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    CRNAs vs. anesthesiologists: study finds no difference in OB anesthesia safety

    By Jennifer Huddleston, staff writer      

    Researchers who sought to identify differences in rates of anesthetic complications during cesarean section procedures found no differences in safety between hospitals that are staffed only by certified registered nurse anesthetists (CRNAs) and those that are staffed only by anesthesiologists. The study also revealed no differences in mortality rates. [1]

    “Hospitals, CRNAs and anesthesiologists should all be pleased to have reassurance that CRNAs working without anesthesiologist supervision can safely take care of the anesthetic requirements of obstetrical patients,” said Daniel Simonson, a CRNA and graduate of Washington State University who lead the study. [2]

    The results of the study, “Anesthesia Staffing and Anesthetic Complications During Cesarean Delivery: A Retrospective Analysis,” were published in the January/February 2007 issue of Nursing Research (Vol. 56, No. 1, pp. 9-17). [3]

    The study involved 134,806 patients, 33,236 of which were cared for at hospitals staffed only by CRNAs and 101,570 who were treated at hospitals staffed only by anesthesiologists. [4]

    Although further studies are needed, according to Simonson, the findings show that “hospitals and anesthesiology groups, particularly those in rural areas and those in medically underserved urban areas with large Medicaid populations, now have a possible long-term solution to their OB anesthesia staffing needs: greater use of CRNAs working without anesthesiologist supervision.” [5]

    The study revealed that hospitals staffed only by CRNAs cared for the largest percentage of Medicaid, rural, urgent admission and very young (under 17) patients, and also found that hospitals staffed only by anesthesiologists treated the largest percentage of emergency admissions and older (over 35) patients. Further, a higher percentage of sicker patients were transferred to hospitals staffed only by CRNAs. While this fact could have translated into a higher number of anesthetic complications at those facilities, the study proved otherwise. [6]

    Shortly after the study was released, the American Society of Anesthesiologists (ASA) Practice Guidelines for Obstetric Anesthesia were revised. The revised guidelines focus on the newest recommendations for anesthetic management and pain control for women during labor, delivery (both operative and nonoperative) and postpartum. [7]

    Key recommendations addressed by the guidelines include [8] :

    • The decision to use a particular technique should be individualized based on anesthetic, obstetric or fetal risk factors, the preferences of the patient and the judgment of the anesthesiologist.
    • Obstetric patients should receive the same standard of care as patients in the main operating room.
    • The equipment, facilities and support personnel for the labor and delivery operating suite should be comparable to the resources available in the main operating suite.
    • The use of spinals or epidurals is preferred over general anesthesia for most cesarean sections.
    • General anesthesia may be the most appropriate choice in some circumstances.

    The findings of the study and the revised guidelines set forth by the ASA are particularly relevant as the rate of cesarean births in the U.S. increases. Between 1996 and 2003, cesarean rates for all women (including low-risk) increased substantially, as did rates for women giving birth for the first time. [9] In 2005, the last year from which birth data is available, the total cesarean delivery rate rose to 30.3 percent—the highest level ever reported in the U.S. [10]

    While the rising rates of cesarean deliveries translate to an increased demand for obstetric anesthesia, Simonson says that “expectant mothers can have great confidence knowing that they and their babies will be safe in the care of a nurse anesthetist or an anesthesiologist.” [11]



    [1]  OB Anesthesia Equally Safe When Provided by CRNAs or Anesthesiologists,  New Washington Study Shows. Medical News Today. March 19, 2007.

    [2] Meehan, Becki. WSU Graduate Reports Findings in Obstetrical Anesthesia Study. Washington State University Research News and Features.

    [3]  Ibid.

    [4]  Ibid.

    [5]  Ibid.

    [6]  Ibid.

    [7]  American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Practice Guidelines for Obstetric Anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Anesthesiology 2007 Apr;106(4):843-63.

    [8]  Ibid.

    [9] Menacker, Fay. Trends in Cesarean Rates for First Births and Repeat Cesarean Rates for Low-Risk Women: United States, 1990-2003. National Vital Statistics Report (Vol. 54, No. 4, pp. 2). National Center for Health Statistics. Sept. 22, 2005.

    [10]  Martin, Joyce A., et al. Births: Final Data for 2005. National Vital Statistics Report (Vol. 56, No. 6, pp. 18). National Center for Health Statistics. Dec. 5, 2007.

    [11]  OB Anesthesia Equally Safe When Provided by CRNAs or Anesthesiologists,  New Washington Study Shows. Medical News Today. March 19, 2007.



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