In the United States, anesthesiologist assistants work alongside anesthesiologists to deliver and monitor anesthesia for patients undergoing procedures. The profession involves rigorous training and regulation and is well integrated into patient care. Nationally, more states are adopting anesthesiologist assistant licensure, with significant support from anesthesiologists.
The anesthesiologist assistant profession originated in the late 1960s, when three academic anesthesiology chairmen—Joachim Gravenstein, John Steinhaus, and Perry Volpitto—sought a solution to a growing shortage of anesthesia providers (Pinegar & Townsend, 2019; American Society of Anesthesiologists [ASA], 2022). Their work led to the first anesthesiologist assistant training programs at Emory University and Case Western Reserve University, in 1969 (ASA, 2022). Anesthesiologist assistant education today occurs at the graduate level, culminating in a master’s degree over 24 to 29 months and requiring a premedical undergraduate background in biology, chemistry, physics, and calculus (Pinegar & Townsend, 2019; ASA, 2022). Programs are accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP, n.d.) and must be affiliated with a medical school; students complete a minimum of 2,000 clinical hours, or roughly 600 cases, spanning airway management, regional anesthesia, and central line placement (Pinegar & Townsend, 2019; ASA, 2022). Graduates must pass a certifying exam from the National Commission for Certification of Anesthesiologist Assistants and complete continuing education and periodic recertification thereafter (CAAHEP, n.d.; ASA, 2022).
In Oklahoma, the profession is governed by the Oklahoma Anesthesiologist Assistant Act, enacted in 2008 and most recently amended in November 2024 (Oklahoma Anesthesiologist Assistant Act, 2024). The Act requires anesthesiologist assistants to practice under the direct, on-site supervision of an anesthesiologist who remains immediately available, and it obligates every supervising anesthesiologist or group to file a written protocol with the State Board of Medical Licensure and Supervision. Oklahoma law permits anesthesiologist assistants to obtain patient histories, manage airways, administer anesthetic drugs, assist with epidural and spinal procedures, and participate in post-anesthesia recovery care, among other delegated tasks. Licensure also requires NCCAA certification, advanced cardiac life support certification, recommendation letters from supervising physicians, and proof of malpractice coverage. A 2024 amendment created an Anesthesiologist Assistants Advisory Committee to counsel the state medical board on licensure and education matters (Oklahoma Anesthesiologist Assistant Act, 2024).
Nationally, anesthesiologist assistants can practice in a subset of states, though the number has grown in recent years, and training programs and open roles have expanded accordingly. In 2018, they could practice in only sixteen states and the District of Columbia (Sun et al., 2018), including Oklahoma since 2008. By 2022, the ASA reported that figure had grown to twenty-one states, districts, or territories, reflecting steady legislative expansion through either formal licensure, as in Oklahoma, or delegatory authority granted to supervising physicians (ASA, 2022).
Concerns about expanding anesthesiologist assistant practice have often centered on whether outcomes might be negatively impacted. Sun and colleagues addressed this directly, analyzing 443,098 Medicare surgical admissions and comparing care teams supervising anesthesiologist assistants to those supervising nurse anesthetists. After adjusting for patient characteristics, comorbidities, and hospital-level factors, the researchers found no statistically significant differences in inpatient mortality, length of stay, or spending between the two models (Sun et al., 2018).
Missouri’s program at the University of Missouri-Kansas City applies similar requirements within the same care-team philosophy, underscoring that Oklahoma’s model reflects a broader, standardized national approach to anesthesiologist assistant practice (Pinegar & Townsend, 2019).
References
- American Society of Anesthesiologists. (2022, October 26). Statement on Certified Anesthesiologist Assistants (CAAs): Description and practice. https://www.asahq.org/standards-and-practice-parameters/statement-on-certified-anesthesiologist-assistants-description-and-practice
- Commission on Accreditation of Allied Health Education Programs. (n.d.). Anesthesiologist assistant.https://www.caahep.org/profession-description-and-certification-information/anesthesiologist-assistant
- Oklahoma Anesthesiologist Assistant Act, 59 Okla. Stat. §§ 3201–3209 (2024). Oklahoma State Board of Medical Licensure and Supervision. https://www.okmedicalboard.org/anesthesiologist_assistants/download/499/AnesAsstLaw.pdf
- Pinegar, M., & Townsend, T. (2019). The role of anesthesiology assistants in the anesthesiology patient care team. Missouri Medicine, 116(1), 63–66. https://mosmedicalreview.com/
- Sun, E. C., Miller, T. R., Moshfegh, J., & Baker, L. C. (2018). Anesthesia care team composition and surgical outcomes. Anesthesiology, 129(4), 700–709. https://doi.org/10.1097/ALN.0000000000002275
