Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1016/j.bjane.2014.07.010
Brazilian Journal of Anesthesiology
Scientific Article

Teaching practices of thoracic epidural catheterizations in different grade of anesthesia residents

Ensino da prática de cateterismo epidural torácico em diferentes anos de residência em anestesia

Ali Alagoz; Hilal Sazak; Mehtap Tunc; Fatma Ulus; Serdar Kokulu; Polat Pehlivanoglu; Saziye Sahin

http://dx.doi.org/10.1016/j.bjane.2014.07.010 Braz J Anesthesiol, vol.66, n1, p.1-6, 2016
PDF English
PDF Português
Downloads: 0
Views: 887

Abstract

BACKGROUND AND OBJECTIVES: In this study, we aimed to clarify the importance of residency grade and other factors which influence the success of thoracic epidural catheterization in thoracotomy patients. METHODS: After the ethical committee approval, data were recorded retrospectively from the charts of 415 patients. All patients had given written informed consent. The thoracic epidural catheterization attempts were divided into two groups as second-third year (Group I) and fourth year (Group II) according to residency grade. We retrospectively collected demographic data, characteristics of thoracic epidural catheterization attempts, and all difficulties and complications during thoracic epidural catheterization. RESULTS: Overall success rate of thoracic epidural catheterization was similar between the groups. Levels of catheter placement, number and duration of thoracic epidural catheterization attempts were not different between the groups (p > 0.05). Change of needle insertion level was statistically higher in Group II (p = 0.008), whereas paresthesia was significantly higher in Group I (p = 0.007). Dural puncture and postdural puncture headache rates were higher in Group I. Higher body mass index and level of the insertion site were significant factors for thoracic epidural catheterization failure and postoperative complication rate and those were independence from residents' experience (p < 0.001, 0.005). CONCLUSION: Body mass index and level of insertion site were significant on thoracic epidural catheterization failure and postoperative complication rate. We think that residents' grade is not a significant factor in terms overall success rate of thoracic epidural catheterization, but it is important for outcome of these procedures.

Keywords

Residency training, Thoracic epidural catheterization, Failure rate, Complications

Resumo

JUSTIFICATIVA E OBJETIVOS: Esclarecer a importância do ano de residência e outros fatores que influenciam o sucesso do cateterismo epidural torácico (CET) em pacientes submetidos à toracotomia. MÉTODOS: Após a aprovação do Comitê de Ética, os dados foram retrospectivamente analisados a partir dos prontuários de 415 pacientes. Todos os pacientes assinaram os termos de consentimento informado. As tentativas de CET foram divididas em dois grupos: segundo-terceiro ano (Grupo I) e quarto ano (Grupo II), de acordo com o ano de residência. Dados demográficos, características das tentativas de CET e todas as dificuldades e complicações durante o CET foram registrados retrospectivamente. RESULTADOS: A taxa de sucesso global de CET foi semelhante entre os grupos. Os níveis de colocação do cateter, o número e a duração das tentativas não foram diferentes entre os grupos (p > 0,05). A alteração do nível de inserção da agulha foi estatisticamente maior no Grupo II (p = 0,008), enquanto que a parestesia foi significativamente maior no Grupo I (p = 0,007). As taxas de cefaleia durante e após punção dural foram maiores no Grupo I. Um índice de massa corporal (IMC) maior e o nível do local de inserção foram fatores significativos para o fracasso do CET e para as taxas de complicações no pós-operatório, mas independentes da experiência dos residentes (p < 0,001, 0,005). CONCLUSÃO: O IMC e o nível do local de inserção foram significativos para o fracasso do CET e para as taxas de complicações no pós-operatório. Pensamos que o ano de residência não é um fator significativo em termos de taxa de sucesso global para o CET, mas é importante para o resultado desses procedimentos.

Palavras-chave

Treinamento em residência, Cateterismo epidural torácico, Taxa de falha, Complicações

References

Giebler RM, Scherer RU, Peters J. Incidence of neurologic complications related to thoracic epidural catheterization. Anesthesiology.. 1997;86:55-63.

Wheatle RG, Schug SA, Watson D. Safety and efficacy of post- operative epidural analgesia. Br J Anaesth.. 2001;87:47-61.

Freise H, Van Aken HK. Risks and benefits of thoracic epidural anaesthesia. Br J Anaesth.. 2011;107:859-68.

Pöpping DM, Zahn PK, Van Aken HK. Effectiveness and safety of postoperative pain management: a survey of 18925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data. Br J Anaesth.. 2008;101:832-40.

Konrad C, Schüpfer G, Wietlisbach M. Learning manual skills in anesthesiology: is there a recommended number of cases for anesthetic procedures?. Anesth Analg.. 1998;86:635-9.

De Oliveira Filho GR. The construction of learning curves for basic skills in anesthetic procedures: an application for the cumulative sum method. Anesth Analg.. 2002;95:411-6.

Smith MP, Sprung J, Zura A. A survey of exposure to regional anesthesia in American anesthesia residency training programs. Reg Anesth Pain Med.. 1999;24:11-6.

Kopacz DJ, Neal JM. Regional anesthesia and pain medicine: residency training - the year 2000. Reg Anesth Pain Med.. 2002;27:9-14.

Kopacz DJ, Neal JM, Pollock JE. The regional anesthesia ''learning curve'': what is the minimum number of epidural and spinal blocks to reach consistency?. Reg Anesth.. 1996;21:182-90.

Program requirements for res- idency education in anesthesiology. Graduate medical education directory 1996. 1996:34-7.

Aitkenhead AR. Undergraduate and postgraduate education. Best Pract Res Clin Anaesthesiol.. 2002;16:375-90.

Saied NN, Helwani M, Tabakian H. Teaching practices of thoracic epidural anesthesia in the United States: should lumbar epidurals be taught before thoracic epidurals?. J Cardiothorac Vasc Anesth.. 2006;20:652-5.

The Accreditation Council for Graduate Medical Education Effective in July 1st, 2003. 2003.

Sprung J, Bourke DL, Grass J. Predicting the difficult neu- raxial block: a prospective study. Anesth Analg.. 1999;89:384-9.

McLeod GA, Cumming C. Thoracic epidural anaesthesia and analgesia. Continuing Education in Anaesthesia. Crit Care Pain.. 2004;4:16-9.

Gil NS, Lee JH, Yoon SZ. Comparison of thoracic epidural pressure in the sitting and lateral decubitus positions. Anesthe- siology.. 2008;109:67-71.

Dalsasso M, Grandis M, Innocente E. A survey of 1000 consecutive epidural catheter placements performed by inexperienced anesthesia trainees. Minerva Anestesiol.. 2009;75:13-9.

Ingrande J, Brodsky JB, Lemmens HJ. Regional anesthesia and obesity. Curr Opin Anaesthesiol.. 2009;22:683-6.

Renck H. Neurological complications of central nerve blocks. Acta Anaesthesiol Scand.. 1995;39:859-68.

5dcd99900e88253651bf58f1 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections