RT Book, Section
A1 Tsui, Ban C. H.
A1 Dryden, Adam M.
A1 Finucane, Brendan T.
A2 Longnecker, David E.
A2 Mackey, Sean C.
A2 Newman, Mark F.
A2 Sandberg, Warren S.
A2 Zapol, Warren M.
SR Print(0)
ID 1144120456
T1 Preventing and Managing Adverse Outcomes During Regional Anesthesia
T2 Anesthesiology, 3e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071848817
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1144120456
RD 2024/04/19
AB KEY  POINTSSafe  regional  anesthesia  begins  with  thorough  knowledge  of  anatomy.  In  Labat’s  words,  “anatomy  is  the  foundation  upon  which  the  entire  concept  of  regional  anesthesia  is  built.”  Studying  the  anatomy  of  the  major  plexuses  and  peripheral  nerves  is  critical  for  learning  regional  anesthesia  and  avoiding  complications.Prior  to  performing  regional  anesthesia,  it  is  imperative  to  discuss  thoroughly  the  techniques  and  their  limitations  with  the  patient.  Assessing  which  patients  are  most  appropriate  for  performing  these  techniques  on  is  important,  as  some  are  not  suitable  candidates  (eg,  those  with  major  anatomic  distortion  or  serious  mental  illness).One  of  the  most  important  principles  for  safe  regional  anesthesia  is  provision  of  a  comfortable  patient  environment.  If  a  patient  suffers  as  a  result  of  one’s  intervention,  a  basic  principle  of  anesthesia  practice  has  been  violated.Resuscitation  equipment  must  be  immediately  available  when  performing  regional  anesthesia.  One  must  be  prepared  at  all  times  to  anesthetize  and  resuscitate  the  patient  if  necessary.A  skilled  anesthesia  provider  must  be  willing  to  abort  the  technique  in  the  face  of  failure.  Dogged  persistence  is  inadvisable.  One  must  seek  assistance  when  faced  with  difficulties  and  be  prepared  to  adopt  an  alternative  route  of  anesthesia  if  persistent  failure  (more  than  three  attempts  or  20  minutes)  occurs.Do  not  perform  regional  anesthesia  procedures  in  anesthetized  adult  patients  unless  the  benefits  far  outweigh  the  risks.  If  this  principle  is  violated,  the  reasoning  must  be  documented  in  the  patient’s  file.Always  be  accompanied  by  a  skilled  assistant  when  performing  regional  anesthesia.The  patient  must  be  monitored  adequately  at  all  stages  during  regional  anesthesia.  Close  monitoring  can  only  be  discontinued  when  the  block  has  worn  off  completely.If  neurologic  injury  following  regional  anesthesia  is  suspected,  the  cause  should  be  determined  quickly  to  prevent  permanent  injury.  Timely  advice  should  be  sought  from  appropriate  consultants  (neurologists,  radiologists).One  must  not  assume  that  all  patient  injury  is  from  regional  anesthesia,  as  other  possibilities  exist.  Do  not  hesitate  to  involve  other  disciplines  in  the  quest  to  determine  the  cause  of  injury.A  major  consideration  for  the  pediatric  population  is  that  regional  anesthesia  is  typically  performed  with  the  patient  under  anesthesia  or  heavy  sedation  due  to  children’s  generally  uncooperative  nature.  This  has  implications  ranging  from  patient  consent  to  recognizing  complications.