There has been controversy in the field of anesthesia regarding whether certified registered nurse anesthetists (CRNAs) or anesthesiologists provide safer and more cost-effective care. This study was done to compare CRNAs with and without supervision of an anesthesiologist and how it affects the cost and safety of anesthesia delivery. The results of this systematic review could provide information to affect policies regarding who is responsible for providing anesthesia, with safety and cost as the necessary variables. Twenty articles, published between the years 1999 and 2017, retrieved from the databases PubMed and Cinahl were analyzed and synthesized as part of this review. Studies that examined safety and cost effectiveness among CRNAs and anesthesiologists were included in this review. All but one article was from the US. Sample sizes in the studies ranged from 27 to over 1,000,000 participants ranging from patient chart reviews to surveys. Findings of this review showed that there was not enough evidence to conclude if CRNAs are more cost effective or provide better quality care alone or supervised
