[Nurse anesthetist in France]

We present the system of nurse anesthetist (Infirmier Anesthésiste Diplômé d'Etat: IADE) in France to the community of Japanese anesthesiologists. This French system with 70 years' history is older than the Japan Society of Anesthesiologists itself. There are 7000 nurse anesthetists in France now and the number of nurse anesthetists increases by 450-500 each year. Training to become a nurse anesthetist requires at least two years' experience as a general nurse and the general nurse must pass an examination after two years' special training in an anesthetistic nurse school to acquire the national certification. The nurse anesthetist's profession is regulated by French law. They work in a team with certified anesthesiologists. They can perform many kinds of anesthetic tasks including tracheal intubation and insertion of arterial catheter under the responsibility and supervision of certified anesthesiologists. The nurse anesthetists are not allowed to perform spinal, epidural, conduction and local anesthesia, although they can maintain these anesthesia and control these methods, e.g., by injecting local anesthetic agents through epidural catheter, following a specified prescription. The nurse anesthetists are not allowed to insert central venous and pulmonary artery catheters, although they can manage them. They are allowed to administer inhalation anesthetic agents, and inject venous anesthetic agents, muscle relaxants, their antagonists, and opioids by their own initiatives, but the decision for the use of catecholamine and emergency drugs is reserved to certified anesthesiologists. The nurse anesthetists perform other tasks preparing and checking anesthetic agents and equipment such as anesthetic machine, monitor, and defibrillator everyday, and sometimes use autologous blood recovery systems. The relationship between the certified anesthesiologist and the nurse anesthetist is marked by mutual respect, confidence and cooperation at each step of the anesthetic management, from induction to recovery of anesthesia. We believe that it is very safe for the patients to undergo anesthesia performed by nurse anesthetists under the control of certified anesthesiologists. We suggest that the introduction of the system equivalent to the French concept and improved training of nurse anesthetists can be the solution to overcome our current shortage of certified anesthesiologists in Japan.