Cerrahi branş hekimlerinin lokal anestezik kullanımı ve toksisitesine yaklaşımının değerlendirilmesi: Anket çalışması
Abstract
Amaç: Lokal anestezik (LA) ilaçlar günümüzde sıkça kullanılmaktadır. Yanlış uygulama şekli ve dozu toksisitesinin en sık nedenleridir. Son yıllarda lipit emülsiyonu infüzyonlarının standart resüsitasyon uygulamalarına yanıt vermeyen toksisite durumlarında başarıyla kullanıldığı bildirilmektedir. Bu çalışmanın amacı, cerrahi branş hekimleri LA’ler ve lokal anestezik toksisite sendromu (LATS) hakkında bilgilerini incelemek, toksisite ve tedavisi hakkında farkındalığı arttırmaktır.
Gereç ve Yöntem: Çalışmamıza hastanemizde çalışan anestezistler dışındaki cerrahi branş hekimleri dahil edildi. Hekimlere yaş, cinsiyet, branş, uzmanlık yılı ve en çok tercih ettikleri LA, uygulama yolu, toksisiteyi önlemek için uyguladıkları yöntemler, toksisitenin erken ve geç dönem bulguları ve tedavisini içeren 14 soru yöneltildi. 108 hekime anket soruları yöneltildi ve tüm sorulara cevap verilmediği için 17’si çalışma dışı bırakılarak 91 anket sonucu değerlendirildi.
Bulgular: Çalışmamıza 9 branş hekimi katıldı. En yüksek katılım %44 oranı ile Genel Cerrahi hekimleri olup, hekimlerin %68’i uzmandı ve meslekte çalışma yılı 10 yıldan fazla olanlar %31,9 oranıyla en yüksekti. En çok tercih edilen lokal anesteziğin lidokain olduğu görüldü. Haftada ikiden fazla kullanımın en yaygın olduğu ve en sık uygulama şeklinin subkutan/intramusküler enjeksiyon olduğu görüldü. %78’i uygun doz ilaç kullanıyordu. Toksisitesinin erken dönem bulguları sorusuna, hekimler en sık alerji derken, geç dönem bulgularında ise en sık kardiyak arrest cevabını verdi. Tedavisinde ise semptomatik tedavi ilk sırayı aldı. LA toksisitesinde lipit kullanımı sorgulandığında %61,6 hekim hiç duymadığını belirtti.
Sonuç: LA uygulayan cerrahi hekimlerin LATS bulguları, semptomları ve toksisite tedavi yöntemleri hakkında yeterli bilgi sahibi olmadıkları belirlendi ve hasta güvenliğini sağlamada ve komplikasyonları önlemede LATS bilinmesi ve tedavisinin önemli olduğunu düşünmekteyiz.
Keywords
References
- Ökten F, Hasdoğan M, Tarhan A. Bupivakain kardiyotoksisitesi ne derece önemlidir? Anestezi Dergisi 2010; 18: 189-93.
- Dickerson DM, Apfelbaum JL. Local anesthetic systemic toxicity. Aesthet Surg J. 2014; 34: 1111-9.
- Fettiplace MR, Weinberg G. Past, present, and future of lipid resuscitation therapy. JPEN J Parenter Enteral Nutr. 2015; 39: 72-83.
- Neal JM, Mulroy MF, Weinberg GL. American Society of Regional Anesthesia and Pain Medicine. American Society of Regional Anesthesia and Pain Medicine checklist for managing local anesthetic systemic toxicity: 2012 version. Reg Anesth Pain Med. 2012; 37: 16-8.
- Guideline for care of the patient receiving local anesthesia. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2017: 617-28.
- Turhan SÇ, Özçelik M, Koza EA, Adaklı B, Ökten F. Aksiller brakial pleksus blokajı sonrası gelişen levobupivakain toksisitesi. Turkiye Klinikleri J Anest Reanim. 2014; 12: 110-3.
- Tierney KJ, Murano T, Natal B. Lidocaine-induced cardiac arrest in the emergency department: effectiveness of lipid therapy. J Emerg Med. 2016; 50: 47-50.
- Mulroy MF, Norris MC, Liu SS. Safety steps for epidural injection of local anesthetics: review of the literature and recommendations. Anesth Analg. 1997; 85: 1346-56.
- Noble KA. Local anesthesia toxicity and lipid rescue. J Perianesth Nurs. 2015; 30 (4): 321-35.
- Bailard NS, Ortiz J, Flores RA. Additives to local anesthetics for peripheral nerve blocks: evidence, limitations, and recommendations. Am J Health Syst Pharm. 2014; 71 (5): 373-85.
- Lokal anestezikler. Editörler: Morgan E, Mikhail MS, Murray MJ. Çeviri Editörleri: Tulunay M, Cuhruk H. Klinik Anesteziyoloji (Clinical Anesthesia). 4. Baskı. Güneş Tıp Kitapevleri- Ankara; 2008. 263-76.
- Neal JM, Mulroy MF, Weinberg GL. American society of regional anesthesia and pain medicine checklist for managing local anesthetic systemic toxicity: 2012 version. Reg Anesth Pain Med. 2012; 37: 816-7.
- Cave G, Harrop-Griffiths W, Harbey M, Meek T, Picard J, Short T, et al. AAGBI Safety Guideline: Management of Severse Local Anaesthetic Toxicity. Assoc Anaesth. 2010; 1-6.
- El-Boghdadly K, Chin KJ. Local anesthetic systemic toxicity: Continuing Professional development. Can J Anesth. 2016; 63: 330-49.
- El-Boghdadly K, Chin KJ. Local anesthetic systemic toxicity: Continuing Professional development. Can J Anesth. 2016; 63: 330-49.
- Foxall G, McCahon R, Lamb J, et al. Levobupivacaine‐induced seizures and cardiovascular collapse treated with Intralipid®.Anaesthesia. 2007; 62: 516–8.
- Marwick PC, Levin AI, Coetzee AR. Recurrence of cardiotoxicity after lipid rescue from bupivacaine-induced cardiac arrest. Anesth Analg. 2009; 108 (4): 1344-6.
- Becker DE, Reed KL. Essentials of local pharmacology. Anesth Prog. 2006; 53: 98–108
The evaluation of the approach of local anesthetic use and toxicity of surgical physicians: A questionnaire study
Abstract
Aim: Local anesthetic (LA) drugs are used frequently today. Incorrect administration and dose are the most common causes of toxicity. In recent years, it has been reported that lipid emulsion infusions have been used successfully in toxicity states that do not respond to standard resuscitation practices. The purpose of this study is to examine the knowledge of surgical physicians about LAs and LATS (local anesthetic toxicity syndrome) and to raise awareness about toxicity and treatment.
Materials and Methods: Surgical physicians other than anesthetists working in our hospital were included in our study. We asked 14 questions including age, gender, branch, specialty year, their preferred LA and method, methods to prevent toxicity, early and late findings and treatment of toxicity. Survey questions were directed to 108 physicians and 17 of them were excluded from the study because all questions were not answered, 91 survey results were evaluated.
Results: 9 physicians attended our study. The highest participation was General Surgery with a rate of 44%, 68% of them were specialists, and those with more than 10 years of work in the profession were the highest with 31.9%.It was found that the most preferred LA was lidocaine. It was observed that more than two uses per week were most common and the most common form of administration was subcutaneous / intramuscular injection.78% were using appropriate doses of drugs. The question of early signs of toxicity was the most frequent allergy, while in the late findings, cardiac arrest was the most common. In the treatment, symptomatic treatment took the first place. When lipid use was questioned in LA toxicity,61.6% of physicians stated that they had never heard of it.
Conclusion: It was determined that surgical physicians who performed LA did not have sufficient information about LATS findings, symptoms and toxicity treatment methods, and we think that knowing and treating LATS is important in ensuring patient safety and preventing complications.
Keywords
References
- Ökten F, Hasdoğan M, Tarhan A. Bupivakain kardiyotoksisitesi ne derece önemlidir? Anestezi Dergisi 2010; 18: 189-93.
- Dickerson DM, Apfelbaum JL. Local anesthetic systemic toxicity. Aesthet Surg J. 2014; 34: 1111-9.
- Fettiplace MR, Weinberg G. Past, present, and future of lipid resuscitation therapy. JPEN J Parenter Enteral Nutr. 2015; 39: 72-83.
- Neal JM, Mulroy MF, Weinberg GL. American Society of Regional Anesthesia and Pain Medicine. American Society of Regional Anesthesia and Pain Medicine checklist for managing local anesthetic systemic toxicity: 2012 version. Reg Anesth Pain Med. 2012; 37: 16-8.
- Guideline for care of the patient receiving local anesthesia. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2017: 617-28.
- Turhan SÇ, Özçelik M, Koza EA, Adaklı B, Ökten F. Aksiller brakial pleksus blokajı sonrası gelişen levobupivakain toksisitesi. Turkiye Klinikleri J Anest Reanim. 2014; 12: 110-3.
- Tierney KJ, Murano T, Natal B. Lidocaine-induced cardiac arrest in the emergency department: effectiveness of lipid therapy. J Emerg Med. 2016; 50: 47-50.
- Mulroy MF, Norris MC, Liu SS. Safety steps for epidural injection of local anesthetics: review of the literature and recommendations. Anesth Analg. 1997; 85: 1346-56.
- Noble KA. Local anesthesia toxicity and lipid rescue. J Perianesth Nurs. 2015; 30 (4): 321-35.
- Bailard NS, Ortiz J, Flores RA. Additives to local anesthetics for peripheral nerve blocks: evidence, limitations, and recommendations. Am J Health Syst Pharm. 2014; 71 (5): 373-85.
- Lokal anestezikler. Editörler: Morgan E, Mikhail MS, Murray MJ. Çeviri Editörleri: Tulunay M, Cuhruk H. Klinik Anesteziyoloji (Clinical Anesthesia). 4. Baskı. Güneş Tıp Kitapevleri- Ankara; 2008. 263-76.
- Neal JM, Mulroy MF, Weinberg GL. American society of regional anesthesia and pain medicine checklist for managing local anesthetic systemic toxicity: 2012 version. Reg Anesth Pain Med. 2012; 37: 816-7.
- Cave G, Harrop-Griffiths W, Harbey M, Meek T, Picard J, Short T, et al. AAGBI Safety Guideline: Management of Severse Local Anaesthetic Toxicity. Assoc Anaesth. 2010; 1-6.
- El-Boghdadly K, Chin KJ. Local anesthetic systemic toxicity: Continuing Professional development. Can J Anesth. 2016; 63: 330-49.
- El-Boghdadly K, Chin KJ. Local anesthetic systemic toxicity: Continuing Professional development. Can J Anesth. 2016; 63: 330-49.
- Foxall G, McCahon R, Lamb J, et al. Levobupivacaine‐induced seizures and cardiovascular collapse treated with Intralipid®.Anaesthesia. 2007; 62: 516–8.
- Marwick PC, Levin AI, Coetzee AR. Recurrence of cardiotoxicity after lipid rescue from bupivacaine-induced cardiac arrest. Anesth Analg. 2009; 108 (4): 1344-6.
- Becker DE, Reed KL. Essentials of local pharmacology. Anesth Prog. 2006; 53: 98–108
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | December 30, 2020 |
| Submission Date | March 12, 2020 |
| Published in Issue | Year 2020 |