Advances in pharmaceuticals, technology and training for nurse anesthetists and physician anesthesiologists have contributed significantly to improvements in patient safety. According to the Institute of Medicine (IOM), AANA, and the American Society of Anesthesiologists, anesthesia care is nearly 50 times safer than it was just 30 years ago, and in a 1999 report, the IOM identified anesthesia as one of the safest healthcare specialties. Today, perioperative deaths attributed to anesthesia occur approximately once for every 250,000-300,000 anesthetics provided, representing a dramatic increase in patient safety despite an aging U.S. population and older, sicker patients being treated in operating rooms nationwide. Numerous outcomes studies have confirmed the safety record of CRNAs and demonstrated that there is no difference in the quality of anesthesia care provided by CRNAs and physician anesthesiologists.