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Surgeons must be very careful
When they take the knife!
Underneath their fine incisions
Stirs the Culprit -- Life!
                                    ---Emily Dickinson
Dr James Cottrell,  when he was President of the American Society of Anesthesiologists, told the New York Times: "...[O]ur job is to keep patients alive while the surgeon does things that could kill them."
---NY Times, 8 JAN 2002
    Unlike any other branch of medicine, we anesthesia providers take perfectly normal patients, most of them healthy people, then knock them out, paralyze them and otherwise block the body's vital defense mechanisms, thereby baring the patient to the surgeon's knife.  The patient's anatomy rests in the surgeon's hands, the patient's physiology in ours.  As the surgeon's accomplice, anesthesia constitutes an altogether unique modality in modern medicine.
Dr Scot Foster, CRNA, past President of the American Association of Nurse Anesthetists, has said:  "Ours is a role of physiologic support and monitoring and intervention. Ours is not a diagnostic and cure paradigm at all."
---Nurse Week, 6 APR 1998

    SUPPORT is indeed the deep-down essence of anesthesia care.  Entering the profession of anesthesia with a critical care nursing background, of course CRNAs excel at intensive care and support.  We need not diagnose anything, we do not cure a single thing (except insomnia perhaps).  Diagnosis and cure are the challenge of other specialists.  Uniquely, we in anesthesia support the patient.   To aid and facilitate the surgeons as they strive to effect their surgical cure, we assume responsibility for sustaining the patient's vital functions through the operation until we can safely restore their reflexes and awaken them.  Anesthesia is quintessential support, the epitome of Intensive Care.

    Why is this intensive level of support necessary?  Well, frankly ... because anesthesia ain't like taking a nap.  Not really.   The same drugs that depress the brain and render you unconscious also depress the heart, blood pressure, kidney and liver function, even temperature regulation.  Drugs slow respiration and may cause your breathing to stop.  It's far from a natural sleep.

   Often anesthesia providers must employ airways, various tubes and mechanical ventilators to breathe for the patient; they must maintain the blood pressure and pulse rate with IV fluids, drugs, and other interventions.  Always they must be MONITORING -- continuously monitoring vital signs and other parameters of the patient's physiology -- constantly aware and alert, quick to counteract untoward changes that may threaten to arise.  We support the patient's vital functions.  In other words, their very life is in our hands.  Acute vigilance is required, moment to moment, throughout our unique intervention.

Anesthesia is INTENSELY Intensive Care.

    Most particularly we maintain a balancing act, matching dosages of painkiller against the level of surgical pain that an unconscious patient's body is experiencing.  It is a dynamic process of titration: as the degree of stimulation goes up or down, we adjust the dosages of drugs up or down, rebalancing the match over time, titrating continuously, vigilantly, through the hours.  Like aviation, anesthesia has been described as fifty-nine minutes of boredom interspersed with sixty seconds of pure panic.  And, like airline pilots, anesthetists too sometimes earn an entire year's salary in the course of a few critical seconds.

    Before admission to the Master's degree programs that prepare RNs to become CRNAs, applicants must complete a minimum of one year of acute care nursing.  Critical care experience is important to form the basis of a CRNA's ability to analyze situations, to make decisions, to communicate clearly with the other members of the surgical team, and to respond quickly and appropriately in an emergency.  From day one nurses learn to be the patient's advocate; CRNAs are very well prepared for those occasions when they must, as Dr Cottrell says above, intervene to protect the patient from the surgeon.

  Numerous studies since the 1960s have shown anesthesia care to be of a uniformly high quality across America, whether provided by anesthesiologists or by CRNAs, in wealthy suburbs or out in rural hospitals.  Anesthesia is anesthesia: two types of providers, one high standard of care.  In 1990 the Centers for Disease Control (CDC) considered undertaking a new multi-million dollar study of anesthesia outcomes, but ultimately the CDC rejected the idea, concluding that anesthesia morbidity and mortality were far too low to warrant spending the money.  They'd have been wasting tax dollars.

    Anesthesia is anesthesia.   Statistics show anesthesia to be extremely safe, no matter who provides it, MD or CRNA.  Never has there been a scientific study that could distinguish a significant difference in quality between the two types of anesthesia provider.   Even a past president of the ASA has confirmed that if nurse anesthetists gave inferior care they would have disappeared long ago.

 "...[T]he participation of Certified Registered Nurse Anesthetists (CRNAs) in delivery of anesthesia care would have ceased many years ago if there was evidence that this participation resulted in a less favorable outcome compared with anesthesia personally administered by an anesthesiologist."

                        --- Robert K. Stoelting, MD,
Department of Anesthesia, Indiana University School of Medicine; Anesthesia & Analgesia. DEC 1996

    In competing with our physician counterparts, a major asset CRNAs  possess is our nursing background itself.  It is emphatically NOT a weakness, but the polar opposite; due to the unique nature of anesthesia, our nursing background is truly a major  STRENGTH for clinical anesthetists.  Attention to detail, multi-tasking, intuition, caring hands -- all that nurses are known for, combining the Science and the Art of hands-on care: these attributes make CRNAs outstanding anesthetists.  Unfortunately, the majority of anesthesiologists have never had our advantages: our nursing skill and experience, the extensive bedside acumen.  Some anesthesiologists appear to mistake hands-on care for manual labor, and manual labor is beneath their dignity.  They just don't know what they don't know.

Anesthesia is Intensive CARING.

    Nurse anesthetists were originally chosen for the unique role of professional 'anesthetizer' primarily because nurses were known to pay extra close attention to the patient.  Nurses care.  What was true then in the 1880s is still true today.  And today nurse anesthetists practice in over one hundred countries around the globe.

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