Can an RN administer general anesthesia?

allnurses Guide · Dec 5, 2013

In a private office, you can get away with a lot of stuff under your MD's direction, which is why so many offices don't even have nurses anymore.

In my hospital, there have been a lot of directives and policies about anesthesia drugs, especially Propafol and Ketamine. Our BON scope is pretty adamant about RNs not giving anesthesia; in the ED we don't even push it when the doc is right there during a conscious sedation, we hand the syringe to them.

Best place to find your answer is call the BON, or go on line to look up the scope of practice for your state.

Anna Flaxis, BSN, RN · Dec 5, 2013

I highly doubt you were given general anesthesia at the oral surgeon's office. More likely, you were given "procedural sedation". What an RN can and cannot do is governed by your State's Nurse Practice Act. These differ from state to state, but where I practice, yes, an RN can administer procedural sedation and local anesthetics, providing certain criteria are met.

Tinkk · Dec 5, 2013

It was definitely general anesthesia - they completely knocked me out. I was personally told by all the docs and nurses that they were giving me both local and general anesthetics. Also had nitrous oxide. Before the surgery they sent directions about not eating before the surgery because of the "general" anesthesia.

elkpark · Dec 5, 2013

I highly doubt you were given general anesthesia at the oral surgeon's office. More likely, you were given "procedural sedation".

(That's what I was thinking, also.)

nurseprnRN, BSN, RN · Dec 5, 2013

It was definitely general anesthesia - they completely knocked me out. I was personally told by all the docs and nurses that they were giving me both local and general anesthetics. Also had nitrous oxide. Before the surgery they sent directions about not eating before the surgery because of the "general" anesthesia.

That might be what they tell patients, but it's very likely not what they did. They may think, for example, that IV sedation that makes the patient compliant and amnesiac for the procedure constitutes a general anesthetic, but they would be wrong.

Altra, BSN, RN · Dec 5, 2013

We do procedural sedation daily in my emergency department, and if you ask any patient who has undergone one of these procedures they would probably say they were "out" or "fully under" or some similar term. However, what we have given them is mostly definitely NOT a general anesthetic.

You can google something like "difference between general anesthesia and moderate sedation" and get some useful information.

roser13, ASN, RN · Dec 5, 2013

Trust us, you were NOT given general anesthesia in a doctor's office without an anesthesiologist or CRNA. That would include a complete paralytic and airway support in the form of an ETT, LMA or nasal intubation.

The dentist/oral surgeon may have called it a general but you had IV sedation.

Valhalla_RN · Dec 5, 2013

I am sure you were given "conscious sedation". I had this done during my wisdom tooth removal at my oral surgeon's office. It was done with propofol. You are given it IV push (in my case, by an anesthesiologist, not an RN) and you remember NOTHING. Next thing I knew I was done, and I asked them "are you guys ready to start?". The nurse laughed and said we were already done. It produces amnesia. You do need to be NPO for propofol. I was also give local anesthesia for pain control. I felt nothing and remembered nothing.

So can RNs administer anesthesia? Not in this office, but I'm not sure about other office settings. As others pointed out, office settings allow RNs to do more and more under the MD's directive. I'm in Canada and I haven't heard of RNs doing this here.

Esme12, ASN, BSN, RN · Dec 5, 2013

It was definitely general anesthesia - they completely knocked me out. I was personally told by all the docs and nurses that they were giving me both local and general anesthetics. Also had nitrous oxide. Before the surgery they sent directions about not eating before the surgery because of the "general" anesthesia.

Just because you were not allowed to eat before the procedure doesn't mean you had general anesthesia. Once you graduate high school and get into nursing school you will learn that there are different regulations for different things....and Yes a nurse can take an x-ray in certain settings and administer certain local anesthetics in certain situation under certain circumstances.

You were given conscious sedation which is done all the time under a MD direction. There are some states that have specific guidelines about propofol...however in am "outpatient" procedural setting can be done by a nurse.

The American College of Emergency Physicians (ACEP) defines procedural sedation as "a technique of administering sedatives or dissociative agents with or without analgesics to induce a state that allows the patient to tolerate unpleasant procedures while maintaining cardiorespiratory function. Procedural sedation and analgesia (PSA) is intended to result in a depressed level of consciousness that allows the patient to maintain oxygenation and airway control independently."
The number of noninvasive and minimally invasive procedures performed outside of the operating room has grown exponentially over the last several decades. Sedation, analgesia, or both may be needed for many of these interventional or diagnostic procedures. Medications that elicit pharmacologic effects, such as anxiolysis, amnesia, or analgesia, provide patient comfort during various procedures. Understanding the efficacy and safe administration of these agents is essential to the practitioner performing interventional procedures.

Medscape: Medscape Access medscape requires registration but it is free.

Understanding the various depths of sedation is essential to provide safe and effective procedural sedation and analgesia. The ASA has defined the various sedation depths. As defined below, minimal sedation or moderate sedation is used for PSA.

Minimal sedation (anxiolysis) is as follows:

Response to verbal stimulation is normal.
Cognitive function and coordination may be impaired.
Ventilatory and cardiovascular functions are unaffected.

Moderate sedation/analgesia (formerly called conscious sedation) is as follows:

Depression of consciousness is drug-induced.
Patient responds purposefully to verbal commands.
Airway is patent, and spontaneous ventilation is adequate.
Cardiovascular function is usually unaffected.

Deep sedation/analgesia is as follows:

Depression of consciousness is drug-induced.
Patient is not easily aroused but responds purposefully following repeated or painful stimulation.
Independent maintenance of ventilatory function may be impaired.
Patient may require assistance in maintaining a patent airway.
Spontaneous ventilation may be inadequate.
Cardiovascular function is usually maintained.

General anesthesia is as follows:

Loss of consciousness is drug-induced, where the patient is not able to be aroused, even by painful stimulation.
Patient's ability to maintain ventilatory function independently is impaired.
Patient requires assistance to maintain patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function.
Cardiovascular function may be impaired.

SwansonRN · Dec 5, 2013

Agreed with everyone else, I can almost guarantee you were given conscious sedation, not general anesthesia. My wisdom teeth were impacted so I was given IV fentanyl+versed for my extraction. You feel like you were put under because of the amnesia, but with conscious sedation you can actually follow simple commands, answer questions, and protect your own airway. And yes nurses can administer conscious sedation, I do routinely where I work, but everywhere is a little different.

0.adamantite · Dec 5, 2013

I have nothing to add but wow, I had my wisdom teeth removed a long time ago and I wondered about that. I too have no recollection of the events. It was a nurse who administered the medication. All I remember is I HATED the way they made me felt initially. Wonder what I said/did while they were performing the extraction.

I had general anesthesia and it was a much bigger "to do," which makes more sense now.