Safety Of Regional Anesthesia Research Articles

Pharmacokinetics in regional anesthesia.

Pharmacokinetics of local anesthetics are one of the main determinants of success and safety of regional anesthesia and comprise local and systemic distribution phases. This review aims to summarize the latest research findings on this topic in the context of various regional blocks performed for different surgeries and patient populations. Research into local kinetics and systemic absorption of local anesthetics has chiefly been focused on novel fascial plane blocks, especially the erector spinae plane block, as these are increasingly adopted for regional anesthesia and pain management. As their clinical efficacy is very dependent on injection of large volumes of local anesthetic, doses over typically recommended limits are often administered. Fascial plane blocks are the regional anesthesia techniques in need of the most pharmacokinetic characterization, not only to better understand their complex mechanisms of action but also to avoid harm from excessive doses of local anesthetics. Further mapping of risk factors for systemic toxicity from administration in different block sites is crucial. Extremes of age and pregnancy are vulnerable patient populations but in whom regional anesthesia, including novel techniques, has been performed with few complications.

Visualizing Pain Management: A Comprehensive Examination of Radiological Techniques in Regional Anesthesia

This review explores the pivotal role of radiological techniques in enhancing precision and safety in regional anesthesia, aiming to provide a comprehensive understanding of their applications and advancements. The objectives are to evaluate the historical progression, current state, and future prospects of imaging modalities, including ultrasound, fluoroscopy, MRI, and CT scans, in the context of regional anesthesia. The methodology involves an extensive literature review, encompassing studies, case reports, and clinical trials related to the use of radiological techniques in regional anesthesia. Emphasis is placed on the outcomes of ultrasound-guided techniques, fluoroscopy applications, and the use of advanced imaging modalities, with a focus on their impact on procedural accuracy and patient outcomes. Key findings highlight the transformative influence of ultrasound guidance in peripheral nerve blocks and central neuraxial techniques, offering real-time precision. Fluoroscopy, integral in epidural and spinal anesthesia, is discussed in terms of its real-time visualization capabilities and recent technological advancements. MRI and CT scans, providing detailed anatomical imaging, contributes to evaluating anesthetic spread effectively. Contrast studies for visual confirmation and emerging technologies are also explored, paving the way for future innovations.

Obstetrik hastalarda, SARS-CoV-2 spinal sonrası hipotansiyon için risk faktörü müdür?

Background: Since the onset of COVID-19, recommendations suggest the use of neuraxial anesthesia, over general anesthesia for cesarian section to avoid the risks of aerosolization associated with intubation and extubation. But the safety of performing spinal anesthesia is unclear especially for post spinal hypotension, during the presence of active COVID-19. According to a few studies there was a controversial discussion about the safety of regional anesthesia. In this study we aimed to compare the incidence of hypotension in COVID-19 pregnant patients between non-COVID 19 pregnant patients in the literature to see if the spinal anesthesia is safe or if it poses an additional risk.
 Materials and Methods: Medical records of COVID-19 pregnant women for cesarean section from the beginning of the pandemic up to December 2020 were retrospectively retrieved. All the demographic-vital data, including systolic and diastolic blood pressure (SBP-DBP), ephedrine-atropine doses, infusion volumes, and nausea and vomiting were retrospectively analyzed. 
 Results: Spinal anesthesia induced hypotension was seen 54 of the patients (21,69%). And vasopressors (Ephedrine) were used to all hypotensive patients. Demographic data’s, the amount of bupivacaine and crystalloid volume which used before the spinal anesthesia showed no differences between hypotensive and non-hypotensive patients. 
 Conclusion: This is the first retrospective study which shows 249 COVID 19 patients’ data in one center that no significant difference was seen in the incidence of hypotension associated with spinal anesthesia for COVID-19 cesarean section compared to non-COVID group in literature. We recommend using of regional anesthesia safely for patients and anesthesiologists during active COVID-19 patients.

Chronic pain patients and time to sustained acceptable pain scores after major surgery - A retrospective registry analysis

Study objectiveWe tested the hypothesis that pre-existing chronic pain is associated with prolonged time to reach sustained acceptable pain scores after major surgery. DesignRetrospective study using the German Network for Safety in Regional Anaesthesia and Acute Pain Therapy registry. SettingOperating rooms and surgical wards. Patients107,412 patients recovering from major surgery who were cared for by an acute pain service. 3.3% of the treatments were in patients who reported chronic pain with functional or psychological impairment. Interventions and measurementWe compared time to sustained adequacy of postoperative pain control defined by numeric rating scores <4 at rest and with movement in patients with and without chronic pain using an adjusted cox proportional hazard regression model and Kaplan-Meier analysis. The observation period was censored at 10 days and propensity score matching was used as a sensitivity analysis. Main resultsPostoperative pain at rest took significantly longer to resolve in patients with chronic pain than in those without (adjusted hazard ratio HR 1.42, 95% CI 1.36–1.49, P < 0.001). Postoperative pain with movement took even longer to resolve in patients with chronic pain (adjusted HR 1.65, 95%CI 1.56–1.75, P < 0.001). ConclusionsPatients with chronic pain sustain more surgical pain than those without, and the pain takes longer to resolve. Clinicians providing postoperative pain management should consider the special needs of chronic pain patients.

Comparison of the efficacy of erector spinae plane block according to the difference in bupivacaine concentrations for analgesia after laparoscopic cholecystectomy: a retrospective study.

Laparoscopic cholecystectomy (LC) is a noninvasive surgery, but postoperative pain is a major problem. Studies have indicated that erector spinae plane block (ESPB) has an analgesic effect after LC. We aimed to compare the efficacy of different ESPB anesthetic concentrations in pain control in patients with LC. This retrospective study included patients aged 20 to 75 years scheduled for LC with the American Society of Anesthesiologists physical status classification I or II. ESPB was administered using 0.375% bupivacaine in group 1 and 0.25% in group 2. Both groups received general anesthesia. Postoperative tramadol consumption and pain scores were compared and intraoperative and postoperative fentanyl requirements in the postanesthesia care unit (PACU) were measured. Eighty-five patients were included in this analysis. Tramadol consumption in the first 12 hours, second 12 hours, and total 24 hours was similar between groups (p>0.05). The differences between postoperative numeric rating scale (NRS) scores at rest did not differ significantly. The postoperative NRS scores upon bodily movement were not statistically different between the two groups, except at 12 hours. The mean intraoperative and postoperative fentanyl requirements in the PACU were similar. The difference in the requirement for rescue analgesics was not statistically significant (p=0.788). Ultrasound-guided ESPB performed with different bupivacaine concentrations was effective in both groups for LC analgesia, with similar opioid consumption. A lower concentration of local anesthetic can be helpful for the safety of regional anesthesia and is recommended for the analgesic effect of ESPB in LC.

Antithrombotic drugs and the risk of bloody punctures in regional anesthesia - a retrospective registry analysis

IntroductionThe risk of bleeding during regional anesthesia implementation in patients on antithrombotic therapy remains poorly characterized. We; therefore, analyzed bloody tap rates and adjusted ORs comparing patients who take antithrombotic...

TEN-YEAR FOLLOW-UP OF QUALITY IN REGIONAL ANESTHESIA AND ANALGESIA IN OBSTETRICS OBSTETRIC REGIONAL ANESTHESIA: IMPROVING QUALITY.

Quality assessment of provided healthcare is becoming a standard in numerous health institutions worldwide, which is beneficial for both the patient and the institution. In order to achieve this standard, it is necessary to develop quality indicators in all segments of healthcare. Postdural puncture headache is a common complication following neuraxial blocks, especially in obstetric anesthesia. If severe, it is a cause of emotional and psychological distress and must be treated by a blood patch. The aim of this study was to determine whether the number of these complications is reduced when blood patch frequency is monitored and analyzed and to assess the effect of countermeasures in order to improve the quality and safety of regional anesthesia in obstetrics. Before 2009 and during that year at the University Hospital Sveti Duh, there had been a large number of severe postdural puncture headaches after spinal anesthesia and epidural analgesia treated by a blood patch in 6.12% of cases. After noticing the rising number of blood patches, we decided to analyses data every year. We recorded all blood patches injected to obstetric patients within the period of nine year, from 2009 to 2018 and concurrently we introduced a set of measures to improve the quality of neuraxial blocks, such as the use of atraumatic 26 or 27-gauge pencil-point spinal needles and modern neuraxial blockade protocols. Data were collected from anesthesiology and gynecology protocols and analyzed with MedCalc software, version 18.1.2. The frequency of blood patch applications has been reduced from 6.12% to 0.30%, which is statistically significant. The percentage of placed epidural catheters for vaginal birth increased from 21% in 2009 to 38% in 2018. Although not statistically significant, the number of pregnant women undergoing a caesarean section is also growing, while the total number of births is falling. The proportion of cesarean sections in spinal anesthesia varies from year to year. A statistically significant decrease in the number of installed blood patches clearly indicates the positive effect of measures taken to improve quality, which could contribute to the growing interest of pregnant women in childbirth in epidural analgesia. The number of placed epidural catheters is increasing despite the decline in the total number of deliveries and the increase in the number of deliveries completed by cesarean section. Monitoring the incidence of severe post-puncture headaches treated with blood patches has shown great progress in improving the quality and safety of regional anesthesia and analgesia in our institution, so we believe that monitoring the number of blood patches could serve as an indicator of regional anesthesia and analgesia in obstetrics. Monitoring the number of blood patches shows that the frequency of post-puncture headaches does not correlate only with the type of needle or epidural catheter used for neuroaxial blocks, but is also a sensitive indicator of any deviations from the achieved standards. Furthermore, it indicates the need for careful analysis of causes in order to adopt and implement appropriate countermeasures.

Efficacy and safety of regional anesthesia after thoracoscopic lobectomy

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Определить оптимальную схему обезболивания пациентов после видеоторакоскопических лобэктомий. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В проспективное рандомизированное исследование включены 54 пациента с диагнозом рака легкого I—II стадии, I—IV функционального класса по ASA, которым выполнена видеоторакоскопическая анатомическая резекция легких с лимфодиссекцией. Пациенты распределены в три группы в зависимости от метода обезболивания: 18 пациентов — с продленным паравертебральным блоком (ПВБ); 18 пациентов — с интраоперационной межреберной блокадой (МРБ); 18 пациентов — без применения регионарных методов обезболивания, с системным введением анальгетических препаратов. В первые 72 ч после операции собирали данные об интенсивности болевого синдрома по визуально-аналоговой шкале (ВАШ) в покое и при кашле. Учитывали уровень гормонов стресса, объем форсированного выдоха за 1 с (ОФВ₁) в динамике, газовый состав артериальной крови, дозу анальгетиков, осложнения, а также значения ВАШ и ОФВ₁ в день после удаления плеврального дренажа. <h3>РЕЗУЛЬТАТЫ</h3> У пациентов<b></b> группы с ПВБ оказались наименьшие значения ВАШ по сравнению с пациентами группы с МРБ и группы без применения регионарной анальгезии (<i>p</i>=0,03 и <i>p</i>=0,039 соответственно). МРБ показывает лучшее качество обезболивания в первые часы после операции по сравнению как с регионарной анальгезией, так и с ПВБ (<i>p</i>=0,064). Пациентам с ПВБ требовалась меньшая доза наркотических анальгетиков (<i>p</i>=0,014), чем пациентам двух других групп сравнения. Индекс оксигенации у пациентов группы с ПВБ оказался выше, чем у пациентов группы с МРБ (<i>p</i>=0,015) и группы без применения регионарных методов обезболивания. Не было осложнений у 60% пациентов группы с ПВБ, у 51% пациентов группы с МРБ и у 40% пациентов группы без применения регионарных методов обезболивания. <h3>ЗАКЛЮЧЕНИЕ</h3> У пациентов с продленным паравертебральным блоком отмечается лучшее качество обезболивания после видеоторакоскопических анатомических резекций легких, а также меньшее количество осложнений в послеоперационном периоде.

The lure of the Lüer connector: Non-Lüer connectors in regional anaesthesia.

Health service professionals do not have perfect vigilance. There will always be the possibility that a serious untoward incident can occur due to crossover injections of medication being administered via the wrong route. The universality of the Lüer connector made it very easy to connect several medical devices for different therapeutic uses. Although this was considered a bonus, it also showed the downside as a string of incidents, leading to permanent harm and even death, occurred, warranting actions to prevent the chance of misconnections and wrong-route injections. The International Organisation for Standardisation introduced specific ISO 80369 connectors for use in different medical systems, with the ISO 80369-6 series of standards specifically designed to improve safety in regional anaesthesia. Human error can never be completely eliminated, but the risk of a patient inadvertently suffering from an inadvertent wrong-route injection can be reduced through the use of new 'fit and no-fit' technology. This article focuses on the universality of the Lüer connector and the introduction of the newly engineered non-Lüer connectors, for specific use in medical systems.

Planning for Birth for a Patient With Hermansky-Pudlak Syndrome

Hermansky-Pudlak Syndrome (HPS) is an autosomal recessive disorder that affects 1 in 500,000–1,000,000 people worldwide. There are three elements of the disorder, including oculocutaneous albinism, disorder of ceroid metabolism, and platelet storage pool deficiency. Due to the platelet storage pool deficiency, risk of bleeding during labor and birth are significantly increased. A 25-year-old gravida 2, para 0101 pregnant woman presented at the maternal-fetal medicine office for a consult related to her diagnosis of HPS. The patient had confirmed HPS Type 1 by genetic testing. She also has ocular albinism and a history of blood transfusions for severe menorrhagia and anemia. The patient’s previous pregnancy was complicated by preterm labor, which ended in a cesarean for breech presentation, requiring a T incision. The patient received regional anesthesia with the previous delivery without adverse outcome and did not experience a postpartum hemorrhage. Collaboration among anesthesia, obstetrics, and hematology resulted in a birth plan that consisted of repeating coagulation studies on the day of surgery to determine type of anesthesia and need for desmopressin (DDAVP) prophylaxis or platelet transfusion before delivery. On the scheduled day of birth, hematology was consulted; platelets, activated partial thromboplastin time (APTT), fibrinogen, collagen epinephrine (EPI), platelet function interpretation, and Von Willebrand factor activity were drawn. Although coagulations studies were normal, hematology recommended general anesthesia for the cesarean due to risk of epidural hematoma and lack of definitive information on the safety of regional anesthesia in HPS. The patient gave birth via cesarean at 36 weeks and did not require prophylactic treatment with DDAVP or platelets. Patients with HPS need thoughtful birth planning and consultation with anesthesia and hematology to obtain the best possible outcome based on the limited evidence available. The delivery mode; anesthesia type; predelivery treatment, including DDAVP or platelet transfusion; and postpartum pain management should be thoroughly reviewed, discussed, and documented in the patient’s medical record to limit adverse events. Understanding HPS and the risk factors associated with it can help nurses better assess and care for patients affected with this syndrome.

Local Anesthetic Toxicity in the Geriatric Population.

This article provides a concise overview of local anesthetic systemic toxicity, its history, mechanisms, risk factors, prevention, clinical presentation, and treatment, with a special emphasis on issues specific to the geriatric population. The authors used MEDLINE, Scopus, and Google Scholar to search for original research articles (human and animal studies), registries data, case reports, review articles, and pertinent online publications using the combinations of the following search terms: local anesthetics, local anesthetic systemic toxicity, intralipid, lipid emulsion, Exparel, ultrasound-guidance, regional anesthesia, lidocaine, bupivacaine, ropivacaine, cocaine, procaine, tetracaine, levobupivacaine, liposomal bupivacaine, lignocaine. Local anesthetic systemic toxicity continues to occur despite the use of putatively less cardiotoxic formulations of local anesthetics and more common use of ultrasound guidance. The elderly appear to be at a disproportionately increased risk for toxicity owing to the presence of relevant comorbidities and decreased muscle mass. Examination of recent case reports involving patients over the age of 65years demonstrates that inadvertent overdosing is responsible for some cases of local anesthetic systemic toxicity. Elderly patients are at increased risk of local anesthetic systemic toxicity. When considering use of local anesthetics in older patients, special attention should be paid to the presence of systemic disease and muscle wasting. The safety of regional anesthesia and multi-modal analgesia among these at-risk patients will be improved by educating physicians and staff to recognize and manage local anesthetic systemic toxicity.

Updates on pediatric regional anesthesia safety data.

The clinical practice of anesthesia continues to evolve and grow toward increasing quality and safety while improving the patient and family perioperative experience. Within the realm of pediatric anesthesia, advances in regional anesthesia techniques are important part in this aim. The aim of this review is to provide an update on recent advances in pediatric regional anesthesia. This includes an emphasis on safety data from large datasets that previously were not available. In addition, novel blocks within pediatric regional anesthesia will be described. Large data sets have given clinical providers information into the practice of regional anesthesia. It has confirmed the safety of common regional anesthetic techniques in addition to providing guidance to improving outcomes for children.

ANESTHESIOLOGICAL MANAGEMENT OF FETOSCOPIC LASER COAGULATION OF PLACENTAL ANASTOMOSES IN TWIN-TO-TWIN TRANSFUSION SYNDROME

In this study we presented the analysis of regional anesthesia (epidural and spinal) effectiveness in 72 fetoscopic laser coagulation (FLC) of placental anastomoses, performed in Saint Petersburg Maternity hospital № 17. In 2008 FLC was performed under epidural anesthesia and average time of procedure was 120 minutes, in 2017 according the rising surgical experience the time of procedure reduced to 33 (23–37.5) minutes, that allowed start to use spinal anesthesia. Conclusions: regional methods (epidural and spinal) manage adequate level of anesthesia. Rising surgical experience and reducing the time of procedure to 33 (23–37.5) minutes allowed to use spinal anesthesia successfully. In 29.2 % of cases of regional anesthesia intraoperative arterial hypotension was observed but was successfully corrected by moderate vasopressors doses. No other anesthesiological maternal complications were observed, which confirming safety of regional anesthesia in fetoscopic laser coagulation of placental anastomoses.

Безопасность регионарной анестезии при родоразрешении беременных с врастанием плаценты

Безопасность регионарной анестезии при родоразрешении беременных с врастанием плаценты

Did ultrasound fulfill the promise of safety in regional anesthesia?

Ultrasound guidance has become the accepted standard of practice for peripheral regional anesthesia. Despite evidence supporting the efficacy of ultrasound-guided regional anesthesia, its impact on patient safety has been less clear. Evidence has been consistent that ultrasound guidance reduces the incidence of vascular injury, local anesthetic systemic toxicity, pneumothorax and phrenic nerve block. Within the limited global scope of the epidemiology and etiologic complexity of perioperative (including block-related) peripheral nerve injury, there has not been consistent evidence that ultrasound guidance is associated with a reduced incidence of nerve injury. However, a recently published retrospective cohort study has demonstrated that the incidence of short-term nerve injury was decreased with ultrasound guidance compared with nerve stimulation. Ultrasound has led to development of novel blocks, approaches and refinement of existing ones, which may contribute to patient safety. Ultrasound has revolutionized the way we approach regional anesthesia and contributed to patient safety. It is important to note that patient safety does not hinge on one single technology. Patient safety in regional anesthesia relies on a well trained practitioner to pay meticulous attention to indication, block and patient selection, anatomy, pharmacology, equipment and technique.

Ultrasound Guided Nerve Stimulation and Nerve Stimulation Alone for Supraclavicular Brachial Plexus Block – A Randomized Comparative Study

Background: The safety of regional anaesthesia become more pronounced by the use of ultrasound andnerve stimulator. Supraclavicular nerve blocks known as ‘spinal of the arm’ are the most attractiveupper extremity blocks to perform in our practice. In this study less experienced hands try to found thebest approach for upper extremity block. Objective: To comparethe success rate when Ultrasound addedwith Peripheral nerve stimulator insupraclavicular brachial plexus block. Methods: After IRB approval and written consents from patients, total 66 patients divided into twogroups,Group USNS had supraclavicular block guided by both ultrasound and Nerve stimulator. Onthe other hand Group BNS had this block by only Nerve stimulator. All the equipments kept ready andmaintaining sterility a mixture of 0.5% Bupivacaine and 2% plain Lignocaine were prepared. The amountinjected according to the body weight without crossing the toxic dose (2mg/Kg 0.5% Bupivacaine, 5mg/Kg 2% Lignocaine). Total volumes were 25-30ml for every patient.The sensory block was assessed byobservers who unaware of the technique for every 2 minutes till the onset of block and every 10 minutesthereafter for 30 minutes. Any failure in establishing the block was converted to GA. The sensorydermatomes were assessed by alcohol swab. The motor blocks were evaluated by the same observer ineach jointfor every 2 minutes till onset than 10, 20 &amp; at the end of 30 minutes.Successful block wasconsidered if no supplementation or conversion to general anaesthesia required. Results: In all demographic variables and ASA Class, there was no differences in between the USNSgroup and BNS group.In group USNS block execution time was significantly higher(P&lt;0.05). The timerequired for both sensory and motor block was statistically significantly less in Group USNS comparedto Group BNS (P value &lt; 0.05). Regarding quality of motor block, at wrist joint statistical significancepresent between two groups ( p value &lt; 0.05 ). The duration of analgesia is significantly lower in GroupBNS than Group USNS (P value is 0.012).In Group USNS, only one (3.03%) patient neededsupplementation. But in Group BNS 7 (21.21%) patients needed supplementation. According to thedefinition, these cases were regarded as failed case. The success rate is significantly higher in GroupUSNS (P value is 0.024). Conclusion: Combined use of ultrasound and peripheral nerve stimulator increases success rate thanperipheral nerve stimulator alone in supraclavicular brachial plexus block. This combined method alsoreduces block execution time, early onset of both sensory and motor block, improve quality of sensory andmotor block and less incidence of complications. JBSA 2018; 31(2): 54-61

Comparison of Percutaneous Nephrolithotomy Under Regional versus General Anesthesia: A Meta-Analysis of Randomized Controlled Trials

The aim of the present meta-analysis was to systematically examine the literature and to identify of the results of randomized controlled trials (RCTs) comparing the efficacy and safety of regional anesthesia (RA) versus general anesthesia (GA) for percutaneous nephrolithotomy (PCNL). An exhaustive electronic literature search of PubMed, Embase, and Web of science was performed until March 2018. Nine prospective RCTs concluding 858 patients comparing the use of RA to GA for PCNL were included. Combined results demonstrated that PCNL under RA could reduce operative time (mean difference [MD] –6.20; 95% CI –10.39 to –2.01), hospital stay (MD –0.59; 95% CI –0.74 to –0.45), visual analgesic score on the first and third postoperative day (MD –2.62, 95% CI –3.04 to –2.19 and MD –0.38; 95% CI –0.58 to –0.18) , analgesic requirements (MD –36.84; 95% CI –55.23 to –18.45), and nausea and/or vomiting (relative risk [RR] 0.28; 95% CI 0.13–0.61). There were no significant differences between RA and GA groups in terms of stone-free rate, blood transfusion, and postoperative fever rate. The results of subgroup analysis were basically consistent with the overall findings. Current evidence suggests that RA is an available and safe option in carefully evaluated and selected patients.

Pharmacokinetic and clinical effects of two bupivacaine concentrations on axillary brachial plexus block

The risk of systemic bupivacaine toxicity is a persistent problem, which makes its pharmacokinetic study fundamental for regional anesthesia safety. There is little evidence of its influence on plasma peak at different concentrations. The present study compares two bupivacaine concentrations to establish how the concentration affects this drug plasma peak in axillary brachial plexus block. Postoperative latency and analgesia were also compared. 30 patients were randomized. In the 0.25% Group, 0.25% bupivacaine (10mL) was injected per nerve. In the 0.5% Group, 0.5% bupivacaine (5mL) was injected per nerve. Peripheral blood samples were collected during the first 2hours after the blockade. For sample analyses, high performance liquid chromatography mass spectrometry was used. Plasma peak occurred 45minutes after the blockade, with no difference between groups at the assessed time-points. Plasma peak was 933.97 ± 328.03 ng.mL-1 (mean ± SD) in 0.25% Group and 1022.79 ± 253.81 ng.mL-1 in 0.5% Group (p = 0.414). Latency was lower in 0.5% Group than in 0.25% Group (10.67 ± 3.71 × 17.33min ± 5.30, respectively, p = 0.004). No patient had pain within the first 4hours after the blockade. For axillary brachial plexus block, there was no difference in bupivacaine plasma peak despite the use of different concentrations with the same local anesthetic mass. The concentration inversely influenced latency.

Evaluation of safety and efficacy of regional anesthesia compared with general anesthesia in thoracoscopic lung biopsy procedure on patient with idiopathic pulmonary fibrosis

Background:Interstitial lung diseases are diseases that need histology diagnosis or obtaining a lung biopsy to establish the diagnosis. Surgical biopsies are performed usually using the thoracoscopy technique under general anesthesia (GA) although this procedure is still associated with morbidity rate. The aim of this study is to determine the effectiveness and safety of regional anesthesia (RA) compared with GA in thoracoscopic lung biopsy procedures done on patients with idiopathic pulmonary fibrosis (IPF).Subjects and Methods:This is a retrospective qualitative study based on adult cases of video-assisted thoracoscopy (VAT) lung biopsy on patients with IPF admitted in the division of Thoracic Surgery, Department of General Surgery, King Khalid University Hospital, Riyadh, KSA. We included 67 patients with IPF, 26 with RA, and 41 with GA, who underwent this procedure from January 2008 to December 2015. Procedures performed under RA were done using three different approaches, intercostal nerve blocks, extrapleural infusion, and paravertebral block while GA was performed using double-lumen endotracheal tube placement. For statistical analysis, SPSS program, version 21.0. Software used to analyze the obtained data. The statistical significance was defined as P < 0.05.Results:Sixty-seven patients underwent the procedure of thoracoscopic lung biopsy. Twenty-six of them (38.8%) underwent the procedure under RA and 41 (61.2%) under GA. The cross tabulation of the intercostal chest tube duration showed that it was significantly longer in GA group (6.23 ± 5.1 days) compared to RA group (3.12 ± 1.5 days), P = 0.004. Furthermore, for the Intensive Care Unit (ICU) stay, it was significantly longer in GA group (3.38 ± 2.1 days) compared to RA group (1.09 ± 0.7 days), P = 0.019. Regarding the relation between the number of biopsies taken and type of anesthesia performed, the probability values for GA group as well as RA group come out to be >0.05 (statistically independent) and the results of risk estimate also show that there was no significant association found between them. The cross tabulation of the representation of biopsies taken by the two methods showed that all biopsies taken under both settings were representative of the disease. Of 41 procedures done under GA, 16 of the total showed a number of complications. Likewise, of 26 procedures under RA, five cases showed complications. The significant (two-sided) value was (P = 0.110), there was no statistical significance between the risks of complications and the two types of anesthesia.Conclusion:There was a significant decrease in chest tube duration and ICU stay in RA group compared to the GA group. There was no statistical difference between both types of anesthesia in the number of biopsy, representation, and postoperative complications although the rate of these complications was much less in the RA group. Based on this outcome, we can conclude that VAT lung biopsy procedure on patients with IPF under RA is safe, representative, and effective operation. In addition, high-risk patients for GA can go through this procedure under RA as an alternative and safe option with no added complications.

Local Anesthetic Delivery and Resuscitation for Systemic Toxicity in China: A Survey of 250 Hospitals

Background: The optimized procedures for local anesthetic (LA) delivery and resuscitation for LA systemic toxicity (LAST) have improved the safety of regional anesthesia. Lipid emulsion (LE) has been the valid treatment for LAST. However, adoption of these revised procedures in developing countries remains unknown.Methods: We conducted a 17-question survey to access the basic knowledge of LA delivery, the practice procedures for LAST resuscitation and an overall understanding of LE usage in both academic and non-academic hospitals of the Chinese Society of Anesthesiology.Results: A total of 250 hospitals completed the survey. Ropivacaine was the most preferred long-acting LA for regional anesthesia. Among the responders, 10 hospitals did not apply test-dosing before epidural anesthesia, including more non-academic than academic hospitals (7.1% versus 1.4%, P=0.0223). 77.5% (107/138) of academic hospitals and 69.6% (78/112) of non-academic hospitals had a protocol for LAST resuscitation. Only 28.2% of academic and 18.8% of non-academic hospitals stated LE preference for LAST. Furthermore, 17% (22/132) academic hospitals and 13% (12/89) non-academic hospitals chose the recommended epinephrine dosage based on the guideline of ARSA for LA-induced cardiac arrest. Significantly higher proportion (1.6 times more, 95% CI 1.082-3.991) of academic hospitals considered LE as the resuscitation method for LA-induced seizure than non-academic hospitals (44.9% versus 28.2%, P=0.0269). Finally, LE was available in only half of the hospitals which adopted its feasibility for LAST resuscitation.Conclusions: The survey revealed the poor practice procedures for regional anesthesia and non-standard use of LE for LAST resuscitation in China, especially among non-academic hospitals. Citation: Feng-Xian Li, Hua-Li Xu, Hui-Qun Chen, Hong-Yi Lei, Zhi-Jian You, Xu-Zhong Xu, et al. Local anesthetic delivery and resuscitation for systemic toxicity in China: a survey of 250 hospitals. J Anesth Perioper Med 2017; x: x-x. doi:10.24015/JAPM.2017.0021This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.