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Reg Anesth Pain Med. 2012 Jan-Feb;37(1):8-15. doi: 10.1097/AAP.0b013e31823d825a.

ASRA checklist improves trainee performance during a simulated episode of local anesthetic systemic toxicity.

Author information

1
Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA, USA. anejmn@vmmc.org

Abstract

OBJECTIVE:

Severe local anesthetic systemic toxicity (LAST) is a rare event, the management of which might best be learned using high-fidelity simulation. In its 2010 Practice Advisory, the American Society of Regional Anesthesia and Pain Medicine (ASRA) created a medical checklist to aid in the management of LAST. We hypothesized that trainees provided with this checklist would manage a simulated episode of LAST more effectively than those without it. A secondary aim of the study was to assess the ASRA Checklist's usability and readability.

METHODS:

Trainees undergoing a simulated LAST event were randomized to the checklist group (n = 12) or the no-checklist group (n = 13). Our primary outcome was the number of medical management tasks completed correctly. Secondary outcomes included assessment of the anesthesiologists' nontechnical skills and posttest performance.

RESULTS:

Trainees receiving the checklist demonstrated superior medical management of the simulated LAST event: the checklist group correctly performed 16.0 (2.6) tasks versus the no-checklist group's 8.8 (3.0) tasks (mean [SD], P < 0.001). The checklist group had higher decision making scores on the anesthesiologists' nontechnical skills assessment (5.2 [1.8] versus 4.0 [1.35] summed rater score, P = 0.037) and had higher knowledge retention 2 months later (P = 0.031). Of those trainees randomized to receive the checklist, 7 of 12 used it fully (versus partially), which was reflected in higher medical and nontechnical performance scores.

CONCLUSIONS:

Use of the ASRA Checklist significantly improved the trainees' medical management and nontechnical performance during a simulated episode of severe LAST. Partial use of the checklist correlated with lower overall performance.

PMID:
22157743
DOI:
10.1097/AAP.0b013e31823d825a
[Indexed for MEDLINE]
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