Is it safe to use a CRNA instead of an anesthesiologist?

Question

I have a lower FL amd neck lift scheduled for Jan 7, and just found out my PS uses a CRNA and not a full on anesthesiologist. I’m kind of uneasy about this and wanted to get some expert opinions. The surgery suite is in her office. Thanks!

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Dear sfgirlnextdoor,

Thank you for your question. It is understandable to want clarity about who will be giving your anesthesia, especially for surgery in an office setting.

A CRNA can be an appropriate anesthesia provider for facelift surgery. CRNAs are licensed advanced practice anesthesia clinicians, and office-based anesthesia safety depends not just on the provider title, but also on the individual’s experience, the facility’s accreditation, the monitoring used, and the emergency protocols in place. Professional guidance from ASA and ASPS emphasizes the importance of proper patient selection, qualified anesthesia personnel, and an accredited office-based facility for safety. ([American Society of Anesthesiologists][1])

That said, every practice is different. I think the most helpful next step is to ask a few direct questions: Will the CRNA be present for the full case and recovery period? Is the office accredited by AAAASF, AAAHC, or the Joint Commission? What type of anesthesia is planned? What emergency equipment and transfer plan are in place? Those details matter a great deal in an office setting. ASPS notes that accredited facilities must meet national standards for equipment, operating room safety, personnel, and surgeon credentials. ([American Society of Plastic Surgeons][2])

Regarding your uneasiness, I would not focus only on whether the provider is a CRNA versus an anesthesiologist. I would focus on whether your surgeon’s team has a clear, well-organized anesthesia plan that you fully understand. It is also very reasonable to ask why the office uses that model for your case and whether your own health history makes office surgery a good fit. ASA’s office-based anesthesia guidance stresses patient safety systems, equipment, staffing, and recovery capabilities in that setting. ([American Society of Anesthesiologists][1])

As for revisions, office policies do vary. Before surgery, make sure you understand exactly what is included, what is not, and what costs could apply later. If you still feel uneasy after that discussion, getting one more consultation would be appropriate.

Warmest regards,

Dr. Stephenson

Kyle Kimura, MD · Answer

Great question. It depends on the state and their laws regarding anesthesia care, but in many situations a CRNA can operate independently. In any situation, if there is some uneasiness you should absolutely bring it up with your plastic surgeon and make sure all your questions are answered. In general, the vast majority of CRNAs are excellent and well trained to handle a case like yours, but you should also be able to speak with them before surgery if you have any unique concerns.
Hope this helps!Kyle Kimura, MD

Stephen Prendiville, MD · Answer

Yes, it is entirely safe to use a CRNA for a facelift,  I have used both CRNA's and Anesthesiologists over my career; for healthy patients, there should be no issues.  For medically complicated patients that belong in a hospital, an Anesthesiologist is mandatory. However, this should not be an issue for outpatient elective surgeries.  I have a team of 5 CRNA's that are excellent that I have worked with over the last 10 years without any major medical issues and a very low incidence of postoperative nausea.

Waylon Zeng, MD · Answer

Hi there, thank you for your question! I can definitely understand your concern with regards to choosing a qualified anesthetist. CRNAs as well as anesthesiologists are widely utilized in many office-based surgery suites as well as surgery center and hospital ORs. I have worked with CRNAs who regularly work in cardiac operating rooms doing open heart surgery as well as anesthesiologists just out of training. The best way to address your concern would be to speak with your surgeon to express your concern as well as ask for the experience of the anesthetist. Thorough communication is key to address your concerns!

Zoran Potparic, MD · Answer

In our practice CRNA providers have shown reliability and safety regarding both twilight and general anesthesia. Careful selection of patients, preoperative clearance by primary care physician and other specialist as needed are part of preoperative evaluation. Providing that anesthesia provider is someone who works with your surgeon for long time you should feel safe. Good luck.

Albert Yang, MD · Answer

I would ask how long they have worked with the individual. The ones that have been there a long time are often very very good. Anesthesia is a big part of making surgery successful (controling BP, nausea, patient experience etc) so if the surgeon has not had any issues with their team I wouldn't try to change it.

Is it safe to use a CRNA instead of an anesthesiologist?

Answers (6)

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