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Related Concept Videos

Local Anesthetics: Adverse Effects01:12

Local Anesthetics: Adverse Effects

447
While local anesthetics are generally safe and well-tolerated, they can occasionally cause adverse effects that vary in severity. Local anesthetics can induce toxicity at two distinct levels. They can either produce local effects through direct contact with the neural elements or be absorbed into the bloodstream from the injection site, leading to systemic effects.
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
447
Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

452
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
452
Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

664
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
664
Local Anesthetics: Pharmacokinetics01:13

Local Anesthetics: Pharmacokinetics

789
The potency and duration of action of local anesthetics (LAs) are determined by their pharmacokinetics. Pharmacokinetics describes how LAs are absorbed, distributed, metabolized, and eliminated from the body. When administered to the vascular tissues, LAs are quickly absorbed and enter the systemic circulation, reducing their localized effects. Adding vasoconstrictors such as epinephrine to LAs reduces their absorption into the systemic circulation, making them clinically effective. The...
789
Local Anesthetics: Common Agents and Their Applications01:23

Local Anesthetics: Common Agents and Their Applications

473
Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...
473
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

452
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
452

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Assessing Changes in Volatile General Anesthetic Sensitivity of Mice after Local or Systemic Pharmacological Intervention
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Assessing CRNA Knowledge of Local Anesthetic Systemic Toxicity Treatment.

Lapio Tkach1, Laura Baillie2, Jamison Newby3

  • 1Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

AANA Journal
|October 3, 2023
PubMed
Summary

Certified registered nurse anesthetists (CRNAs) demonstrated low knowledge of 2020 Local Anesthetic Systemic Toxicity (LAST) guidelines, averaging 47.3%. Access to guidelines significantly improved knowledge, highlighting the need for cognitive aids in LAST management.

Keywords:
LASTknowledgelocal anesthetic toxicitylocal anesthetics

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Area of Science:

  • Anesthesiology
  • Patient Safety
  • Pharmacology

Background:

  • Local anesthetic systemic toxicity (LAST) is a rare but life-threatening complication.
  • Effective management of LAST is critical for preventing severe patient outcomes.
  • Anesthesia providers must be knowledgeable about current LAST treatment guidelines.

Purpose of the Study:

  • To evaluate certified registered nurse anesthetists' (CRNAs) knowledge of the 2020 American Society of Regional Anesthesia and Pain Medicine (ASRA) LAST treatment guidelines.
  • To investigate the correlation between CRNAs' exposure to local anesthetics and their understanding of LAST management.
  • To identify factors influencing CRNA knowledge of LAST protocols.

Main Methods:

  • A quantitative descriptive study utilizing a national electronic survey distributed by the American Association of Nurse Anesthetists.
  • 184 practicing CRNAs participated in the survey.
  • Survey assessed knowledge of 2020 ASRA LAST guidelines and factors related to local anesthetic exposure.

Main Results:

  • CRNAs achieved an average knowledge score of 47.3% regarding LAST guidelines.
  • While 97.8% recognized the importance of early lipid emulsion, 54.3% were unaware of recommended epinephrine dosing.
  • No significant relationship was found between frequency of local anesthetic exposure and knowledge level.
  • CRNAs with immediate access to written or electronic guidelines demonstrated significantly higher knowledge scores (P = .049).

Conclusions:

  • Significant knowledge gaps exist among CRNAs concerning the 2020 ASRA LAST guidelines.
  • Immediate access to cognitive aids or guidelines is associated with improved LAST knowledge.
  • Implementing cognitive aids may enhance CRNA preparedness and adherence to critical LAST management steps.