CRNA’s Present Possible Solution to Demand for Anesthesia Nov 15

By Sterling Medical Staff:

As the demand for healthcare grows quicker than the supply, one of the most daunting setbacks lies in the lack of qualified anesthesiologists.  A study conducted by the American Society of Anesthesiologists (ASA) found that “a nationwide shortage of anesthesiologists is beginning to have a profound effect in larger hospitals, delaying elective procedures, and in extreme cases, closing down surgical suites.”1 However, findings of a recent study suggest CRNAs may provide the greatest hope in meeting anesthesia needs in the future.

CRNA is the acronym for Certified Registered Nurse Anesthetist, also known as a Nurse Anesthetist. CRNAs are highly specialized nurses who hold graduated degrees, and are trained to administer anesthesia under the supervision of an anesthesiologist. In most states CRNAs are required to work under the gaze of a supervising physician. But due to demand, 15 states have waived this requirement, allowing CRNAs to practice independently of a licensed physician.

Some studies suggest that independently practicing CRNAs may provide a remedy to the dearth of anesthesiologists.  A retrospective review conducted by Dr. Murtaza Parekh, MD of Raleigh Endoscopy Center in North Carolina suggests that the risk is minimal.  Data from over 106,000 ambulatory endoscopy procedures, spread across 5 years, indicate that CRNAs may conduct anesthesia in certain types of procedures with little or no ill-effect. “The data showed no significant difference between CRNA with anesthesiologist supervision and CRNA alone in the frequency of aspiration…desaturation…laryngospasm…cardiac adverse events…perforation…and splenic injury.”2

Practitioners agree that highly complex and risky procedures require the supervision of an anesthesiologist to account for the extensive physiological variables. However, less risky procedures can likely be handled by CRNAs, whose numbers outstrip those of anesthesiologists due to less stringent education and licensing requirements. “In the end, MD supervision did not significantly impact safety outcomes with propofol in our ambulatory endoscopy center,” remarked Dr. Parekh.2

Still, some physicians aren’t sure that granting CRNAs more autonomy is the solution. Drs. Evan Pivalizza, MBChB and George W. Williams II, MD from the University of Texas’ Health Science Center both disagree with Dr. Parekh’s conclusion. “In terms of strength of evidence, which should be driving practice standards, this study is weak,” stated Dr. Pivalizza.2  The two doctors emphasized the need for anesthesiologist presence during procedures, stating “when physician anesthesiologists direct care, mortality is lower, especially in rescue situations, which by definition are unpredictable.”1

While Drs. Pivalizza and Williams present legitimate concerns about breadth of CRNAs treatment scope, the question of what will assuage the need for anesthesia services remains. Whether their role remains strictly supportive or grows to be more independent, CRNAs are sure to be an integral part of healthcare in this country for years to come.