CRNAs Keep You Safe
Every patient going in for surgery has fears about the unknown. As a CRNA I have been asked every question you can think of, “Will I wake up during the surgery”… “How do you know that I am asleep”… “I heard that some people feel everything during the surgery like in the movie Awake.” These are all very valid questions, and part of my standards of practice is to discuss all the anesthetic options and risks with the patient in language that they can understand. During CRNA training, we learn how to answer all of these questions.
One of the best ways to help reduce any stress the patient might be having is to inform them about every step that is taken to ensure their safety and comfort. I know that anesthesia can seem to be this scary mysterious concept that most people don’t fully understand. That is why I have put together a simplified list of a few steps CRNAs take to keep you safe.
CRNAs Know When You Are Sleeping… We Know When You’re Awake…
One of the more common questions that I get is, “How do you know I’m asleep?” A popular movie called “Awake” depicts a young man who is conscious during surgery, however he is unable to move or talk to let anyone know that he’s awake. The medical term for this is “Anesthesia Awareness” and yes it is possible. Even with that being said, you should not let this worry you. The truth is that the incidence of “Anesthesia Awareness” is very low, and most cases consist of a patient remembering a few voices or sounds that they heard while falling asleep or waking up. Top nurse anesthetist programs have multiple case studies that outline this very issue.
When CRNAs use an anesthetic gas to keep a patient asleep they are always titrating the amount being delivered to you based on what we call the “Minimum Alveolar Concentration” or “MAC” value. This numerical value appears on our monitors and shows us how “deep” or asleep you are. We are always monitoring this during your surgery, and it is a reliable tool that helps prevent “Anesthesia Awareness” from happening. You shouldn’t stress yourself out thinking you might wake up during your surgery. CRNAs are always assessing and readjusting the anesthesia to ensure your safety and comfort.
You’re Never Left Alone
When I am explaining the anesthesia plan to my patients prior to surgery, I always make sure to inform them that I will be there the entire time of their surgery. At no point will they be left unattended. If I am required to leave the operating room for some reason, it will only be after a full report has been given, and the patient’s care has been transferred to another qualified anesthesia provider.
Don’t Worry CRNAs Will Breath for You
Certified Registered Nurse Anesthetists (CRNA) are well qualified in advanced airway management. During your entire surgery we make sure that you are receiving a continuos supply of oxygen. The way we deliver oxygen to you depends on your health history, type of surgery, anesthetic being delivered, length of surgery, and several other factors. CRNAs have a wide range of airway devices that we can choose from. Simple mildly invasive surgeries may only require a small amount of intravenous sedation and a nasal cannula. You will be breathing on your own and will not require mechanical ventilation.
Laryngeal Mask Airway “LMA”
One step up from that is what we call a Laryngeal Mask Airway or “LMA” for short. This is an device that is made up of an airway tube that connects to an elliptical mask with a cuff at the end. This is inserted into the patient’s mouth after they are asleep and rests in the back of the throat just above the vocal cords. CRNAs use this when a “General” anesthetic is require. This means the patient must be fully asleep for the procedure and may or may not be breathing on their own. After the LMA is inserted you are kept asleep by a continuous delivery of anesthetic gases from the anesthesia machine via a anesthesia circuit that connects to the LMA. Once the surgery is over we wake you up and remove the LMA.
Endotracheal Tube “ETT”
Lastly we have an Endotracheal Tube, also called an “ETT”, which is a flexible plastic tube that is inserted into the mouth and through the vocal cords after the patient is asleep. A small balloon cuff located at the end of the ETT is inflated with air, which creates a sealed or “protected” airway. Just like with the LMA, you are then kept asleep with anesthetic gases, which are being delivered from the anesthesia machine. Same as with the LMA, once your surgery is over, we will wake you up and remove the ETT as long as you are able to maintain adequate breathing on your own. There are only a few instances where the patient must remain intubated with the ETT. This usually occurs if the patient is undergoing very invasive surgery and will need ventilatory support after the procedure,
I love being a CRNA and all of the training I received from my CRNA school helps me on a daily basis. One of my favorite parts is talking with patients and helping relieve any fears that they may have about their surgery. If you ever need surgery, I encourage you to ask the Nurse Anesthetist as many questions as you want to. There is no such thing as a stupid question, and if you are concerned about something don’t hesitate to ask. Hopefully you have a little bit of a better understanding of what CRNAs do to ensure your safety. I know this was a very short summary, so if you have questions about something I didn’t cover please contact me through our website.
John Keith | CRNA Career Pro
Chief CRNA
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