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Local Anesthetic Systemic Toxicity Knowledge Of Emergency Medicine Residents: A Cross-Sectional Study

Year 2020, Volume: 12 Issue: 3, 414 - 419, 20.10.2020
https://doi.org/10.18521/ktd.746744

Abstract

Objective: Local anesthetics (LAs) are starting to be used after the discovery of cocaine, which is used in medical practice. Now LAs are used many procedures in many clinics, especially in emergency departments (EDs). The extensive use of LAs was brought side effects and toxicity. Local anesthetic systemic toxicity (LAST) have been reported from simple allergic conditions to cardiovascular and neurological complications that can be fatal. The study aims to evaluate the level of knowledge and awareness of LAST among emergency medicine residents (EMRs).

Method: This was a questionnaire-based cross-sectional study. The questionnaires were sent to EMRs via e-mail, and responses were collected. The participants who gave informed consent included in the study, and who didn’t use LAs in their daily practice were excluded. All of the participants responded all of the questions and responses were analyzed.
Results: 92 EMRs were included in the study. The median age of the participants was 29 (24-50) years, and 48.9% were women. In the research, no one could recognize all LAST symptoms, ranging from mild to severe. Only 16.3% of the participants answered all treatment options of the LAST correctly, and 27.2% knew the ILE dosage accurately.

Conclusion: The level of knowledge and awareness of the EMRs were insufficient. EMRs training rates on LAs and LAST were found to be low. In addition, it was stated that the patient's informed consent was not appropriately obtained from the vast majority of patients undergoing LA procedure. As the first study on LAST among EMRs, we believe that necessary arrangements should be made regarding the detected deficiencies.

Thanks

The authors would like to thank ForEMS study group and EMAT Toxicology study group for their valuable support.

References

  • Referans1. Dickerson DM, Apfelbaum JL. Local anesthetic systemic toxicity. Aesthetic surgery journal. 2014;34(7):1111-1119.
  • Referans2. Karasu D, Yılmaz C, Özgünay ŞE, Dayıoğlu M, Baytar Ç, Korfalı G. Knowledge of the research assistants regarding local anaesthetics and toxicity. Turkish journal of anaesthesiology and reanimation. 2016;44(4):201-205.
  • Referans3. Safety Committee of Japanese Society of A. Practical guide for the management of systemic toxicity caused by local anesthetics. J Anesth. 2019;33(1):1-8.
  • Referans4. Ciechanowicz S, Patil V. Lipid emulsion for local anesthetic systemic toxicity. Anesthesiol Res Pract. 2012;2012:131784.
  • Referans5. Fencl JL. Local anesthetic systemic toxicity: perioperative implications. AORN J. 2015;101(6):697-700.
  • Referans6. Sagir A, Goyal R. An assessment of the awareness of local anesthetic systemic toxicity among multi-specialty postgraduate residents. Journal of anesthesia. 2015;29(2):299-302.
  • Referans7. Neal JM, Bernards CM, Butterworth JF, Di Gregorio G, Drasner K, Hejtmanek MR, et al. ASRA practice advisory on local anesthetic systemic toxicity.Reg Anesth Pain Med 2010; 152-161
  • Referans8. Hayaran N, Sardana R, Nandinie H, Jain A. Unusual presentation of local anesthetic toxicity. J Clin Anesth. 2017;36:36-38.
  • Referans9. Inceoz H, Tutal ZB, Babayigit M, Kepek A, Horasanli E. Late Local Anaesthetic Toxicity After Infraclavicular Block Procedure. Turk J Anaesthesiol Reanim. 2015;43(3):199-201.
  • Referans10. Tierney KJ, Murano T, Natal B. Lidocaine-Induced Cardiac Arrest in the Emergency Department: Effectiveness of Lipid Therapy. J Emerg Med. 2016;50(1):47-50.
  • Referans11. Bonfim MR, Melo Mde S, Dreyer E, Borsoi LF, Oliveira TG, Udelsmann A. Lipid therapy with two agents in ropivacaine-induced toxicity: experimental study in Swine. Rev Bras Anestesiol. 2012;62(5):685-695.
  • Referans12. Piskin O, Ayoglu H. Effects of Remifentanil Pretreatment on Bupivacaine Cardiotoxicity in Rats. Cardiovasc Toxicol. 2018;18(1):56-62.
  • Referans13. Urfalıoğlu A, Urfalıoğlu S, Öksüz G. The knowledge of eye physicians on local anesthetic toxicity and intravenous lipid treatment: Questionnaire study. Turkish journal of ophthalmology. 2017;47(6):320-325.
  • Referans14. Oksuz G, Urfalioglu A, Sekmen T, Akkececi N, Alpay N, Bilal B. Dentists knowledge of lipid treatment of local anaesthetic systemic toxicity. Nigerian journal of clinical practice. 2018;21(3):327-331.
  • Referans15. Gaeta T, Torres R, Kotamraju R, Seidman C, Yarmush J. The need for emergency medicine resident training in informed consent for procedures. Acad Emerg Med. 2007;14(9):785-789.

Acil Tıp Asistanlarının Lokal Anestetik Sistemik Toksisitesine İlişkin Bilgi Düzeyleri: Kesitsel Bir Çalışma

Year 2020, Volume: 12 Issue: 3, 414 - 419, 20.10.2020
https://doi.org/10.18521/ktd.746744

Abstract

Amaç: Lokal anestetikler (LA) kokainin keşfiyle birlikte, özellikle acil servisler olmak üzere birçok klinik tarafından, birçok prosedürde kullanılmaktadır. LA’ in yaygın kullanımı, beraberinde yan etki ve toksisite vakalarını da getirmiştir. Lokal anestetik sistemik toksisitesi (LAST) basit alerjik durumlardan ölümcül olabilecek kardiyak ve nörolojik komplikasyonlara kadar geniş bir yelpazede bildirilmiştir. Literatürde acil tıp asistanları (ATA)’ nın LAST konusunda bilgi ve farkındalıklarını ortaya koyan çalışma bulunmamaktadır. Bu çalışmada ATA’ nın LAST bilgi ve farkındalık düzeylerinin değerlendirilmesi amaçlanmıştır.
Metod: Bu çalışma anket tabanlı kesitsel bir çalışmadır. Anket formları e-mail yoluyla ATA’ na gönderildi ve cevapları kayıt edildi. Aydınlatılmış onam veren ATA çalışmaya dahil edildi ve günlük pratiğinde LA kullanmayan ATA çalışmadan dışlandı. Tüm katılımcılar, bütün sorulara yanıt verdiler ve yanıtların analizleri yapıldı.
Bulgular: 92 ATA çalışmaya katıldı. Katılımcıların yaş ortancası 29 (24-50) ve %48,9 u kadındı. Çalışmamızda, hafiften ağıra doğru sıralanmış LAST semptomlarının tamamına ATA’ nın hiçbiri doğru yanıt veremedi. Katılımcıların sadece %16,3 ü tüm LAST tedavi seçeneklerini ve %27,2 si intravenöz lipid emülsiyonu dozunu doğru olarak cevapladılar.
Sonuç: ATA’ nın LAST konusunda bilgi ve farkındalık düzeyleri yetersizdir. LA ve LAST konusunda ATA’ nın eğitimleri düşüktür. Ayrıca, LA kullanılan prosedürlerin çoğunda uygun aydınlatılmış onam alınmamaktadır. ATA arasında yapılan ilk çalışma olması nedeniyle, tespit edilen eksikliklere yönelik gerekli düzenlemelerin yapılacağına inanıyoruz.

References

  • Referans1. Dickerson DM, Apfelbaum JL. Local anesthetic systemic toxicity. Aesthetic surgery journal. 2014;34(7):1111-1119.
  • Referans2. Karasu D, Yılmaz C, Özgünay ŞE, Dayıoğlu M, Baytar Ç, Korfalı G. Knowledge of the research assistants regarding local anaesthetics and toxicity. Turkish journal of anaesthesiology and reanimation. 2016;44(4):201-205.
  • Referans3. Safety Committee of Japanese Society of A. Practical guide for the management of systemic toxicity caused by local anesthetics. J Anesth. 2019;33(1):1-8.
  • Referans4. Ciechanowicz S, Patil V. Lipid emulsion for local anesthetic systemic toxicity. Anesthesiol Res Pract. 2012;2012:131784.
  • Referans5. Fencl JL. Local anesthetic systemic toxicity: perioperative implications. AORN J. 2015;101(6):697-700.
  • Referans6. Sagir A, Goyal R. An assessment of the awareness of local anesthetic systemic toxicity among multi-specialty postgraduate residents. Journal of anesthesia. 2015;29(2):299-302.
  • Referans7. Neal JM, Bernards CM, Butterworth JF, Di Gregorio G, Drasner K, Hejtmanek MR, et al. ASRA practice advisory on local anesthetic systemic toxicity.Reg Anesth Pain Med 2010; 152-161
  • Referans8. Hayaran N, Sardana R, Nandinie H, Jain A. Unusual presentation of local anesthetic toxicity. J Clin Anesth. 2017;36:36-38.
  • Referans9. Inceoz H, Tutal ZB, Babayigit M, Kepek A, Horasanli E. Late Local Anaesthetic Toxicity After Infraclavicular Block Procedure. Turk J Anaesthesiol Reanim. 2015;43(3):199-201.
  • Referans10. Tierney KJ, Murano T, Natal B. Lidocaine-Induced Cardiac Arrest in the Emergency Department: Effectiveness of Lipid Therapy. J Emerg Med. 2016;50(1):47-50.
  • Referans11. Bonfim MR, Melo Mde S, Dreyer E, Borsoi LF, Oliveira TG, Udelsmann A. Lipid therapy with two agents in ropivacaine-induced toxicity: experimental study in Swine. Rev Bras Anestesiol. 2012;62(5):685-695.
  • Referans12. Piskin O, Ayoglu H. Effects of Remifentanil Pretreatment on Bupivacaine Cardiotoxicity in Rats. Cardiovasc Toxicol. 2018;18(1):56-62.
  • Referans13. Urfalıoğlu A, Urfalıoğlu S, Öksüz G. The knowledge of eye physicians on local anesthetic toxicity and intravenous lipid treatment: Questionnaire study. Turkish journal of ophthalmology. 2017;47(6):320-325.
  • Referans14. Oksuz G, Urfalioglu A, Sekmen T, Akkececi N, Alpay N, Bilal B. Dentists knowledge of lipid treatment of local anaesthetic systemic toxicity. Nigerian journal of clinical practice. 2018;21(3):327-331.
  • Referans15. Gaeta T, Torres R, Kotamraju R, Seidman C, Yarmush J. The need for emergency medicine resident training in informed consent for procedures. Acad Emerg Med. 2007;14(9):785-789.
There are 15 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Bugra Ilhan 0000-0002-3255-2964

Mehmet Demir This is me 0000-0002-0106-3383

Publication Date October 20, 2020
Acceptance Date July 17, 2020
Published in Issue Year 2020 Volume: 12 Issue: 3

Cite

APA Ilhan, B., & Demir, M. (2020). Local Anesthetic Systemic Toxicity Knowledge Of Emergency Medicine Residents: A Cross-Sectional Study. Konuralp Medical Journal, 12(3), 414-419. https://doi.org/10.18521/ktd.746744
AMA Ilhan B, Demir M. Local Anesthetic Systemic Toxicity Knowledge Of Emergency Medicine Residents: A Cross-Sectional Study. Konuralp Medical Journal. October 2020;12(3):414-419. doi:10.18521/ktd.746744
Chicago Ilhan, Bugra, and Mehmet Demir. “Local Anesthetic Systemic Toxicity Knowledge Of Emergency Medicine Residents: A Cross-Sectional Study”. Konuralp Medical Journal 12, no. 3 (October 2020): 414-19. https://doi.org/10.18521/ktd.746744.
EndNote Ilhan B, Demir M (October 1, 2020) Local Anesthetic Systemic Toxicity Knowledge Of Emergency Medicine Residents: A Cross-Sectional Study. Konuralp Medical Journal 12 3 414–419.
IEEE B. Ilhan and M. Demir, “Local Anesthetic Systemic Toxicity Knowledge Of Emergency Medicine Residents: A Cross-Sectional Study”, Konuralp Medical Journal, vol. 12, no. 3, pp. 414–419, 2020, doi: 10.18521/ktd.746744.
ISNAD Ilhan, Bugra - Demir, Mehmet. “Local Anesthetic Systemic Toxicity Knowledge Of Emergency Medicine Residents: A Cross-Sectional Study”. Konuralp Medical Journal 12/3 (October 2020), 414-419. https://doi.org/10.18521/ktd.746744.
JAMA Ilhan B, Demir M. Local Anesthetic Systemic Toxicity Knowledge Of Emergency Medicine Residents: A Cross-Sectional Study. Konuralp Medical Journal. 2020;12:414–419.
MLA Ilhan, Bugra and Mehmet Demir. “Local Anesthetic Systemic Toxicity Knowledge Of Emergency Medicine Residents: A Cross-Sectional Study”. Konuralp Medical Journal, vol. 12, no. 3, 2020, pp. 414-9, doi:10.18521/ktd.746744.
Vancouver Ilhan B, Demir M. Local Anesthetic Systemic Toxicity Knowledge Of Emergency Medicine Residents: A Cross-Sectional Study. Konuralp Medical Journal. 2020;12(3):414-9.