Vital Times 2020 - 101

anesthesiology, allowing for increasingly complicated
patients to be carried safely through a growing range of
surgeries.
Although it may seem obvious to anesthesiologists that
physicians, just as in other areas of health care, should
direct care in the perioperative setting, our history has

shown the complexities of implementing physician
leadership of CRNAs in the U.S.
Understanding the roots of this longstanding turf war
may help us to approach present-day challenges in a
more informed manner.

References
1 Bacon DR, Lema MJ. Anaesthetic team and the role of nurses - North American perspective. Best Pract Res Clin

Anaesthesiol. 2002;16(3):401-8.

2 Snow S. Operations without Pain: The Practice and Science of Anaesthesia in Victorian Britain. New York: Palgrave

Macmillan; 2006.

3 American Association of Nurse Anesthetists (AANA). CRNAs: We are the answer. AANA website. https://www.aana.

com/docs/default-source/marketing-aana-com-web-documents-(all)/crnas-we-are-the-answer.pdf?sfvrsn=b310d913_4.
Published May 23, 2019. Accessed May 27, 2019.

4 Bankert M. Watchful Care: A History of America's Nurse Anesthetists. New York: Continuum; 1989.
5 Ray WT, Desai SP. The history of the nurse anesthesia profession. J Clin Anesth. 2016;30:51-8.
6 Thatcher VS. History of Anesthesia: With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott; 1953.
7 Calmes SH. A History of Women in American Anesthesiology. In: Eger EI, Saidman LJ, Westhorpe RN, eds. The Wondrous

Story of Anesthesia. New York: Springer; 2014: 185-203.

8 Bacon DR. Francis Hoeffer McMechan, MD: Creator of modern anesthesiology? Anesth Analg. 2012;115(6):1393-1400.
9 Gunn IP. The history of nurse anesthetist education: highlights and influences. Report of the National Commission on

Nurse Anesthetist Education. AANA Journal. 1991;59(1):53-61.

10 Thomas MA. Anesthesiology - the John Adriani story. Ochsner J. 2011;11(1):5-9.

In Response:
A Historical Argument for Physician
Leadership of the Anesthesia Care Team
Merlin D. Larson, MD

T

he discovery of ether anesthesia was made
by a physician, Crawford Long, MD, in 1842.
In the subsequent 50 years or so, the mask
delivery of anesthetics was refined by physicians such
as Snow, Buxton, Hewitt, Simpson, Gwathmey, and
others. These physician anesthetists were in short

supply, but the technique of mask delivery was soon
adopted by interns and nurses.
These methods were only marginally safe. Deaths
during anesthesia during the first half of the
20th century were estimated to be close to 0.1

Annual Publication 2020

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