What is a CRNA?

• Certified Registered Nurse Anesthetists (CRNAs) are advanced practice nurses who administer approximately 65% of all anesthetics given to patients each year in the United States.
• We have been providing anesthesia care in the United States for over 125 years. Nurses first provided anesthesia to wounded soldiers during the Civil War.
• More than 90% of this country’s nurse anesthetists are members of the American Association of Nurse Anesthetists.  CRNAs are the sole anesthesia providers in approximately two thirds of all rural hospitals in the United States, enabling these healthcare facilities to offer obstetrical, surgical, and trauma stabilization services. In some states, CRNAs are the sole providers in nearly 100% of the rural hospitals.
• CRNAs provide anesthetics to patients in collaboration with surgeons, anesthesiologists, dentists, podiatrists, and other qualified healthcare professionals.When anesthesia is administered by a nurse anesthetist, it is recognized as the practice of nursing; when administered by an anesthesiologist, it is recognized as the practice of medicine.
• CRNAs practice in every setting in which anesthesia is delivered: traditional hospital surgical suites and obstetrical delivery rooms; critical access hospitals; ambulatory surgical centers; the offices of dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists; and U.S. Military, Public Health Services, and Department of Veterans Affairs healthcare facilities.

PUBLIC INFORMATION

In particular, you must speak freely and follow instructions closely regarding your intake of medications, food, or beverages before anesthesia. Such substances can react negatively with anesthetic drugs and chemicals.

The preoperative interview is essential to effective communication.
This confidential discussion with the nurse anesthetist prior to surgery provides information vital to your care. To help you prepare for the interview, we have included a questionnaire for you to fill out, and bring along to the preoperative interview. Information supplied by the questionnaire assists your nurse anesthetist in doing the interview thoroughly and efficiently.

Different types of patients or procedures may require different types of anesthesia.

There are three basic types of anesthesia:

General anesthesia produces a loss of sensation throughout the entire body.

Regional anesthesia produces a loss of sensation to a specific region of the body.

Local anesthesia produces a loss of sensation to a small specific area of the body.

A preoperative interview with your anesthesia professional will determine which anesthetic is best for you.

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Herbal products are also known as dietary supplements, alternative therapies, complementary medicine, and homeopathic healthcare.

Some of the most common herbal products are: ephedra, feverfew, garlic, ginger, ginkgo, ginseng, Kava, and St. John's Wort.

Herbal products are available as tablets, liquids, granules, or powders. They may be available in their natural state as well.

The Dietary Supplement Health & Education Act of 1994 considers herbal products to be foods or dietary supplements. Therefore, they are not regulated by the Food and Drug Administration. There are few instructions on proper use and dosage requirements, and little information about possible side effects, toxicity and possible drug interactions.

While many herbal products offer noticeable health benefits when used correctly, taking herbal products right up until the day of your procedure/surgery may have an impact on the success of your anesthetic and procedure.

Concerns may arise when herbal products interact with anesthetics.

Some of the potential side effects are increased surgical bleeding, heart and blood pressure effects, reaction withsedatives and changes in the body's reactions to certain medications.

What are Herbal Products and What are the Concerns?

STOP taking the herbal product at least two weeks prior to the scheduled procedure or surgery to prevent side effects.

Inform your surgeon and anesthesia provider that you are taking an herbal product.

Offer accurate information about any herbal products you are taking.

When asked about your medication history, include all herbal products, over-the-counter drugs, dietary supplements, minerals, and teas.

If you are not sure of the contents of an herbal product, then bring the product and the container it comes in with you for the preoperative anesthesia interview.

Make sure that someone close to you is aware that you take an herbal product. In the event that you need emergency care, this person will need to share this information with your healthcare providers.

Realize that herbal products need to be treated as medicine. Even if the product is natural, it still may be harmful when combined with anesthetics.

Popular Herbal Products and Possible Side Effects
When Interacting with Anesthetics

Ephedra
Blood pressure changes; exaggerated response to high blood-pressure medications; risk of heart attack and stroke

Feverfew
Migraine, insomnia, anxiety and joint stiffness; risk of prolonged bleeding

Garlic
Blood pressure changes; risk of prolonged bleeding

Ginger
Sedative effects; risk of bleeding, especially if taken with aspirin and ginkgo

Ginseng
Insomnia and irritability; risk of cardiac effects

Kava
Sedative effects; potential liver toxicity; risk of additive effect to medications

St. John's Wort
Sedation; blood pressure changes; risk of interaction with other medications that prolong effects of anesthesia.