and any other interested editors. Respectfully, DiverDave ( talk) 05:30, 10 September 2010 (UTC)
I think Dr. Horace Wells should be mentioned in this article. He gave an unsuccessful demonstration of laughing gas with a dental patient in MGH and was booed at. But he was a pioneer of anesthesiology also. — Preceding unsigned comment added by 66.30.5.187 ( talk) 23:24, 2 October 2011 (UTC)
Classification has to be refined to only two broad groups such as 1)General and 2)Regional. Further Regional anesthesia is to be divided into a.Spinal anesthesia, b.Epidural anesthesia, c.Nerve Blocks, d.Bier's Block (IV Regional anesthesia), e.Field block, f.Local infiltration. Dissociative anesthesia is a type of phenomenon caused by specific drug such as ketamine to induce painlessness. It comes under the classification of Total Intravenous anesthesia (TIVA) which is a sub-group under general anaesthesia. Drvijay2000 ( talk) 17:13, 22 December 2011 (UTC)
There is no citation for the section about Raymond Lullus first discovering ether. His wikipedia page makes no mention. Other sources -- including Cordas' wikipedia page -- say it was first synthesized by Valerius Cordas in 1570 when he mixed ethanol and sulfuric acid, calling the result "Sweet Oil of Vitriol." Msalt ( talk) 21:52, 26 April 2012 (UTC)
The discussion of OMFS in this detail is WP:UNDUE weight. All surgical residencies, as well as many internal medicine subspecialties, are trained in administering anesthetic medications. However, this is not the place to discuss one specific surgical subspecialty, but to discuss those providers whose primary roles are to provide anesthesia related medciations (such as anesthesiologists, CRNAs, etc). I would not mind a section, appropriately sourced and weight to describe that physicians in general can be trained in administering anesthetics such as critical care physicians, etc., but the section as written was completely UNDUE and reads like an advertisement for the OMFS subspecialty. Yobol ( talk) 22:25, 8 July 2012 (UTC)
Looking to see who is active on this article. I started looking to see where people land when investigating basic medical topics and this is a popular landing page for anesthesia related topics. However, it seems largely to be a discuss/debate about the role of various professionals who provide anesthesia rather than anaesthesia itself. I'd like to rework the article following the basic Surgeries and procedures MEDMOS outline and putting the Outline of anesthesia into the narrative so people can link to the specific topic needed. Would people be opposed to this? Anyone wanting to help? Thanks. Ian Furst ( talk) 18:43, 8 February 2014 (UTC)
My plan is to use the following MEDMOS heading structure listed below. Sources in this article are mostly primary and need to be changed to secondary. My main resource will be Miller's Anes 2009 to start with a planned change to sources available online with time. I'll also be making a conscious effort to include as many of the Wikilinks listed in the Outline of anesthesia as possible (without making the article look link a link-farm). My first priority is to create a scope more directed to the user.
Please jump in if you feel these ideas need to be modified. Ian Furst ( talk) 13:05, 9 February 2014 (UTC)
I've started changing the article. See Anesthesia#indication to see the general tone I'm proposing. Very general with lots of links to relevant information. Looking for feedback from other editors. Thanks. @ DiverDave: Ian Furst ( talk) 16:44, 9 February 2014 (UTC)
The overall outline, headings and general themes are now created. My next step will be to copy edit, improve the language so it's geared more towards the layperson, diversify the references (so far I've relied heavily on Miller's Anesthesia) and add some graphs or tables especially in the Risks and complications section. Ian Furst ( talk) 13:24, 16 February 2014 (UTC)
I've now got the article to, what I believe is, the appropriate weight and scope for each area. I'll continue with general copy editing and adding in references. A graph for risk and complication turned out to be useless (it's misleading to compare M&M over the years due to risk stratification of patients). If anyone can see where a graphic might better add to the story please let me know and I'll try to create it. 13:55, 17 February 2014 (UTC)
Upgrading this article to B-class now. I think it follows MEDMOS for the most part, has 1/2 decent references (although I'd like to add more online stuff) and I think the scope is OK. Please leave feedback if you see areas for improvement. Ian Furst ( talk) 02:30, 22 February 2014 (UTC)
From the lead section, paragraph 2: "Local anesthesia inhibits sensory perception within a specific location on the body, such as a tooth or the urinary bladder." Why is the urinary bladder suggested a location for local anaesthesia? Axl ¤ [Talk] 12:55, 22 February 2014 (UTC)
The opening sentence of "Medical uses" implies analgesia. However "analgesia" is repeated in the list of five bullet points. Axl ¤ [Talk] 13:03, 22 February 2014 (UTC)
In "Medical uses", "immobility (lack of movement)" is not accurate. Immobility could perhaps be achieved with restraints (maybe like prisoner restraints?). The phrase should properly be "muscle relaxation". When the surgeon's scalpel cuts, the muscles will reflexively contract. Muscle relaxation is required to prevent this and make the surgeon's job easier. Muscle relaxation is an important part of general anaesthesia, but it hasn't been mentioned anywhere in the article. Axl ¤ [Talk] 13:11, 22 February 2014 (UTC)
From "Medical uses", paragraph 4: "More important to the patient, is the loss of any memory of the events (amnesia)." Is that really more important to the patient? Axl ¤ [Talk] 13:13, 22 February 2014 (UTC)
From "Medical uses", paragraph 4: "Inhalational anesthetics will reliably produce amnesia though general suppression of the nuclei but at doses well above those required for loss of consciousness." Is that really true? Inhalational anaesthetics will cause unconsciousness but without causing loss of memory? Axl ¤ [Talk] 13:16, 22 February 2014 (UTC)
In the "Medical uses" section, I am not convinced that amnesia is an important part of anaesthesia. Amnesia is listed first in the bullet points, and a paragraph about it comes before unconsciousness. Certainly amnesia is a useful side-effect in certain unpleasant wakeful procedures such as endoscopy, but is this really a part of anaesthesia? Axl ¤ [Talk] 13:25, 22 February 2014 (UTC)
I checked 2 other e-books and can't find the endpoints listed. I found this article that lists them as hypnosis, analgesia, amnesia and reflex suppression (it's a study using fMRI so maybe the didn't use muscle relaxation as an endpoint?). I'll keep looking. Imo, the endpoints should all be met for a full GA and at least one of them met for other types of anesthesia. E.g. LA hit analgesia alone. What do you think the end points should be (and can you give me a reference for them)? Agree that hypnosis and analgesia need to go together. But what is awareness under GA?. What is dreaming under GA? Ian Furst ( talk) 13:44, 23 February 2014 (UTC)
Is anaesthetic hypnosis truly different from unconsciousness? Axl ¤ [Talk] 13:26, 22 February 2014 (UTC)
Another general comment about the "Medical uses" section: when I was a student, I learnt that anaesthesia focussed on three aspects—analgesia, hypnosis and muscle relaxation. While that view may be a little simplistic, it would be a good rule to focus on those three features in this Wikipedia article. Axl ¤ [Talk] 13:29, 22 February 2014 (UTC)
Axl From one of the authors of Millers who coauthored the relevant chapter,
Thanks for contacting me. I'm happy to help clarify. In anesthesiology, when we discuss the term "hypnosis" it is used to describe the loss of consciousness endpoint. While there are many uses of term hypnosis, especially in psychology, we mean to imply the drug-induced state that causes a loss of consciousness. The presence or absence of memory (amnesia) can be completely dissociated from the loss of consciousness. However, you are correct that the loss of consciousness necessarily induces a loss of memory. I agree with the notion that anesthesia at its core can be distilled into hypnosis, analgesia, and muscle relaxation. However, there are some who would disagree with me and say that true core of anesthesia is merely amnesia, muscle relaxation, and analgesia and does not require unconsciousness. Rarely, in the setting of trauma that is life-threatening, anesthesiologists will induce a state that is merely amnesia and muscle relaxation. Once again, let me stress that this is only done during conditions when the adverse side effects of using a drug that would cause hypnosis (ie: further low blood pressure) might lead to death.
Ian Furst ( talk) 22:03, 23 February 2014 (UTC)
Axl reworked and shortened the first paragraph and 3 endpoints for your review. Ian Furst ( talk) 17:51, 24 February 2014 (UTC)
At the beginning of the section, I have explained that hypnosis has a specialized meaning in pharmacology and anesthesiology, different from its more familiar meaning in psychology and literature. I also changed three uses of the word "affect" to "effect", because I think the latter corresponds with the intended meaning. To affect means to influence, whereas to effect means to cause or bring about. CharlesHBennett ( talk) 07:15, 20 August 2015 (UTC)
The current version of the article claims that the fight or flight response leads to circulatory shock. This seems counter-intuitive, since the fight or flight response increases blood pressure, while circulatory shock is a result of low blood pressure. This statement needs to have a reliable reference, and probably also an explanation to justify how the fight or flight response results in shock.
I think it would make sense if it were clarified to refer to only cases of excessive fight or flight response, causing extreme sinus tachycardia, resulting in decreased stroke volume leading to reduced cardiac output. However, the way it's written right now, it sounds like the article is claiming that people have a dangerous drop in blood pressure whenever they are exposed to an alarming or stressful situation, but that's the opposite of what usually happens. - NorsemanII ( talk) 00:10, 4 May 2014 (UTC)
NorsemanII Axl, like everything else with this article the answer doesn't seem to be so clear cut. There is evidence that blunting the response prevent perioperative MI's. Second, it decreases levels of catabolic hormones which are thought to prolong recovery (nothing about morbidity). Here are two quotes, "Studies have demonstrated that perioperative β-adrenergic blockade reduces the risk for perioperative myocardial infarction in patients at risk for this complication.": 30 "It was learned that during major surgery, patients anesthetized with traditional vapor anesthetics, with or without opioids, displayed increased levels of catabolic hormones postoperatively" ... "Various methods of preventing postoperative catabolism have been under investigation for several years. The resulting catabolic state is thought by some to delay recovery..": 30 Let me keep looking to see if it's tied to shock. BTW, currently the article is titled Shock (circulatory) but it describes all types of shock. Maybe we should rename to Shock (physiologic) Ian Furst ( talk) 22:46, 4 May 2014 (UTC)
Got it Axl Ian Furst ( talk) 11:39, 7 May 2014 (UTC)
really have a problem with this statement- what about keeping you alive while the "actual benefit" is being performed? or not recalling the assault? or perhaps emerging pain-free? shall i continue? and this is for a "standard" anesthetic not to mention the myriad other "non-beneficial" aspects of anesthesia — Preceding unsigned comment added by 69.201.149.239 ( talk) 02:32, 29 March 2015 (UTC)
this article suggests that chloroform use replaced ether, but the wiki article on ether says that ether "supplanted" chloroform. this appears to be a contradiction.... and i wonder what the resolution would be. -- chris — Preceding unsigned comment added by 108.34.62.49 ( talk) 10:45, 17 October 2015 (UTC)
In the UK, "Anaesthesia" is also the name of the medical specialty known elsewhere as "Anesthesiology". I wonder if this is worth mentioning? Axl ¤ [Talk] 23:46, 19 March 2014 (UTC)
I believe Anesthesia is the only spelling, correct? Or am I mistaken? ThisGuyIsGreat ( talk) 21:41, 27 July 2015 (UTC)
Anaesthesia is the usual spelling in British English, anesthesia in American English. CharlesHBennett ( talk) 07:22, 20 August 2015 (UTC)
The intro to the article contained information about the difference between British versus American naming of the term. I removed this, and changed the lead a little to avoid drawing attention one way or the other to the name of the professional discipline.
This information is already present in the "society and culture" section with references, so when I removed the information from the intro, I did not paste it elsewhere because it already was included.
I removed this because I did not think that the UK/US variation was so urgent to describe in the lead. It is enough to list the two spelling variations, anesthesia or anaesthesia, and leave further discussion to the society section in the body of the article. Blue Rasberry (talk) 19:50, 27 July 2016 (UTC)
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Hanaoka Seishū was the first surgeon to perform operations under general anesthetic (40 years before Crawford W. Long), yet he isn't even mentioned in the article. Kaldari ( talk) 04:17, 31 December 2016 (UTC)
An anesthesiologist now dead (Alan Dobkin) told me that although unconcious during the procedure, some patients can recall under hypnosis aspects of the procedure, including conversations in the operating room. I am not a doctor and have no way of knowing the truth of this (my father, also dead, was an anesthesiologist), but if it is true, I'm surprised not to see it mentioned. I don't believe he was talking about awareness during anesthesia. deisenbe ( talk) 13:37, 19 September 2017 (UTC)
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Can you help me move all the pages in Category:Anesthesia to use the American form. I already did some. The reasons why I am doing this is because firstly, the American spelling is used on the article title on this page. I never moved this page at all, and secondly, all the articles in the category should have consistent titles with each other. I appreciate any help from any editor(s) available. Thank you. Interstellarity ( talk) 22:35, 29 April 2019 (UTC)
The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.
I would like to discuss whether it whether the titles in the should be consistent with one another. I moved some of the pages, but I was told to discuss this prior to doing that. Any thoughts on this? Interstellarity ( talk) 00:19, 30 April 2019 (UTC)
"The English Wikipedia prefers no national variety of the language over any other."In the absence of policy arguments or sources supporting the change, MOS:RETAIN seems to apply. Little pob ( talk) 10:43, 30 April 2019 (UTC)
"When an English variety's consistent usage has been established in an article, maintain it in the absence of consensus to the contrary."(emphasis added) clearly anticipates that there are occasions when the established usage normally promoted under ENGVAR might be found undesirable for whatever reason. And again, at the end of that subsection of the policy:
"An article should not be edited or renamed simply to switch from one variety of English to another."(emphasis again added), meaning only changes made expressly for the purpose of promoting one spelling variant or another, without another (sufficiently more worthwhile) justification are to be uniformly avoided. And then there's the fact that both ENGVAR and RETAIN are manual of style guidance, which must yield to compelling content WP:policy arguments in almost all cases.
This article was the subject of a Wiki Education Foundation-supported course assignment, between 18 February 2024 and 13 April 2024. Further details are available on the course page. Student editor(s): Chris SS BE ( article contribs).
— Assignment last updated by Chris SS BE ( talk) 06:29, 11 March 2024 (UTC)
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I was redirected to this page from Emergence Phenomenon, but emergence phenomena are not discussed on this page at all! —Preceding unsigned comment added by 72.207.77.105 ( talk) 16:42, 18 September 2008 (UTC)
Likewise. Checking the original article's history I found a definition for Emergence Phenomenon as "In medicine, emergence phenomena are reactions experienced by patients during or after awakening from anaesthesia". Perhaps it would be more useful to redirect that page to a link in Wiktionary for this term? Either that, or please include the definition of the term on the Anesthesia page! -- Fjb3 ( talk) 00:29, 17 May 2009 (UTC)
To those who are now attempting to edit the CRNA section to reflect YOUR politics, (anonymous IPs), it has been mandated by the staff of wiki that no changes are to be made without discussion here and agreement. I am the default protector of the CRNA section in this wiki entry and keep it from being politicized by ASA peons. Please, keep YOUR politics out of my section. Thanks, Mmackinnon ( talk) 02:20, 15 June 2009 (UTC)
Hello there
First, I am always suspicious (after 3 years) of people who come here making random edits without using the talk page. It suggests ulterior motives. Having said that, here is the reason why your edit is incorrect.
You had edited "CRNAs do not require Anesthesiologist supervision in any state and require surgeon/dentist/podiatrists to sign and approve the chart for medicare billing in all but 16 states. Many states place restrictions on practice, and hospitals often regulate what CRNAs can or can not do."
Here is what was stated previously: "CRNAs do not require Anesthesiologist supervision in any state and only require surgeon/dentist/podiatrists to sign the chart for medicare billing in all but 16 states."
The difference here is significant. First, noone is required to "approve" anything a CRNAs does by law or state law. Hospital policy may be different in each hospital as it IS for all physicians as well. So that statement, which makes the suggestion that CRNAs are somehow limited in comparison, is not needed since it also applies to physicians. In otherwords, it goes without saying. CRNAs are not the same an NPs in that regard. Second, the requirement to sign the chart ONLY exists as a CMS requirement for billing. In every state in the union CRNAs work independently in ASCs like plastic surgery centers, where it is an all cash buisness and CRNAs require noone to sign their chart. There is no "approval" of anything the CRNA does by a physician. This is a misconception.
The actual document says this:
"Thirty-nine states do not have a physician "supervision" requirement for CRNAs in nursing or medical laws or regulations. If clinical "direction" requirements are considered in addition to "supervision," 31 states do not have a physician supervision or direction requirement for CRNAs in nursing or medical laws or regulations. Taking into account state hospital licensing laws or regulations as well, 33 states still do not require physician supervision. Taking into account state hospital licensing laws or regulations, 24 states still do not require physician supervision or direction."
The states which do have some language are left intentionally grey as the expert for anesthesia services is the CRNA and not the operating physician. Case law has proven that in every case, the CRNA working independently (including in supervision states) is 100% liable for the anesthetic and surgeons do not get sued any more often with CRNA only vs MDA only practice. Surgeons carry ZERO additional liability for working with a CRNA.
So the term "supervision" becomes very negative when in reality it means nothing but signing a chart and no actual supervision or direction is required. That is the reason I leave the word out since in reality it has a different meaning that what people would take it as. The reality is this is ONLY about a billing situation.
Comments? Mmackinnon ( talk) 18:34, 15 June 2009 (UTC)
Second, the source states: "The federal requirement has been that CRNAs must be supervised by a physician. The November 13, 2001 rule allows states to "opt-out" or be "exempted" (the terms are used synonymously in the November 13 rule) from the federal supervision requirement"...further "14 states as of June 2005)
Iowa opted out of the federal supervision requirement in December 2001. Nebraska opted out in February 2002. Idaho opted out in March 2002. Minnesota opted out in April 2002. New Hampshire opted out in June 2002. New Mexico opted out in November 2002. Kansas opted out in March 2003. North Dakota opted out in October 2003. Washington opted out in October 2003. Alaska opted out in October 2003. Oregon opted out in December 2003. Montana opted out in January 2004. (Gov. Judy Martz opted-out; Gov. Brian Schweitzer reversed the opt-out in May 2005, without citing any evidence to justify the decision. Subsequently, after the governor and his staff became more familiar with the reasons justifying the January 2004 opt-out, Gov. Schweitzer restored the opt-out in June 2005. Montana’s opt-out, therefore, is currently in effect.) South Dakota opted out in March 2005. Wisconsin opted out in June 2005." and: "18 states permit CRNAs to practice "independently."" This is not consistent to what is stated in this and other articles on this topic. Fuzbaby ( talk) 01:21, 16 June 2009 (UTC)
"Many states place restrictions on practice, and hospitals often regulate what CRNAs and other midlevel providers can or can not do based on local laws, provider training and experience, and hospital and physician preferences"
This article is getting rather long, and to mirror other medical fields on Wikipedia, I propose that the "Anesthetic agents" section be split to its own article. Almost all drug groups have their own articles, separate from the field of medicine that uses the drugs (see {{ Major drug groups}}). There used to be an article called Anaesthetic drugs, but it was moved to List of anaesthetic drugs. What I propose is merging the "Anesthetic agents" section of this article with List of anaesthetic drugs, and then moving the article to Anesthetic. Anesthesia/ Anesthetic would then parallel the related articles local anesthesia/ local anesthetic and general anesthesia/ general anesthetic. A {{ main}} link to Anesthetic with an overview summary would then be placed in the "Anesthetic agents" section of this article. -- Scott Alter 18:08, 20 June 2009 (UTC)
Since there were no objections, I completed this split. The article is currently at List of anaesthetic drugs, until an admin deletes Anesthetic so List of anaesthetic drugs can be moved there. -- Scott Alter 17:23, 8 September 2009 (UTC)
NYCMD, it is not your place to delete valid references from this article. Nor is it your place to edit the Nurse Anesthesia section because it does not fit your personal opinions. Moreover, lifelinetomodernmedicine.com is an ASA owned website and by definition biased. It isnt a reference, simply a page for ASA agenda. Mmackinnon ( talk) 03:03, 11 May 2010 (UTC)
This article has significant problems related to MoS compliance, content (e.g., the prose is riddled with grammatical and spelling errors) and referencing (e.g., the article is nearly devoid of reliable sources). Due to these issues, I have reassessed this article as Start class. There is also a long history of NPOV issues, edit wars, vandalism, and heavy use of edit reversions. This article is greatly in need of attention from expert editors and any other interested editors. Respectfully, DiverDave ( talk) 05:30, 10 September 2010 (UTC)
I think Dr. Horace Wells should be mentioned in this article. He gave an unsuccessful demonstration of laughing gas with a dental patient in MGH and was booed at. But he was a pioneer of anesthesiology also. — Preceding unsigned comment added by 66.30.5.187 ( talk) 23:24, 2 October 2011 (UTC)
Classification has to be refined to only two broad groups such as 1)General and 2)Regional. Further Regional anesthesia is to be divided into a.Spinal anesthesia, b.Epidural anesthesia, c.Nerve Blocks, d.Bier's Block (IV Regional anesthesia), e.Field block, f.Local infiltration. Dissociative anesthesia is a type of phenomenon caused by specific drug such as ketamine to induce painlessness. It comes under the classification of Total Intravenous anesthesia (TIVA) which is a sub-group under general anaesthesia. Drvijay2000 ( talk) 17:13, 22 December 2011 (UTC)
There is no citation for the section about Raymond Lullus first discovering ether. His wikipedia page makes no mention. Other sources -- including Cordas' wikipedia page -- say it was first synthesized by Valerius Cordas in 1570 when he mixed ethanol and sulfuric acid, calling the result "Sweet Oil of Vitriol." Msalt ( talk) 21:52, 26 April 2012 (UTC)
The discussion of OMFS in this detail is WP:UNDUE weight. All surgical residencies, as well as many internal medicine subspecialties, are trained in administering anesthetic medications. However, this is not the place to discuss one specific surgical subspecialty, but to discuss those providers whose primary roles are to provide anesthesia related medciations (such as anesthesiologists, CRNAs, etc). I would not mind a section, appropriately sourced and weight to describe that physicians in general can be trained in administering anesthetics such as critical care physicians, etc., but the section as written was completely UNDUE and reads like an advertisement for the OMFS subspecialty. Yobol ( talk) 22:25, 8 July 2012 (UTC)
Looking to see who is active on this article. I started looking to see where people land when investigating basic medical topics and this is a popular landing page for anesthesia related topics. However, it seems largely to be a discuss/debate about the role of various professionals who provide anesthesia rather than anaesthesia itself. I'd like to rework the article following the basic Surgeries and procedures MEDMOS outline and putting the Outline of anesthesia into the narrative so people can link to the specific topic needed. Would people be opposed to this? Anyone wanting to help? Thanks. Ian Furst ( talk) 18:43, 8 February 2014 (UTC)
My plan is to use the following MEDMOS heading structure listed below. Sources in this article are mostly primary and need to be changed to secondary. My main resource will be Miller's Anes 2009 to start with a planned change to sources available online with time. I'll also be making a conscious effort to include as many of the Wikilinks listed in the Outline of anesthesia as possible (without making the article look link a link-farm). My first priority is to create a scope more directed to the user.
Please jump in if you feel these ideas need to be modified. Ian Furst ( talk) 13:05, 9 February 2014 (UTC)
I've started changing the article. See Anesthesia#indication to see the general tone I'm proposing. Very general with lots of links to relevant information. Looking for feedback from other editors. Thanks. @ DiverDave: Ian Furst ( talk) 16:44, 9 February 2014 (UTC)
The overall outline, headings and general themes are now created. My next step will be to copy edit, improve the language so it's geared more towards the layperson, diversify the references (so far I've relied heavily on Miller's Anesthesia) and add some graphs or tables especially in the Risks and complications section. Ian Furst ( talk) 13:24, 16 February 2014 (UTC)
I've now got the article to, what I believe is, the appropriate weight and scope for each area. I'll continue with general copy editing and adding in references. A graph for risk and complication turned out to be useless (it's misleading to compare M&M over the years due to risk stratification of patients). If anyone can see where a graphic might better add to the story please let me know and I'll try to create it. 13:55, 17 February 2014 (UTC)
Upgrading this article to B-class now. I think it follows MEDMOS for the most part, has 1/2 decent references (although I'd like to add more online stuff) and I think the scope is OK. Please leave feedback if you see areas for improvement. Ian Furst ( talk) 02:30, 22 February 2014 (UTC)
From the lead section, paragraph 2: "Local anesthesia inhibits sensory perception within a specific location on the body, such as a tooth or the urinary bladder." Why is the urinary bladder suggested a location for local anaesthesia? Axl ¤ [Talk] 12:55, 22 February 2014 (UTC)
The opening sentence of "Medical uses" implies analgesia. However "analgesia" is repeated in the list of five bullet points. Axl ¤ [Talk] 13:03, 22 February 2014 (UTC)
In "Medical uses", "immobility (lack of movement)" is not accurate. Immobility could perhaps be achieved with restraints (maybe like prisoner restraints?). The phrase should properly be "muscle relaxation". When the surgeon's scalpel cuts, the muscles will reflexively contract. Muscle relaxation is required to prevent this and make the surgeon's job easier. Muscle relaxation is an important part of general anaesthesia, but it hasn't been mentioned anywhere in the article. Axl ¤ [Talk] 13:11, 22 February 2014 (UTC)
From "Medical uses", paragraph 4: "More important to the patient, is the loss of any memory of the events (amnesia)." Is that really more important to the patient? Axl ¤ [Talk] 13:13, 22 February 2014 (UTC)
From "Medical uses", paragraph 4: "Inhalational anesthetics will reliably produce amnesia though general suppression of the nuclei but at doses well above those required for loss of consciousness." Is that really true? Inhalational anaesthetics will cause unconsciousness but without causing loss of memory? Axl ¤ [Talk] 13:16, 22 February 2014 (UTC)
In the "Medical uses" section, I am not convinced that amnesia is an important part of anaesthesia. Amnesia is listed first in the bullet points, and a paragraph about it comes before unconsciousness. Certainly amnesia is a useful side-effect in certain unpleasant wakeful procedures such as endoscopy, but is this really a part of anaesthesia? Axl ¤ [Talk] 13:25, 22 February 2014 (UTC)
I checked 2 other e-books and can't find the endpoints listed. I found this article that lists them as hypnosis, analgesia, amnesia and reflex suppression (it's a study using fMRI so maybe the didn't use muscle relaxation as an endpoint?). I'll keep looking. Imo, the endpoints should all be met for a full GA and at least one of them met for other types of anesthesia. E.g. LA hit analgesia alone. What do you think the end points should be (and can you give me a reference for them)? Agree that hypnosis and analgesia need to go together. But what is awareness under GA?. What is dreaming under GA? Ian Furst ( talk) 13:44, 23 February 2014 (UTC)
Is anaesthetic hypnosis truly different from unconsciousness? Axl ¤ [Talk] 13:26, 22 February 2014 (UTC)
Another general comment about the "Medical uses" section: when I was a student, I learnt that anaesthesia focussed on three aspects—analgesia, hypnosis and muscle relaxation. While that view may be a little simplistic, it would be a good rule to focus on those three features in this Wikipedia article. Axl ¤ [Talk] 13:29, 22 February 2014 (UTC)
Axl From one of the authors of Millers who coauthored the relevant chapter,
Thanks for contacting me. I'm happy to help clarify. In anesthesiology, when we discuss the term "hypnosis" it is used to describe the loss of consciousness endpoint. While there are many uses of term hypnosis, especially in psychology, we mean to imply the drug-induced state that causes a loss of consciousness. The presence or absence of memory (amnesia) can be completely dissociated from the loss of consciousness. However, you are correct that the loss of consciousness necessarily induces a loss of memory. I agree with the notion that anesthesia at its core can be distilled into hypnosis, analgesia, and muscle relaxation. However, there are some who would disagree with me and say that true core of anesthesia is merely amnesia, muscle relaxation, and analgesia and does not require unconsciousness. Rarely, in the setting of trauma that is life-threatening, anesthesiologists will induce a state that is merely amnesia and muscle relaxation. Once again, let me stress that this is only done during conditions when the adverse side effects of using a drug that would cause hypnosis (ie: further low blood pressure) might lead to death.
Ian Furst ( talk) 22:03, 23 February 2014 (UTC)
Axl reworked and shortened the first paragraph and 3 endpoints for your review. Ian Furst ( talk) 17:51, 24 February 2014 (UTC)
At the beginning of the section, I have explained that hypnosis has a specialized meaning in pharmacology and anesthesiology, different from its more familiar meaning in psychology and literature. I also changed three uses of the word "affect" to "effect", because I think the latter corresponds with the intended meaning. To affect means to influence, whereas to effect means to cause or bring about. CharlesHBennett ( talk) 07:15, 20 August 2015 (UTC)
The current version of the article claims that the fight or flight response leads to circulatory shock. This seems counter-intuitive, since the fight or flight response increases blood pressure, while circulatory shock is a result of low blood pressure. This statement needs to have a reliable reference, and probably also an explanation to justify how the fight or flight response results in shock.
I think it would make sense if it were clarified to refer to only cases of excessive fight or flight response, causing extreme sinus tachycardia, resulting in decreased stroke volume leading to reduced cardiac output. However, the way it's written right now, it sounds like the article is claiming that people have a dangerous drop in blood pressure whenever they are exposed to an alarming or stressful situation, but that's the opposite of what usually happens. - NorsemanII ( talk) 00:10, 4 May 2014 (UTC)
NorsemanII Axl, like everything else with this article the answer doesn't seem to be so clear cut. There is evidence that blunting the response prevent perioperative MI's. Second, it decreases levels of catabolic hormones which are thought to prolong recovery (nothing about morbidity). Here are two quotes, "Studies have demonstrated that perioperative β-adrenergic blockade reduces the risk for perioperative myocardial infarction in patients at risk for this complication.": 30 "It was learned that during major surgery, patients anesthetized with traditional vapor anesthetics, with or without opioids, displayed increased levels of catabolic hormones postoperatively" ... "Various methods of preventing postoperative catabolism have been under investigation for several years. The resulting catabolic state is thought by some to delay recovery..": 30 Let me keep looking to see if it's tied to shock. BTW, currently the article is titled Shock (circulatory) but it describes all types of shock. Maybe we should rename to Shock (physiologic) Ian Furst ( talk) 22:46, 4 May 2014 (UTC)
Got it Axl Ian Furst ( talk) 11:39, 7 May 2014 (UTC)
really have a problem with this statement- what about keeping you alive while the "actual benefit" is being performed? or not recalling the assault? or perhaps emerging pain-free? shall i continue? and this is for a "standard" anesthetic not to mention the myriad other "non-beneficial" aspects of anesthesia — Preceding unsigned comment added by 69.201.149.239 ( talk) 02:32, 29 March 2015 (UTC)
this article suggests that chloroform use replaced ether, but the wiki article on ether says that ether "supplanted" chloroform. this appears to be a contradiction.... and i wonder what the resolution would be. -- chris — Preceding unsigned comment added by 108.34.62.49 ( talk) 10:45, 17 October 2015 (UTC)
In the UK, "Anaesthesia" is also the name of the medical specialty known elsewhere as "Anesthesiology". I wonder if this is worth mentioning? Axl ¤ [Talk] 23:46, 19 March 2014 (UTC)
I believe Anesthesia is the only spelling, correct? Or am I mistaken? ThisGuyIsGreat ( talk) 21:41, 27 July 2015 (UTC)
Anaesthesia is the usual spelling in British English, anesthesia in American English. CharlesHBennett ( talk) 07:22, 20 August 2015 (UTC)
The intro to the article contained information about the difference between British versus American naming of the term. I removed this, and changed the lead a little to avoid drawing attention one way or the other to the name of the professional discipline.
This information is already present in the "society and culture" section with references, so when I removed the information from the intro, I did not paste it elsewhere because it already was included.
I removed this because I did not think that the UK/US variation was so urgent to describe in the lead. It is enough to list the two spelling variations, anesthesia or anaesthesia, and leave further discussion to the society section in the body of the article. Blue Rasberry (talk) 19:50, 27 July 2016 (UTC)
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Hanaoka Seishū was the first surgeon to perform operations under general anesthetic (40 years before Crawford W. Long), yet he isn't even mentioned in the article. Kaldari ( talk) 04:17, 31 December 2016 (UTC)
An anesthesiologist now dead (Alan Dobkin) told me that although unconcious during the procedure, some patients can recall under hypnosis aspects of the procedure, including conversations in the operating room. I am not a doctor and have no way of knowing the truth of this (my father, also dead, was an anesthesiologist), but if it is true, I'm surprised not to see it mentioned. I don't believe he was talking about awareness during anesthesia. deisenbe ( talk) 13:37, 19 September 2017 (UTC)
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Can you help me move all the pages in Category:Anesthesia to use the American form. I already did some. The reasons why I am doing this is because firstly, the American spelling is used on the article title on this page. I never moved this page at all, and secondly, all the articles in the category should have consistent titles with each other. I appreciate any help from any editor(s) available. Thank you. Interstellarity ( talk) 22:35, 29 April 2019 (UTC)
The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.
I would like to discuss whether it whether the titles in the should be consistent with one another. I moved some of the pages, but I was told to discuss this prior to doing that. Any thoughts on this? Interstellarity ( talk) 00:19, 30 April 2019 (UTC)
"The English Wikipedia prefers no national variety of the language over any other."In the absence of policy arguments or sources supporting the change, MOS:RETAIN seems to apply. Little pob ( talk) 10:43, 30 April 2019 (UTC)
"When an English variety's consistent usage has been established in an article, maintain it in the absence of consensus to the contrary."(emphasis added) clearly anticipates that there are occasions when the established usage normally promoted under ENGVAR might be found undesirable for whatever reason. And again, at the end of that subsection of the policy:
"An article should not be edited or renamed simply to switch from one variety of English to another."(emphasis again added), meaning only changes made expressly for the purpose of promoting one spelling variant or another, without another (sufficiently more worthwhile) justification are to be uniformly avoided. And then there's the fact that both ENGVAR and RETAIN are manual of style guidance, which must yield to compelling content WP:policy arguments in almost all cases.
This article was the subject of a Wiki Education Foundation-supported course assignment, between 18 February 2024 and 13 April 2024. Further details are available on the course page. Student editor(s): Chris SS BE ( article contribs).
— Assignment last updated by Chris SS BE ( talk) 06:29, 11 March 2024 (UTC)