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Anesthesia is necessary for the safe practice of surgery. Modern anesthesia allows a surgeon to operate while keeping the patient comfortable and safe. While anesthesia as a practice had in the past been a source of significant morbidity and mortality during surgical procedures, advances in medications, monitoring, and techniques have made it one of the safest medical practices. This has allowed many patients, once thought to be too ill for surgery, to have the opportunity for safe operative care. Because of the strong interdependence between surgery and anesthesiology, a surgeon must have at least a basic knowledge of the principles and practice of anesthesia.

Because of the large and increasing number of surgical and nonsurgical cases requiring anesthesia services, the supply of anesthesiologists is not adequate to meet current needs. In the United States, anesthesia may be provided by a physician anesthesiologist, a certified registered nurse anesthetist (CRNA), or a certified anesthesiologist assistant (CAA); the latter two professions are analogous to nurse practitioners and physician assistants, respectively. All types of providers are highly trained professionals who are fully qualified to administer anesthesia.

Anesthesiologist assistants are required to practice under the supervision of an anesthesiologist. The Centers for Medicare and Medicaid Services currently require CRNAs to be supervised by a physician. However, some states have opted out of this requirement, meaning that nurse anesthetists can practice unsupervised in certain settings. Even in these opt-out states, hospitals may still require a CRNA to practice under a physician’s supervision. When not operating under the anesthesia care team model of an anesthesiologist and a CRNA, the supervision requirement will frequently fall to the surgeon. Hence the surgeon must bear in mind that in the absence of a trained anesthesiologist, it is the surgeon who is legally accountable should catastrophe from any cause compromise the outcome of the surgical procedure.


The anesthesia provider has many roles in the operating room. Her or his first responsibility above all others is to maintain the safety of the patient. This includes making the decision about whether a patient is healthy enough to receive anesthesia. The anesthesia provider must also maintain the patient’s comfort throughout the surgical procedure, whether through the use of general anesthetic agents, analgesics, or regional anesthetic techniques. The anesthesiologist must also help to provide optimal operating conditions with muscle relaxation and optimization of hemodynamics. All these tasks require open and frequent communication between the anesthesia provider and surgeon.


Providing adequate ventilation and oxygenation is of prime importance. Anesthesia can cause hypoxia and hypoventilation through multiple mechanisms, including airway obstruction from relaxation of oropharyngeal musculature, suppression of respiratory drive, laryngospasm, and paralysis of the muscles of respiration. It is for this reason that the anesthesia provider must be an expert at airway management.

Typically, patients requiring ...

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