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Medical practitioners
Non-medical practitioners
Other assistants

Anaesthetist

Depending on where you live, your anesthesia care may be provided by a specially trained medical practitioner (doctor), nurse, or technician.

Medical Practitioners

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In some countries, your anesthesia care may be provided a doctor with special training in anesthesiology. In the United States of America or Canada, this medical specialist is known as an anesthesiologist. American and Canadian anesthesiologists are known by this term to distinguish these doctors from Certified Registered Nurse Anesthetists or CRNAs (see below), although there are no nurse anesthetists practising in Canada (nor in Australia, New Zealand or the United Kingdom).

If you live in Australia, New Zealand, South Africa, or the United Kingdom, this specialist is known as the anaesthetist. In Europe and many other countries, specialist anaesthetists are known as anaesthesiologists. This again denotes the distinction from 'nurse anaesthetists' who practise with specialists in many European countries.

After graduating from medical school, these doctors have undertaken several years of additional training in anesthesia, which varies in content and length, depending on the country in which it is undertaken. In those countries mentioned above, the training is for a minimum of several years and equal in length to that of other specialists, including surgeons.

Usually this training is under the direction of a professional body and includes intensive assessment and written and oral examinations. For example, in the United States, the American Board of Anesthesiology (ABA) examines and certifies doctors who complete an accredited program of anesthesiology training and who then voluntarily apply to the Board for certification. This process requires that, at the completion of anesthesia training, the doctor takes a written examination. The successful candidate must then pass an oral examination to become a Board Certified anesthesiologist.

In other countries, such as Australia, Canada, and the United Kingdom, anesthesia training is under the auspices of a ‘College’, such as the Australian and New Zealand College of Anaesthetists, the Royal College of Physicians and Surgeons of Canada, or the Royal College of Anaesthetists in the United Kingdom. In these countries, if successful in passing the examinations, the anaesthetist then becomes a Fellow of the national professional accrediting body, such as one of the Colleges.

After qualification, anesthesiologists are strongly encouraged to continue their education throughout their professional lives. The ABA and most Colleges or other regulatory and licensing bodies now require some on-going evidence that the anesthesiologist is keeping up to date. The degree of professional regulation depends on the country in which the anesthesiologist practises. In the United States, the ABA runs a Maintenance of Certification in Anesthesiology (MOCA) program, which enables anesthesiologists to document maintenance of their skills in six general areas. In Canada, the Canadian Anesthesiologists’ Society is a professional organisation that has undertaken development of Guidelines to the Practice of Anesthesia. These provide recommendations as to how anesthesia care is provided are given - for example, which monitors should be used during anaesthesia. The Royal College of Physicians and Surgeons of Canada (RCPSC), which regulates training and certification of anesthesiologists, plays no further specific role in the regulation of anesthesia practice. However, the RCPSC does direct a system of continuing medical education, known as Maintenance of Competence.

By way of contrast, in Australia and New Zealand, the College of Anaesthetists (ANZCA) has developed guidelines for anesthesia practice. In addition, the College directs a Continuing Professional Development program in which any medically-trained anaesthetist can participate.

In some countries, non-specialist doctors may also provide anesthesia care, most often in rural areas. Smaller communities depend on medically-trained non-specialist anesthesiologists because the amount of work available is not sufficient to support a full-time specialist. These doctors have not usually had full specialty training, and tend to provide anesthesia care for less complex operations. However, they also participate in programs aimed at maintaining skills and knowledge. Many non-specialist anesthesiologists also continue to work as Family or General Practitioners.

Non-medical practitioners

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In some countries, particularly in Europe, nurse anesthetists provide anesthesia care under the supervision of a specialist anesthesiologist. Often they will work as a team, with one nurse anesthetist and one anesthesiologist for each patient. In other areas, nurse anesthetists provide anesthesia care under the direction of the surgeon, cardiologist or radiologist who may be operating or performing a procedure on a patient at the same time. In a few countries, including parts of the United States, nurse anesthetists are legally allowed to practise without any supervision by a doctor.

Other assistants

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In the Operating Room, your anesthesiologist will usually have the help of an assistant. This person could be a nurse, respiratory therapist or an anesthesia technician. Ideally, the assistant has undergone formal training and examination, although this is not always the case. Anesthesiologists value good assistants, who carry out many differing tasks. These tasks include preparing and checking medications and equipment, and obtaining extra equipment from outside the Operating Room. The assistant may also attach various monitors to patients, such as an automatic blood pressure cuff, and then may record heart rate, blood pressure and other measurements on the anesthesia record. In addition, the assistant hands drugs or equipment to your anesthesiologist, and is generally available to help at all times, particularly at the beginning and end of the anesthesia.

Depending on where you live and where your hospital is, a number of the people described above may be involved in providing your anesthesia care. In addition, some hospitals also train other health care workers, such as ambulance attendants and paramedics, who may be present in the Operating Room and help with part of your anesthesia.