By Joseph F. Answine, M.D.

Non-Physicians

A Nurse Anesthetist:

Is a registered nurse who has completed a training program in nurse anesthesia
Is most commonly under the supervision of an anesthesiologist

An Anesthesiologist Assistant:

Is a medical professional who has completed an anesthesiologist assistant training program
Works under the supervision of an anesthesiologist

A Student Nurse Anesthetist:

Is a registered nurse who is enrolled in a nurse anesthesia training program
 According to the American Society of Anesthesiologists’ Statement of An Anesthesia Care Team: “… the use of non-physician students in place of fully trained and credentialed anesthesia personnel is not endorsed as best practice by the American Society of Anesthesiologists”

A Student Anesthesiologist Assistant:

Is a health professional who is enrolled in an accredited anesthesiologist assistant training program and, therefore, has completed the necessary coursework required for enrollment
Is always directly supervised (continuously present in the room) by another anesthesia provider such as an anesthesiologist or anesthesiologist assistant.

Non-Anesthesiologist Physicians

If an anesthesiologist is not immediately available to supervise the anesthesia care, the operating physician may take over those duties – as long as the requirements of a qualified physician are met based on the Pennsylvania Department of Health regulations.

Here are the appropriate passages from the Pennsylvania Department of Health regulations (Note that currently, in Pennsylvania, anesthesiologist assistants are not licensed to practice.):

§ 123.5. Administration of Anesthesia

Anesthesia care shall be provided by a qualified physician, anesthesiologist, resident, physician in training, dentist anesthetist, qualified nurse anesthetist under the supervision of the operating physician or anesthesiologist, or supervised nurse trainees enrolled in a course approved by the American Association of Nurse Anesthetists.

§ 123.6. Physician Qualifications

(a) Physician anesthetists must be able to perform all of the independent services usually required in the practice of anesthesiology, as set forth in subsection

(b) Independent services usually required in the practice of anesthesiology include:

(1) Performance of accepted procedures commonly employed to render a patient insensible to pain for the performance of surgical, obstetrical, or other necessary but pain-producing clinical procedures.

(2) Support of life functions during the period of anesthesia.

(3) Provision of appropriate pre-anesthesia and post-anesthesia management for the patient.

(4) Consultation regarding anesthesiology-related patient care, such as inhalation therapy, emergency cardiopulmonary resuscitation, and special problems in pain relief, unless these responsibilities are assigned to another physician who is judged by medical staff peer evaluation to be especially well qualified and is willing and able to assume them.

If the individual performing the procedure is not a physician, a physician must be immediately available as outlined in section 123.7 (subsection c) to supervise the anesthesia care. The appropriate subsection is stated below:

§ 123.7. Dental Anesthetist and Nurse Anesthetist

Qualifications

(c) When the operating/anesthesia team consists entirely of non-physicians, for example, dentist with nurse anesthetist, dentist with dentist anesthetist, podiatrist with dentist or nurse anesthetist, a physician shall be immediately available in case of an emergency, such as cardiac standstill or cardiac arrhythmia. The requirement that the physician be immediately available may mean in the hospital or in the immediate proximity of the operative procedure area or within minutes of the operating suite.

Usually, the procedures performed without the presence of an anesthesiologist are considered of minor risk such as endoscopies, and are commonly performed in surgical centers. It has to be remembered, however, that the same vigilance necessary for higher risk surgical procedures has to be present for all anesthetics given, and the presence of an anesthesiologist should always be strongly considered.