Why are anesthesia providers important?

You are a perfectly healthy human being. Your heart, brain, kidneys, liver and other vitals are working like clockwork; or as Donald Trump would put it, “running like a fine-tuned machine”; like his government is functioning.

Suddenly, someone knocks you out. The lights are turned off, it’s freezing. You can hardly breathe; now your temperature regulation is no longer what it was. Your blood pressure is out of control. You need help regulating your vitals to stay alive. You remain in this state for what feels like hours on end.

Then the cobwebs are blown away. The lights are back. You’re no longer chilly. Your reflexes are restored and you awaken; hardly aware of what just happened -such is the power of an anesthesia provider!

As surgeons are busy slicing your flesh apart, leaving battle scars to always remind me you of what you conquered, anesthesia providers are charged with the responsibility of sustaining your vitals through the operation until it is safe to resuscitate you.

 There are two main types of anesthesia providers- anesthesiologists and certified registered nurse anesthetists (CRNAs). The former are physicians that have specialized in anesthesiology -over a period of four years – a branch of medicine that deals with anesthetics. It involves the pharmacological, physiological, and clinical basis of anesthesia such as resuscitation, intensive respiratory care and management of pain. On the other hand, CRNAs are nurses with experience in intensive care provision with training on how administer anesthesia. CRNAs train over a shorter period of time.

Anesthesia providers are in charge of a patient’s physiology while the surgeons take over their anatomy during surgery. Anesthetists’ skills are unique -they do not diagnose or cure but support and monitor patients- as they provide a wide range of physiological support. The drugs that they administer depress the brain rendering one unconscious while the surgery is underway. However, these same drugs have effects on other body process such as temperature regulation and breathing, and organs such as kidneys, heart, liver etc. This is best summarized in the words of the former President of the American Society of Anesthesiologists Dr. James Cottrell when he said that, “Our job [anesthesiologists] is to keep patients alive while the surgeon does things that could kill them.” This involves employing artificial airways to assist the patient in breathing, maintaining blood pressure and pulse rate using IV fluids and drugs. Additionally, they monitor the level of surgical pain that patients are experiencing –while unconscious- and administer the appropriate pain killer dosage.

Numerous studies have shown that there isn’t any difference in the level of quality of service provision between anesthesiologists or certified registered nurse anesthetists. CRNAs already have exposure of intensive care provision and are therefore able to monitor and respond fast in case of changes in the patient’s condition. If the use of CRNAs was not successful they would not be seen as a solution to bridging the gap between the high population in need of surgical care services and a shortage of healthcare personnel to administer anesthesia especially in resource- limited settings such as SSA. It is far much cheaper and faster to train a CRNA than it is to train an anesthesiologist thus the increase in the number of CRNAs and CRNA training programs. 

The Center for Public Health and Development (CPHD) uses innovations to provide solutions to public health challenges. As such, the center started an anesthesia training program in collaboration with various partners such as the Kenya Medical Teaching College, the Nursing Council of Kenya, Vanderbilt University, Kijabe College of Health Sciences, General Electric (GE) and ELMA Philanthropies among others. This ensures that high quality education is delivered that involves theory and practicums before deployment to counties that are in dire need of an increment in the number of anesthesia providers. The program seeks to ensure that anesthesia is safe, improve perioperative nursing outcomes and reduce maternal and child mortality through life saving surgical operations that arise from pregnancy-related complications.

CPHD’s findings from post deployment research show an increase in the number of lives saved in low-level facilities through drastic reduction in the number of outgoing referrals, faster care provision and increase in the number of cesarean section operations carried out. In September, we are admitting the fourth cohort of trainees since the program inception. The trainees are awarded with a higher diploma in Anesthesia and become KRNAs upon successful seating on examinations. We are excited at the prospect of equipping more care givers with lifesaving skills that will ultimately improve public health in Kenya.