What Does a Nurse Anesthetist Do?

A nurse anesthetist, also known as a certified registered nurse anesthetist (CRNA) is an advanced practice registered nurse (APRN) who plays a critical role in the healthcare system.  

These nursing professionals are responsible for administering anesthesia and providing care before, during and after surgical, therapeutic, diagnostic, and obstetrical procedures.  

The expertise of a nurse anesthetist ensures patient safety and comfort throughout medical procedures. In fact, CRNAs administer over 50 million anesthetics to patients each year in the U.S. (in various clinical settings), according to the American Association of Nurse Anesthesiology (AANA). And in rural areas, CRNAs represent over 80% of anesthesia providers.  

Let’s explore the role and responsibilities of a nurse anesthetist before, during, and after surgery. 

Preoperative assessments 

A nurse anesthetist plays a pivotal role in the preoperative phase of surgical care. The nurse anesthetist’s responsibilities begin with conducting comprehensive patient assessments. This ensures safe and effective anesthesia administration. Prior to surgery, the nurse anesthetist does the following: 

• Evaluate the patient’s medical history, current medications, allergies, underlying medical conditions, and previous anesthesia experiences. The evaluation allows the nurse anesthetist to identify potential risks and tailor the anesthesia to the patient’s specific needs. 
• Perform a physical examination to evaluate the patient’s overall state of health. During the examination, a nurse anesthetist assesses the airway, heart, and lungs to detect any issues that might complicate anesthesia administration.  
• Order and review any necessary diagnostic tests (such as blood work or imaging studies) to gather additional information as needed.  

Based on this assessment, a nurse anesthetist develops a tailored anesthesia plan that ensures the patient’s safety and comfort. This plan can involve: 

• Deciding on the most appropriate type of anesthesia (general, regional, or local) based on the patient's health, the procedure, and the surgeon's preferences. 
• Choosing the right anesthetic agents and dosages. A nurse anesthetist must achieve the desired level of anesthesia, while minimizing risks and side effects. 
• Educating the patient and their family about the process of anesthesia, potential risks, and postoperative care. A nurse anesthetist explains what to expect before, during and after the procedure, and addresses any concerns or questions.  

Intraoperative responsibilities 

During surgery, a nurse anesthetist is responsible for dispensing and managing anesthesia and supervising the patient’s vital signs. They perform the following actions: 

• Initiate anesthesia by administering the chosen anesthetic agents. This ensures that the patient transitions smoothly into an unconscious or sedated state. 
• Monitor the patient’s physiological status and respond to any changes or complications. A nurse anesthetist constantly monitors the patient’s vital signs. (This includes a patient’s heart rate, blood pressure, oxygen levels, and respiratory status.) CRNAs use advanced monitoring equipment to detect any physiological changes and make necessary adjustments to the anesthetic levels to maintain a stable condition. This helps to prevent complications and ensures the patient remains in a controlled, pain-free state. 
• Work closely with the surgical team to communicate the patient’s status. Nurse anesthetists quickly identify and address any complications, such as changes in blood pressure, heart rhythm abnormalities, or adverse reactions to anesthesia. They can adjust the anesthetic levels as needed, to maintain a stable and safe state of anesthesia. 
• Ensure the patient’s airway remains open and clear throughout the procedure. This may involve intubation, or other airway management techniques to secure the airway. Proper airway management is essential to prevent respiratory complications. 

Postoperative responsibilities 

After surgery, a nurse anesthetist is responsible for ensuring that the patient recovers safely from anesthesia. Their responsibilities begin immediately after surgery. 

A nurse anesthetist carefully manages the emergence process. Gradually, they reduce the levels of anesthesia while monitoring vital signs, to ensure that the patient regains consciousness safely. They assess the patient’s airway, breathing, and circulation, addressing any immediate complications that may arise, such as respiratory distress or hemodynamic instability. 

Once the patient is stable, CRNAs transfer the patient to the post-anesthesia care unit (PACU). In the PACU, the nurse anesthetist continues to monitor vital signs, pain levels, and overall recovery. They prescribe medication to manage pain, nausea, and other postoperative symptoms, ensuring that the patient remains comfortable.  

CRNAs develop individualized pain management plans. This may include administering opioids, non-opioid analgesics, or regional anesthesia techniques. A nurse anesthetist educates the patient and their family on pain control methods and medication schedules to ensure proper pain management at home. 

CRNAs provide patients and their families with essential information about postoperative care. Typically, a nurse anesthetist will cover activity restrictions, medication instructions, and signs of potential complications. This education helps to facilitate a smooth recovery and empowers patients to manage their care effectively.   

Lifelong learning for nurse anesthetists 

Nurse anesthetists can gain additional expertise and contribute to the advancement of the field, by taking on new responsibilities. Some examples are: 

• Conducting research studies: A nurse anesthetist may study techniques to improve patient outcomes, for example.  
• Advocating for the profession by participating in professional organizations: Nurse anesthetists are promoting policy changes and raising awareness about the role of nurse anesthetists in healthcare.  
• Taking on leadership or teaching roles: This contributes to the development of the next generation of healthcare professionals. Nurse anesthetists may mentor or supervise nursing students in the specialty or newly certified CRNAs. Some nurse anesthetists teach in academic settings, such as nursing schools and anesthesia programs, to share knowledge and expertise. 
• Staying current with the latest advancements in anesthesia: A nurse anesthetist must maintain certification through periodic recertification exams and meeting continuing education requirements set by the National Board of Certification & Recertification for Nurse Anesthetists.   

An essential role in patient safety 

A nurse anesthetist’s role encompasses a wide range of responsibilities, from preoperative assessments and anesthesia planning to intraoperative monitoring and postoperative care. Their continuous monitoring, skilled airway management, and collaborative efforts ensure a high standard of care. 

A nurse anesthetist has expertise that is vital for patient safety and successful surgical outcomes. As the demand for skilled anesthesia providers continues to grow, nurse anesthetists will remain at the forefront of delivering high-quality, patient-centered care.