Page 52 - CASA Bulletin of Anesthesiology 2022; 9(2) (5)

CASA Bulletin of Anesthesiology

争鸣原地

The performance of the anesthesiologist in current clinical practice

Ning Miao MD, Xiaowei Lu MD
Department of Perioperative Medicine
Clinical Center, National Institute of Health
Bethesda, MD, 20892

Brief Anesthesia history

Anesthesiology is a relatively young profession in comparison to other specialty of medicine
that continues to evolve. Modern anesthesia originated from the discovery of two inhalational
agents- ether and chloroform in 1846. Over next two centuries, innovations anesthetic
techniques rapidly expanded including the endotracheal intubation for establishing artificial
airway , handheld laryngoscope, different blade morphology, anesthetic delivery system,
advances in inhalational and intravenous anesthetics, neuromuscular blocking drugs and the
addition of regional nerve block are some of the classic example of invaluable anesthetic
advancement , which provided important modalities for innovative surgeries to be safely
performed. It is clear that modern medicine would not be possible without the field of
anesthesiology .
1
From mid-nineteenth century in the USA, a shortage of suitable anesthetists and the
reluctance of physicians to transition their career to become an anesthesiologist , encouraged
nurses to take care of the surgical patients under supervision of surgeons. Nurse Anesthetists
have been providing anesthesia care to patients for more than 150 years and were among the
1-3
first specialty nurses to require continuing education. The first formal training program in nurse
anesthesia education began in 1909. The American Association of Nurse Anesthetists (AANA)
founded in 1931 and implemented a certification program for certified registered nurse
anesthetists (CRNA) in 1957. More recently, legislative changes have allowed CRNA to
independently practice anesthesia in 16 states in the USA . In 2021, there are more than 57000
2
CRNAs in the USA and together with anesthesiologists, currently provide more than 40 million
anesthetic procedures performed annually in the civilian and military setting throughout the
United States .
3
As surgical procedures became more complex, it demands anesthetic techniques to be
improved to meet the challenge maintaining patient’s intraoperative hemodynamic stability and
safety. Due to fast growth of anesthesia profession, and physicians gradually realized the
importance of safe anesthesia for surgery and started to campaign for anesthesia to be performed
by physicians in 1910 1, 4-5 . The first residency program for anesthesia in the US was established
in 1927, 18 years after the establishment of the nurse anesthetist’s program. The first class of
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