Anesthesia allows patients to undergo critical, often life-saving medical procedures they otherwise couldn’t handle. During most of those procedures, the anesthesia is administered not by an anesthesiologist, but by a certified registered nurse anesthetist, or CRNA. These nurses never leave their patient’s side, monitoring vital signs and adjusting dosages to ensure a safe and comfortable experience.

Nurses have been providing anesthesia since the Civil War, and Americans receive 34 million doses of anesthesia from CRNAs each year. In fact, every study in the last 15 years shows patients fare just as well with a CRNA looking after them as with an anesthesiologist. “You’re safer being here and having an anesthetic than you are driving here,” Juan Quintana, a Texas-based CRNA with a doctorate in nursing practice, tells his patients.

Here are some of the ways CRNAs are making sure that stays true:

New technology

Anesthesia is safe and routine, and new medical devices help further refine the practice. CRNAs now use blood oxygenation and brainwave monitors to observe patient responses and ultrasounds to prevent hidden complications.

"Nurses have been providing anesthesia since the Civil War, and Americans receive 34 million doses of anesthesia from CRNAs each year."

“We have simulators, so our students’ first experience in giving anesthesia is to a physiologic model that behaves like you and I would,” said Ladan Eshkevari, assistant program director of the Nurse Anesthesia Program at Georgetown University. “It’s a high-fidelity simulation with a drug recognition system that mimics effects and side effects.”

Targeted application

No one wants to take a drug they don’t need, so even though full-body general anesthesia is extremely effective, CRNAs are taking advantage of advances that allow them to use local anesthetics instead. “We numb your arm if you’re having arm surgery, or leg for leg surgery,” Quintana said. That’s followed by a more gentle sedative, which means patients don’t need a breathing tube, and they wake up more quickly after the procedure. “Just enough medication to make you sleepy,” he added.

Advanced qualifications

CRNAs must have experience in a critical care or intensive care unit. “You can’t be a CRNA without having that ICU background,” said Eshkevari.

Though all certification programs already require a master’s degree, the educational requirements are becoming even more rigorous. “By 2025, all CRNAs will have to be educated at the doctorate level,” said Joseph Pellegrini, director of the Nurse Anesthetist Program at the University of Maryland. “And you can’t start a new program in nurse anesthesia at the master’s level after this year."