Expert: Ronald Levy, M.D. - 3/10/2010

Question
Please excuse my rather hostile questions; I'm a 28 year old female who needs GI (cancer) surgery and I'm having a really frustrating time dealing with the anesthesia end of my surgery.  I'm not a doctor or nurse, but I just finished my doctorate in biochem so I'm not totally clueless about my upcoming surgery.  I'm supposed to have a hemicolectomy under general.  I didn't think too much about the surgery since I trust the surgeon, but when I had the preop interview, thing went south quickly.  I want the most qualified person to do my anesthesia and I was told that I must accept a nurse not an MD to do my anesthesia.  I patiently listened to the mantra of "CRNA's supervised by aneshtesiologists" and definately don't want a nurse (albiet with 2 additional years of schooling=CRNA) to do my anesthesia.  I want a physician.  I was courteous and respectful in my request, but the response was totally inappropriate.  A major university med center told me "we use CRNA's and that's how it's done, they are credentialed to practice without supervision and take it or leave it".   I just got accepted to med school and can't believe that  patients don't have the option of an MD providing.  I understand that CRNA's are capable in most situations; I just want an MDA just like most surgeons would want.   I understand that an insider (such as an aneshtesilogist/surgeon) might say that a CRNA is o.k. for their on case; but they can cherry pick a crna that they know to be good.  I'm facing surgey that at best will be life-changing and want to stack the deck n my favor.....would most anesthesiologists be comfortable with their anesthesia being done by a CRNA??? and the "supervision" is less than 1:1........thanks

Answer
As with anything, that is a loaded question. There are a number of CRNA's I know that are excellent and there are a number who I wouldn't trust with any major procedure (but that is also true of MDAs). I'm going to answer your question in several ways. First of all, as a 28 yr old (who I assume is otherwise healthy) having [even a mediocre] CRNA do your case will not be a problem. That being said, you are entirely correct that you have the right to have an MD perform your anesthetic. The caveat to that is that you may have to have your surgery performed at a different hospital. Each hospital chooses how to provide anesthetic care. Some use MD supervised CRNAs, some combine CRNAs with MD only, some are MD only, some have residents +/- CRNAs, etc. It may be that the hospital you went to does not have the manpower to allow for MDA only anesthesia. It was definitely rude of them to say "...take it or leave it" but you may have to make that choice if you insist on MDA only. It is true that if I (or any physician) were having surgery, we would handpick our team. While you can't directly do that, your surgeon should be pretty familiar with the anesthesia team and should be able to request a specific MDA or CRNA (or both) for your case. Most places will try to accomodate these requests (so at least you will get the best team that they can provide).

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston