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Patient Simulation Improves Staffs Confidence in Recognizing and Managing Local Anesthetic Systemic Toxicity as Measured by Self-evaluation Survey
Session: MP-04a
Thurs, April 19, 3:30-5:00 pm
Shubert (Shubert Complex), 6th floor

Please note, medically challenging cases are removed three months after the meeting and scientific abstracts after three years.

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Patient Simulation Improves Staff’s Confidence in Recognizing and Managing Local Anesthetic Systemic Toxicity as Measured by Self-evaluation Survey

Local Anesthetic Systemic Toxicity (LAST) is a rare and potentially devastating complication of regional anesthesia that is ideally suited for simulation training given its low incidence, cited as ranging from 0.4 to 21 per 10,000.1-3

Given the benefit of simulation training, we assessed the confidence of staff in recognizing and assisting the management of LAST before and after a simulation exercise.

Support staff completed a pre-simulation questionnaire regarding their experience and confidence in managing LAST.

Next, participants were taken through a low-fidelity simulation of diagnosing and caring for a suspected case of LAST, designed around the 2012 ASRA Checklist for the Treatment of LAST.

After participation in the exercise, participants completed post-simulation questionnaires regarding the management of LAST in the work environment.

Only 2 individuals (5%) reported having been involved in the care of a patient with LAST. When asked about managing a patient with suspected LAST, only a small minority of 6 individuals (15%) responded with a feeling of confidence. Only 5 individuals (12.5%) reported that they felt confident anticipating the medications and supplies that would be necessary in treating LAST.

Furthermore, only 16 individuals (40%) reported knowing that lipid emulsion was a mainstay of treatment for LAST, and 20 individuals (50%) acknowledged knowing how and where to find it in our perioperative environment.

After completion of the simulation exercise, 39 participants (90%) agreed that the experience had improved their knowledge regarding the management of LAST and all individuals (100%) responded with a feeling of confidence.

There was also unanimous agreement (100%) knowing the importance of lipid emulsion as a mainstay of treatment.

Local Anesthetic Systemic Toxicity is a rare complication that requires early recognition and management for patients to have successful outcomes.

Simulation training provides an opportunity to respond to infrequent but stressful events without placing patients at risk, while also improving the ability of providers.

Our data show a marked increase in the confidence of perioperative staff regarding management of a suspected case of LAST and their ability to provide needed resources.

1. Liu SS, Ortolan S, Sandoval MV, et al. Cardiac arrest and seizures due to local anesthetic systemic toxicity after peripheral nerve blocks: should we still fear the reaper? Reg Anesth Pain Med. 2016;41: 5-21

2. Barrington MJ, Kluger R. Ultrasound guidance reduces the risk of local anesthetic systemic toxicity following peripheral nerve blockade. Reg Anesth Pain Med. 2013;38: 289-297

3. Neal JM, Hsiung RL, Mulroy MF, Halpern BB, Dragnich AD, Slee AE. ASRA checklist improves trainee performance during a simulated episode of local anesthetic systemic toxicity. Reg. Anesth. Pain Med. 2012;37: 8–15.

4. Neal JM, Weinberg GL, Bernards CM, et al. ASRA practice advisory on local anesthetic systemic toxicity. Reg Anesth Pain Med. 2010;35: 152-161

5. 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;37:16-18.


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