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Non-physician anaesthetists and who should provide anaesthesia?

Feiss, P.

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European Journal of Anaesthesiology: May 2001 - Volume 18 - Issue 5 - p 336


I read with great interest, in the September 2000 issue of the EJA, the proposed guidelines by Professor Vickers on the employment of non-physician anaesthetists within the anaesthesia team [1]. There is an ongoing debate in France on the subject that is driven by health authorities' fear of a future shortage in the number of trained anaesthesiologists; also by their aim to reduce the costs of healthcare. Many professionals show an ambiguous attitude in this debate. Instead of defending the fact that anaesthesia as a physician-only speciality is associated with a reduction in patients' mortality [2] they now want to shift their responsibilities to nonmedical assistants or nurses! It would be interesting to test the response of surgeons if it were proposed that so-called simple operations – such as hernia repair, cataract, those for varicose veins, etc. – could be routinely practised by adequately trained nurses under their supervision as is the case in some of the developing countries. I fear that terms such as ‘under supervision’ or ‘rapidly available anaesthesiologist’ or ‘available at all times’ will soon come to mean the time it takes to get from the ward (or the anaesthetist's office, or wherever, perhaps using a lift) to the operating theatre. I fear (it still exists) that one anaesthesiologist will practice in some public and private hospitals (with different motivation) with several nurses conducting anaesthesia in the operating theatres, while he or she is involved with other tasks in other parts of the hospital. I believe that anaesthesiologists must strongly defend the physician-only nature of the practice of anaesthesia. Nevertheless, anaesthesiologists do require skilled and dedicated assistance by nonmedical trained nurses or assistants. If any part of the continuous observation of the patient and care may be delegated, one must state that the anaesthesiologist's presence within the operating theatre is mandatory. The most reasonable system that I would propose is a team composed of two nurses or assistants and one anaesthesiologist working in two contiguous operating rooms. Thus, the anaesthesiologist is better able to anaesthetize and to supervise two patients simultaneously with the help of two assistants. I strongly believe that the security of our patients requires the presence of a trained anaesthesiologist. In an aeroplane, a qualified pilot stays on board; our patients deserve the same considerations.


1 Vickers MD. Non-physician anaesthetists: can we agree their role in Europe ? Eur J Anaesthesiol 2000; 17: 537–541.
2 Silber JH, Kennedy SK, Even-Shoshan O et al. Anesthesiologist direction and patient outcomes. Anesthesiology 2000; 93: 152–163.
© 2001 European Academy of Anaesthesiology