Regional anaesthesia for a abdominal surgeries: so how safe is R A for abdominal surgery ?
Sood, Jayashree (2002) Regional anaesthesia for a abdominal surgeries: so how safe is R A for abdominal surgery ? 36 th Annual Conference of indian Society of anaesthesiologists- Delhi.
Full text available as:
No technique, regional or general anaesthesia, can be considered safe unless the factors affecting the requirement of the surgical procedure are taken into consideration. It is the apprehensive and non cooperative patient receiving a regional block from a 'not so well trained trained in nerve blocks' anaesthesiologist who is likely to create problems and make the procedure unsafe and unsuccessful. Proper patient selection, judicious use of local anaesthetics and sedatives, a proper infrastructure for performing a regional block along with adequate monitoring and resuscitation facilities are essential for safe conduction of abdominal surgery. It is the unmonitored regional block, which leads to critical incidents in the intra operative period. For acquiring expertise in the regional anaesthesia techniques for abdominal surgery they should be practiced routinely and not just infrequently on the high risk patient. Familiarity with the regional anaesthesia techniques together with the anticipation and prompt dealing with any problems would definitely find greater acceptability of regional techniques for abdominal surgery by both patient and surgeon. The most important factor for ensuring safety of this block is an anaesthesiologist well-trained in regional anaesthesia techniques. In a North American training programme (1980), residents performed only two subarachnoid blocks per year in one centre as compared to another in which 234 spinals were administered per year by residents (26). This study was repeated in 1990, and although the use of regional anaesthesia had increased in most of the training programs, it was mainly due to an increase in postoperative epidural analgesia and not intra-operative use of blocks (27). It is believed that "acceptable success" with neuraxial blocks takes approximately the performance of 40 blocks each of spinal and epidural anaesthesia (28). Finally peripheral nerve stimulators and in proved imaging techniques increase the safety and reliability of the regional anaesthetic techniques. Thus if we expand the focus of "Safety of R A for abdominal surgery" from an exclusive intra-operative to a peri-operative one, we can clearly appreciate the several advantages of administering RA for abdominal surgery.
Archive Staff Only: edit this record