Patients

Your anesthesiologist takes several factors into account when recommending the type of anesthesia. Some of those factors include the type of surgery or non-operative procedure being performed and your medical history. These types of anesthesia are not always clearly defined, and patients may progress from one level of sedation/anesthesia to a lighter or deeper level during the procedure. For this reason, the American Society of Anesthesiologists (ASA) considers anesthesia a continuum, from light sedation to general anesthesia.

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“Anesthesia Care Team”
Most anesthetics administered in Pennsylvania are provided using an “Anesthesia Care Team” model, with the anesthesiologist serving as the “director” of the anesthesia care team. Prior to surgery the anesthesiologist evaluates the patients’ current state of health and is responsible for designing the anesthesia plan taking into account the patient’s condition and the nature of the surgery.

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Anesthesiologists

 

PSA Member Advocates for Controlled Substances Database

Michael Ashburn, MD, MPH, a PSA member, provided information to the Pennsylvania House Human Services Committee on June 16 regarding the possible creation of a controlled substances database. Legislation to create a new controlled substances database (CSDB) in Pennsylvania, House Bill 1651, was introduced in the state House of Representatives in early June.

Supporters say that an effective CSDB would help lower non-medical use of controlled substances and improve access to care.

The Pennsylvania Medical Society (PAMED) began educating legislators and their staffs on the need for a better CSDB last fall. Dr. Ashburn’s presentation on June 16 continued those outreach efforts.

Along with being a PSA board member, Dr. Ashburn is Professor of Anesthesiology and Critical Care Medicine at the Hospital of the University of Pennsylvania, Director at Pain Medicine and Palliative Care, chair of the Pennsylvania Pain Coalition (PPC), and a member of the PAMED Pain Management Work Group.

Pennsylvania’s current prescription drug database can only be accessed by the Office of the Attorney General and only collects information on Schedule II drugs.

HB 1651, which was referred to the House Human Services Committee on June 8, would require timely reporting of all Schedule II-V medications dispensed within the state and allow physicians and their authorized agents electronic access to the database to obtain data regarding their patients.

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Physicians

The choice of anesthetic or sedation is made by a physician taking into account various factors, including but not limited to the procedure being performed and the general medical condition of the patient. General anesthesia may be administered by an anesthesiologist, a nurse anesthetist under the direct supervision of a physician, preferably an anesthesiologist, or in some states by an anesthesiologist’s assistant under the direct supervision of an anesthesiologist. 

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The Anesthesiologist’s Expanding Role
The Centers for Medicare and Medicaid Services (CMS) released a January 2011 update to their Interpretive Guidelines for the Anesthesia Services Condition of Participation for Hospitals. As a result anesthesiologists have assumed a leadership role in developing and implementing medical staff rules and regulations (bylaws) that define the qualifications and supervision requirements for many “categories of practitioners”, such as those providers performing “Moderate Sedation”, “Deep Sedation” or obstetrical “analgesia” services. 

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