Certified Registered Nurse Anesthetist (CRNA)

Nurse anesthetists have roots that go as far back as the 1860s when they administered anesthesia to wounded soldiers during the Civil War. A Certified Registered Nurse Anesthetist (CRNA) has the very important role of providing anesthesia to a patient about to undergo surgery. Certification for the occupation of nurse anesthetist has been a requirement since 1945. To practice as a nurse anesthetist anywhere in the United States, passing the CRNA national examination is compulsory.

In order to be eligible to take the national certification examination and to become a Certified Registered Nurse Anesthetist (CRNA), a candidate must:

• Have a current and unrestricted license as a professional Registered Nurse (RN).
  
• Complete a nurse anesthesia educational program accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs within two years of taking the examination.
  
• Submit an examination application form.
  
• Submit an official transcript of performance in an accredited nurse anesthesia educational program.
  
• Submit a digitalized photo, taken within six months of the examination date, along with a signed authentication of the applicant’s identity form.
  
• Never have had a license revoked, restricted, suspended, or limited by any state. The license must never have been surrendered and it cannot be the subject of a pending action or investigation.
  
• Not currently suffering from a mental or physical condition that might interfere with the practice of nurse anesthesia.
  
• Not currently suffering from drug or alcohol addiction or abuse.
  
• Never convicted of or currently under indictment for any felony.
  
• Never been the subject of any documented allegations of misconduct, incompetent practice, or unethical behavior.
  
• Never been the subject of a disciplinary action, has never been placed on probation, suspended, or dismissed from a nurse anesthesia educational program for unethical behavior, questions of academic integrity, or documented evidence of cheating.
  
• Sign a waiver of liability and agreement of authorization, confidentiality, and nondisclosure statement.

An outline of content that is covered on the examination is detailed below:

Basic sciences: 25 percent

Anatomy, physiology, and pathophysiology

• Cardiovascular
• Respiratory
• Central nervous system
• Musculoskeletal
• Endocrine
• Renal
• Hematologic
• Gastrointestinal
• Immune

Pharmacology

• General principles
• Inhalation anesthetics
• Intravenous agents
• Local anesthetics
• Muscle relaxants
• Antagonists
• Neuraxial analgesics
• Anticholinergics and cholinergic agonists
• Cyclooxygenase inhibitors
• Sympathomimetics
• Digitalis and related drugs
• Alpha and beta receptor antagonists
• Antihypertensives
• Antidysrhythmics
• Calcium channel blockers
• Bronchodilators
• Psychopharmacologic therapy
• Prostaglandins
• Histamine receptor antagonists
• Serotonin antagonists
• Insulin
• Oral hypoglycemics
• Diuretics
• Antacids
• Gastrointestinal prokinetic medications
• Anticoagulants
• Antimicrobials
• Chemotherapeutics
• Antiepileptic drugs
• Antiparkinsonian drugs
• Drugs used to treat lipid disorders
• Herbal remedies and dietary supplements
• Minerals and electrolytes
• Dantrolene
• Corticosteroids
• Tocolytics
• Uterotonics

Equipment, instrumentation, and technology: 10 percent

Anesthetic delivery systems

• High and low pressure gas sources
• Regulators and manifolds
• Flow meters, valves, and floats
• Vaporizers
• Proportioning systems
• Pressure failure safety devices
• Fail-safe devices
• Ventilators
• Carbon dioxide absorbents
• Anesthetic circuits
• Pneumatic and electronic alarm devices

Airway devices

• Face masks
• Laryngoscope
• Endotracheal tube
• Endobronchial tube
• Airways
• Tracheostomy tubes
• Laryngeal mask airway
• Intubating laryngeal mask airway
• Jet ventilation
• Lighted stylet

Monitoring devices

• Central nervous system
• Cardiovascular
• Pulmonary and airway monitoring
• Peripheral nerve stimulator
• Urinary output monitoring
• Temperature monitoring
• Maternal and fetal monitoring devices

Basic principles of anesthesia: 30 percent

(Preoperative assessment and patient preparation, and post-anesthesia care and respiratory therapy)

Fluid and blood replacement

• Fluid therapy
• Hemotherapy

Positioning

• Prone
• Supine
• Lithotomy
• Lateral
• Sitting
• Beach chair
• Trendelenburg
• Reverse trendelenburg

Interpretation of data

• Lab tests
• Diagnostic data
• Intraoperative monitoring data

Airway management

• Mask
• Intubation
• Cricothyrotomy
• Fiber-optics

Local and regional anesthesia

• Infiltration
• Topical
• Regional blocks

Post-operative pain management

• Epidural analgesia
• Infiltration nerve blocks
• Intrathecal narcotics
• PCA management
• Epidural steroids

Advanced principles of anesthesia: 30 percent

Surgical procedures and procedures related to organ systems

• Intra-abdominal
• Extrathoracic
• Extremities
• Genital and urologic
• Head
• Intrathoracic
• Neck
• Neuroskeletal
• Vascular
• Diagnostic and therapeutic

Pediatrics

• Anatomy, physiology, and pathophysiology
• Pharmacology
• Anesthesia techniques and procedures

Obstetrics

• Anatomy, physiology, and pathophysiology
• Pharmacology
• Anesthesia techniques and procedures

Geriatrics

• Anatomy, physiology, and pathophysiology
• Pharmacology
• Anesthesia techniques and procedures

Obesity

• Anatomy, physiology, and pathophysiology
• Pharmacology
• Anesthesia techniques and procedures

Chronic pain management

• Anatomy, physiology, and pathophysiology
• Pharmacology
• Anesthesia techniques and procedures

Professional issues: 5 percent

• Legal
• Research and quality improvement
• Professional practice standards
• Patient safety