Southwest General Health Center

Student - Anesthesia Assistant

Delineation of Approved Responsibilities

***All student documentation MUST be co-signed by the Supervising Physician***

*Supervising Physician must hold these privileges in order to supervise a student*

Able to Perform Independently Able to Perform with Direct Supervision*

Perform, Write Pre-Anesthetic Assessment I. ​General Anesthesia
Completion of Anesthesia record, including post- A. Monitoring and Administration of agents for induction
op note and maintenance of general anesthesia and MAC
Insertion of Peripheral IV lines ​ 1. Gaseous Agents
2. Intravenous agents
B. ​Emergence of patients from general anesthesia, including
​extubation
II. ​Regional and Local Anesthesia
A. Administration of and Monitoring patients under regional
​nerve blocks
​1. Spinal, Epidural
​2. Peripheral Nerve Blocks
​3. Local infiltration

III. ​Related Procedures

​1. Placement of arterial lines ​
​2. Placement of central lines ​
3. Monitoring of patients with arterial and central lines ​

C. Management of the airway, including intubation and LMA ​

D. Cardiopulmonary support of the patient in the OR

​1. Fluid resuscitation
​2. Blood product administration ​
​3. Cardiovascular drug administration by infusion or bolus
4. Ventilator management
​5. CPR
E. Ultrasound for placement of lines and blocks ​

_______________________________________ ​_______________________________________
A.A. Student ​ John Bologna, MD - Supervising Physician

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11/10/15 ​ ​_______________
Date ​Date

_______________________________________ ​_ ______________________________________
Marilyn McNamara, MD ​Mark Panigutti, MD
Vice President, Medical Affairs ​President, Medical Staff
_______________________________________ ​_ ______________________________________
Marilyn McNamara, MD ​Mark Panigutti, MD
Vice President, Medical Affairs ​President, Medical Staff
​

_______________ ​_______________
Date ​Date