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Evolution of Nurse Anesthesia 1

Running Head: Evolution of Nurse Anesthesia

The Evolution of Nurse Anesthesia

Alexandra N. Milton

Glen Allen High School

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This literature review discusses the changes in technology and education that have been

made to the nurse anesthesia field, also including the role nurse anesthetists play in providing

anesthesia to their patients. Since nurse anesthesia started as early as the 1800s, much as

changed regarding the practice. It was a practice that was feared long ago and still frightens

many people today, but it is nearly 50 times safer than it was during the 1980s due to the

technological advancements and stricter education. One way certified registered nurse

anesthetists (CRNAs) differ from anesthesiologists is their nursing background which allows

them to gain an emotional bond with their patient. This bond allows their patient to instill trust

with their nurse anesthetist, therefore they feel calmer already. These three aspects of the review

will highlight the evolution of nurse anesthesia from its past, present, and future outlook. The

conclusion of this review discusses the future of nurse anesthetists, suggesting that the future is

always changing and if CRNAs continue to do what they are taught, they will always thrive.


The practice of nurse anesthesia has dated all the way back to the 1800s. Two hundred

years later, it is a practice still known and widely accepted today. From the earliest known nurse

anesthetist, Sister Mary Bernard, all the way to a nurse anesthetist providing anesthesia

tomorrow, there have been setbacks and successes of the field (Wilson, 2012). The essential

question of this CAPSTONE is: How has the practice of nurse anesthesia evolved over time?

There are been multiple improvement and changes made the education path, the technology, and

the practice itself. The American Association of Nurse Anesthetists was created and has helped

lay the foundation for nurse anesthetists years ago and today. They have created the educational

requirements of certified registered nurse anesthetists (CRNAs) and other helpful sources of
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information for current and future CRNAs. Many people fear anesthesia today, especially by a

nurse anesthetist, but they know little as to how the practice has evolved and how much safer it is


Educational Changes

When the practice first began, nurses were sent all over the country by their surgeons to

learn how to provide anesthesia. The Mayo Clinic in Rochester, Minnesota became the hotspot

for surgeons to send their nurses to learn from Alice Magaw, the Mother of Anesthesia. Surgeons

also sent their nurses to Agatha Hodgins at the Lakeside Hospital in Cleveland, Ohio to observe

and learn how to administer nitrous-oxide anesthesia (Stewart, 2012). Today, nurses are not sent

all over the country to learn about different techniques, they are taught in many schools and

programs in different states to learn the same technique of intubation.

The American Association of Nurse Anesthetists was created in 1931 and has set the

foundation for nurse anesthetists today. They have designed the education requirements for

nurse anesthetists over the years. As of January 2012, the requirements are as follows:

a Bachelor of Science in Nursing (BSN) or other appropriate

baccalaureate degree, a current license as a registered nurse, at least one year
of experience as a registered nurse in an acute care setting, graduation with a
minimum of a masters degrees from an accredited nurse anesthesia
educational program, [the] national certification examination [is passed]
following graduation, [must obtain a minimum of forty hours of approved
continuing education every two years, document substantial anesthesia
practice, maintain current state licensure, and certify that they have not
developed any conditions that could adversely affect their ability to practice
Before 1998 when these requirements were set in stone, the education differed in every area.

Now the AANA has announced its for nurse anesthetists to gain doctorate degrees by 2025
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(Wilson, 2012). Every few years the field is always changing and improving, the education

changes in order to promote better performing nurse anesthetists.

Technology Changes

When walking into an Operating Room today, the room is filled with technology for each

position, the surgeon, surgical nurse, registered nurse, and nurse anesthetist. Today a nurse

anesthetist has an anesthesia machine and cart. The machine contains two gases, Sevoflurane

and Desflurane, both putting the patient to sleep differently. The machine also contains the

patients vitals, heart rate, oxygen intake, and the carbon dioxide outtake. The cart contains the

materials needed to put the patient to sleep, such as different sizes of laryngoscopy endotracheal

tubes, IVs, drugs, etc. (Cryster). Two hundred years ago, these technological advancements were

not available to the nurse anesthetists. Instead, the first recorded technique in 1906 was the

open-drop technique which used chloroform and ether anesthesia. This technique reported not a

single fatality related to anesthesia. Two years later, Agatha Hodgins perfected administering

nitrous-oxide anesthesia to patients (Wilson, 2012). Today anesthesia is performed through the

gasses Sevoflurane and Desflurane, with intubation being the technique used by CRNAs and


A Nurse Anesthetists Role

A nurse anesthetists role is not only to provide anesthesia to their patient, but to create an

emotional bond with each patient. The nurse anesthetist is with the patient the entire time,

before, during, and after the procedure, allowing for the patient to trust someone. Mary Stewart

(2011), claims that a nurse anesthetist sees their role as a guide through a frightening
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experience. Nurses care about the patients feelings and needs, so nursing is integral to the

role of the CRNA, and without it an emotional bond would not likely form.

The bond begins during the interview with the patient, prior to the operation and is the

first time the patient meets the CRNA, including a history and a physical. The history includes

prior surgeries, any types of diseases, NPO or nothing by mouth, drug allergies, and then the

consent is signed. Throughout this interview, patients may begin to feel anxious, so the CRNA

provides them with an anxiety reducer such as Versed (Cryster). Because of this interview, nurse

anesthetists take into account the patients physical and psychosocial needs., in return

emotional energy is created between the patient and CRNA (Aagaard et al., 2016).


Nurse anesthesia has evolved into a difficult, yet rewarding career for many. The fear of

anesthesia still grows in many, but as Wanda Wilson (2012), argues, anesthesia is nearly 50

times safer than it was during the 1980s. The evolution of the practice has led to successful

findings and different techniques of administering anesthesia, but no one can predict what the

future holds for CRNAs. The world is always changing, different jobs come across different

problems, but nurse anesthetists will always be able to thrive because of their vigilance,

preparation, determination, knowledge, experience, and ability that serve them so well caring for

their patients every day. (Wilson, 2012). What is known, is the new education requirement

instilled by the American Association of Nurse Anesthetists for a doctoral degree by 2025

(Stewart, 2012). It is unpredictable what might happen next, but as each day progresses it

becomes more known.

Research List
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Aagaard, K., Laursen, B. S., Rasmussen, B. S., & Srensen, E. E. (2016). Interaction Between

Nurse Anesthetists and Patients in a Highly Technological Environment. Journal of

PeriAnesthesia Nursing. Retrieved

from http://www.sciencedirect.com.proxy.library.vcu.edu/science/article/pii/S108994721


Cryster, Leslie, personal communication, August 2016.

Stewart, M. W. (2011). Research news: nurse anesthesia. Journal of PeriAnesthesia

Nursing, 26(3), 176-

178. Retrieved from http://ac.els-




Wilson, W. O. (2012). Nurse anesthesia: a past, present, and future perspective. Nursing Clinics

of North America, 47(2), 215-223. Retrieved from