Anesthesia may be defined as the use of a pharmacologic or non-pharmacologic method to reduce a patient's level of consciousness and/or sensitivity to pain or emotional stress during surgical, obstetrical and certain other medical procedures.

The use of anesthesia mandates monitoring through the continuous, periodic or intermittent evaluation of the patient's physical and/or mental status and reaction to the anesthetic process in order to ensure patient safety, effective conduct of the anesthetic process and generation of a standard anesthetic record of that event.

The administration of anesthesia constitutes the practice of medicine under Ohio law, and licensed allopathic and osteopathic physicians are legally authorized to administer anesthesia. In addition, licensed podiatrists may administer anesthesia provided that they use general anesthetics only in approved college of podiatry and in hospitals approved colleges of podiatry and in hospitals approved by the JCAHO or the AOA (Section 4731.51, Ohio Revised Code).

Ohio law also grants legal authority to administer anesthetics to two additional groups of licensed professionals: 1) certified registered nurse anesthetists (CRNA) when under the direction of and in the immediate presence of a licensed physician (Section 4731.35, Ohio Revised Code), and 2) regularly qualified dentists (Section 4731.36, Ohio Revised Code).1

The physician or podiatrist performing the procedure requiring anesthesia bears the responsibility to ensure that monitoring appropriate to the level of anesthesia and types of agents being used is carried out. This responsibility for ensuring that anesthesia is adequately monitored may only be transferred to another fully licensed physician or podiatrist. Monitoring activities themselves may be delegated to another person under the direction and supervision of that physician or podiatrist, provided, however, that the person performing the activities is both adequately trained to monitor and record all observations and to interpret the monitoring devices sufficiently to timely recognize any adverse reaction which might occur during anesthesia.

The level of monitoring must be determined by consideration of a number of factors, including the level of anesthesia, the risks associated with the particular agents used, the complexity of the procedures being performed, the condition of the particular patient and any other factor which may influence the risk to the patient.

The availability of emergency resuscitation and other support services must also be considered before performing a particular procedure or using a given level or type of anesthesia. While some procedures and anesthetic agents are sufficiently safe, reliable and predictable to justify their use in a non-hospital setting, others are inherently high risk or are known to cause highly variable and unpredictable reactions; these should only be performed or utilized when adequate support services for the known risks and adverse reactions are immediately available.

Failure to adequately assess the risks to the particular patient and to ensure adequate monitoring or to perform the procedure and provide the anesthesia in a setting conducive to patient safety may be considered the failure to maintain minimal standards of care in violation of Section 4731.22 (B)(6)(a), Ohio Revised Code, and may provide grounds for action against the responsible physician's license.

1 Residents participating in a residency training program accredited by the ACGME or AOA and graduates of a podiatric school participating in a residency program pursuant to Section 4731.36 (B), O.R.C., may also administer anesthesia if such administration is prescribed by or incidental to participation in the accredited program.

approved 6/16/93