评估CRNA对局部麻醉系统性毒性治疗的知识
Lapio Tkach1, Laura Baillie2, Jamison Newby3
1Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
AANA journal
|October 3, 2023
概括
认证注册护士麻醉师 (CRNA) 对2020年局部麻醉系统毒性 (LAST) 准则的了解很低,平均为47.3%. 获得指导方针显著改善了知识,突出了在LAST管理中需要认知辅助的需要.
科学领域:
- 麻醉学 麻醉学
- 患者安全 患者安全
- 药理学 药理学是指药理学的学科.
背景情况:
- 局部麻醉系统性毒性 (LAST) 是一种罕见但危及生命的并发症.
- 对LAST的有效管理对于预防患者严重后果至关重要.
- 麻醉提供者必须了解当前的LAST治疗指南.
研究的目的:
- 评估认证注册护士麻醉师 (CRNA) 对2020年美国区域麻醉和疼痛医学学会 (ASRA) LAST治疗指南的知识.
- 调查CRNA暴露于局部麻醉剂和他们对LAST管理的理解之间的相关性.
- 确定影响CRNA对LAST协议知识的因素.
主要方法:
- 一项使用美国麻醉护士协会分发的全国电子调查进行的定量描述性研究.
- 184名实践CRNA参与了调查.
- 调查评估了2020年ASRA LAST指南的知识以及与局部麻醉剂暴露相关的因素.
主要成果:
- 关于LAST指南,CRNA的平均知识得分为47.3%.
- 虽然97.8%的人认识到早期脂质乳液的重要性,54.3%的人不知道推的上腺素剂量.
- 在局部麻醉剂暴露频率和知识水平之间没有发现显著的关系.
- 具有立即访问书面或电子指南的CRNA显示了显著更高的知识分数 (P = .049).
结论:
- 关于2020年ASRA LAST指南,CRNA之间存在重大知识差距.
- 立即获得认知辅助或指导方针与改善LAST知识有关.
- 实施认知辅助可以提高CRNA准备能力和遵守关键的LAST管理步骤.
相关概念视频
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...
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 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...
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 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: 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 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...
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 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...
One of the advantages of...
452


