Does all hospitals use as assistants nurses or residents during surgery?

Is this new hospital protocol to use nurses (not residents, fellows or attending) during surgery? Or is it usually done at teaching hospitals only?

I had a melanoma skin surgery yesterday. It was the third one. The first two were done with linocaine in the office. The third was done by an oncology surgeon at the hospital and he insisted light twilight sleep-propofol. I called the scheduler at the hospital to confirm I would get an attending anesthesiologist since I have heart failure and I get hypoxia, it was confirmed I got an attending.

An attending anesthesiologist showed up pre surgery to say I’m getting a nurse but he will be in the floor and check in if there was problems. He requested the lightest twilight sleep-enough sleep I wasn’t awake screaming.

She gave me adivan, propofol and I ended up with heavy sedation. She claims heavy sedation is safer than twilight. She used a size 4 child tube instead of a size 7 adult size tube. My BP before the surgery after requesting an attending was 115/65. I’m sure it dropped when I was drugged.

The attending surgeon left the room after the cutting and I was left with a resident and a young nurse to finish.

Never expected this during my 22 surgeries. The surgical assistants were always attending.

Everything went safely and I’m ok. I should not be venting and I’m grateful but I felt blindsided. But due to my hypoxia, coughing for air and heart failure and being fragile, I should had been assigned attending personnel. In fact, if I get a pvc ablation, the EP and his EP attending assistant will not sedate me with anything. They don’t want the risk. I’ll be wide awake for the ablation because my PVCs are suppressed during sleep and they want me awake to map me. I will get linocaine only for the groin cuts,

So who was right?

Just wonder.



Edited 1 time(s). Last edit at 06/05/2025 10:20AM by susan.d.

In all likelihood that nurse wasn't just an RN, but almost certainly a CRNA, or nurse anesthetist. A CRNA requires 7-10 years of training and prior ICU experience. They are very often used for procedures like you had and all the colonoscopies I've had used one. I think you were in good hands.

These people are high achievers who put themselves in the position to be rejected or to fail in achieving certification. They WANT TO help, to do a specialized form of help, to be trusted, and to succeed for the patient's sake. So, even though the nurse is not a qualified anaesthetist, he/she is very skilled and can get you the proper help if something goes wrong....which can happen even when highly experienced anaesthetists are attending.

I learned to trust my outreach nurse from the AF clinic at Royal Jubilee in Victoria, BC. She was really good, very caring, and was forceful in insisting I was fretting unduly and to trust that the second ablation had me free of AF finally. She was right. I was fretting unduly. Her experience told her to tell me that my doubts were self-defeating, and that I would ultimately learn I was wrong. Again, she was right.

I apologized to her afterwards. She was a sweet person…but the truth of the matter the attending did visit me pre surgery and wrote a plan of only giving me the lightest twilight sleep using propofol because of my frailty and she added a sedative (Adivan) , propofol and heavy sedation. My BP was 115/65 beforehand.. The surgery included three layers of stitches that took 50 minutes. I was immediately put out upon laying down and then prepped so I could had been longer under anesthesia.

I’m alive so she did a good job. I would use her again.

You have a right to be miffed by all this. A nurse anesthetist is more likely to default to more sedation out of inexperience and caution, while a more experienced physician anesthesiologist is better trained, has more confidence, and would more likely use lighter sedation with more precision titration especially in cases like yours. I'm glad the procedure went well, but next time try and pin them down as to who will do what and where physically they will be. I know this is easier said than done, and I'm still not sure if my ep was actually in the same room for all parts of my ablation, even after reading the detailed report!

Jim