Many of you picking up this text work now as anesthesia technicians and need a reference book, or a source for study for the anesthesia technologist exam. This book is certainly for you; we hope it will meet your needs, answer your questions, and deepen your knowledge.
Some of you may have worked elsewhere in hospitals or operating rooms and may be actively interested in pursuing a career as an AT. This book is definitely for you; we hope you will join us in anesthesia and that this book will spark your interest in our sciences and technology. Some of you, however, may be exploring career areas completely unknown and wondering; what is an anesthesia technician, anyway? This book is for you, too. We hope it can introduce you to our field and its possibilities.
Sixty or seventy years ago, the technical needs of an anesthesia provider were simple and could be supplied by the surgical equipment staff of the operating room; there was no need for specialty staff for anesthesia equipment. Surgery, delivery of anesthesia, and monitors were straightforward and accomplished with few pieces of equipment: intravenous fluids, tubing and reusable needles, ventilation masks, an anesthesia machine, laryngoscopes and endotracheal tubes, oral airways, a few drugs and syringes. Anesthesia gas delivery did not require electrical power, and any problems could be sorted out on the fly.
Fast forward to the present. Health care is the largest industry in our economy, and its delivery is complex. Patients have surgical and noninvasive procedures that no one could have dreamed up: robotic airway surgery, cardiopulmonary bypass, and MRI. People live longer and present for anesthesia with severe illnesses; technology is needed to help anesthesiologists care for patients with defibrillators or ventricular assist devices, home ventilators for Lou Gehrig’s Disease, or perhaps an external pacemaker coming down from the ICU that absolutely, positively, cannot run out of batteries.
With the introduction of each new surgical procedure, and each new anesthetic technique, new technology and equipment has arrived in the operating room. Surgical technology is so complex that it has its own academic field for support, with an associate’s degree and certification, due in part to the vast diversity of surgical tools and in part to the challenge of maintaining sterility at all times. Hospitals and freestanding surgical centers employ biomedical and other engineers with advanced degrees to manage equipment and building installations costing millions of dollars.
Anesthesia equipment is also unique. Patients do not come to the hospital to have an anesthetic; they come to have a surgical procedure, or a baby, or an imaging test; the anesthetic keeps them safe and comfortable no matter how invasive or difficult the intervention may be. Anesthesia services must accommodate a variety of patient and surgical environments and be efficient and flexible while maintaining uncompromised standards of safety. Ideally, anesthesia equipment should be easy to operate, light, quick to set up, portable, and durable.
As the quantity, variety, and rapid pace of anesthesia technology equipment have expanded, anesthesia providers and hospital operating rooms have employed specialized staff to care for the many pieces of equipment used in anesthesia care. Anesthesia providers also need an unusual kind of help caring for patients, since an anesthetist cannot leave the side of an anesthetized patient even for a moment; any drug, tool, or supply that a patient needs must be brought by someone else who understands right away what is being requested and where to find it. Anesthesia providers need assistance with procedures, particularly as these have become more complex: many procedures require more than two hands to accomplish successfully, or require assistance with operating electronics and monitoring equipment during the procedure.
The anesthesia technician supports the equipment side of the anesthesia service. This role is vast and can encompass everything from making sure that a disinfected, fully stocked, and functional set of anesthesia equipment is available promptly at the start of every case (“room turnover”) to the planning of supplies, personnel, and equipment for the opening of a new facility, and everything in between. On a daily basis, it includes supporting anesthesia providers with their tools as they care for patients. It includes understanding the function, use, maintenance, and repair of a wide variety of durable and disposable equipment; the technician must understand not only what the machine or item is and how to use or fix it, but why it is used, when it might be needed, and how fast to bring it when it is called for. The difference between a technician and a technologist (the Cer.ATT, see Chapter 1) is like the difference between a mechanic and an engineer. The anesthesia technician must know the equipment, but the technologist has achieved a recognized degree of understanding of the science behind it. This book, we hope, will inspire you to that level of knowledge.
A last word about terminology, as we are frequently asked this question. This textbook will refer throughout to the “anesthesia provider.” In the United States, most anesthesia providers are either physician anesthesiologists or certified registered nurse anesthetists. A physician anesthesiologist is an MD or a DO and has completed both medical school and anesthesia residency. A CRNA has completed nursing school, at least 2 years of clinical ICU nursing, and a masters or doctoral program in nurse anesthesia. A small number of anesthesia providers are trained AAs, anesthesia assistants; this training path is a master’s degree and includes 2 years of clinical training specific to anesthesia. Often anesthesiologists and nurse anesthetists work together in a team; in some areas, CRNAs work independently. AAs always work with anesthesiologist supervision. This book will refer to the “anesthetist” or “anesthesia provider” without reference to their degree: it does not matter, from a patient care or equipment perspective, which training pathway the anesthetist pursued. What will matter is the knowledge you have when you arrive to help them.
Emily Guimaraes
Matthew Davis
The Anesthesia Technician