Improving local anaesthetic systemic toxicity (LAST) awareness in maternity care using tailored educational tools

Edwards, Amy; Bowsher, Gemma; Deepak, Sahil; Ali, Mohamed

doi:10.1136/bmjoq-2017-000070

Cited by 8 publications

(10 citation statements)

References 8 publications

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“…However, teaching programs led to a significant improvement in knowledge. 18 A Danish study conducted among anesthetists, revealed that about 50% knew about lipid therapy but were not aware how to acquire ILE. 19 In a cross-sectional study in Turkey, 42% of the emergency physicians identified ILE dosage.…”

Section: Discussionmentioning

confidence: 99%

An online study of knowledge and practices of local anesthetic systemic toxicity among doctors in Sri Lanka

Munasinghe¹,

Subramaniam²,

Srisothinathan³

et al. 2022

Anaesth. pain intensive care

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Background: Inadvertent over-dosage or intravascular injections may still lead to systemic toxicity. Local anesthetic systemic toxicity (LAST) could be potentially life threatening. This study focused on the current knowledge and practices in use of LA by the doctors in Sri Lanka and their ability to detect and manage an event of LAST. Methodology: A descriptive cross-sectional study was conducted among doctors in Sri Lanka using an online self-administered questionnaire based on AAGBI guidelines (2010). Descriptive statistics were analyzed by cross-tabulations and presented as numbers and percentages using IBM-SPSS 25. Results: The response rate was 60% out of 600 doctors. Majority were males (58%) while 45% of the respondents were anesthetists. Ultrasound was used by 47.4% during specific LA use. The majority (74%) considered total body weight for dose calculations. Around 50% of the respondents identified bupivacaine as the most cardiotoxic. The majority (77%) utilized some form of monitoring and were knowledgeable on identification, prevention and initial management of LAST. Approximately 45% identified Intralipid (ILE) as the definitive treatment of LAST, out of which, 66.8% knew the correct dose, 77.2% and 26.5%, the availability and the location of the stored drug, respectively. Conclusion: The basic knowledge about LAST was satisfactory among the respondents. A statistically significant difference on knowledge on maximum safe doses of LA, ILE in established LAST, its dosage and the availability was identified between anesthetists and non-anesthesia doctors; and postgraduate trainees and the rest of the doctors. Overall, significant lapses were noted with regard to the use of total body weight for dose calculations, use of ultrasound during LA administration and dosage, availability and storage of the definitive therapy and ILE. Abbreviations: LA - Local anesthetics; LAST - Local anesthetic systemic toxicity; ILE - Intralipid Key words: Local Anesthetic Systemic Toxicity; LAST, cardiac toxicity, Intralipid Citation: Munasinghe BM, Subramaniam N, Srisothinathan N, Jayamanne BDW. An online study of knowledge and practices of local anesthetic systemic toxicity among doctors in Sri Lanka. Anaesth. pain intensive care 2022;26(1):69-74. DOI: 10.35975/apic.v26i1.1770 Received: August 27, 2021, Reviewed: October 05, 2021, Accepted: October 10, 2021

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Section: Discussionmentioning

confidence: 99%

An online study of knowledge and practices of local anesthetic systemic toxicity among doctors in Sri Lanka

Munasinghe¹,

Subramaniam²,

Srisothinathan³

et al. 2022

Anaesth. pain intensive care

View full text Add to dashboard Cite

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“…A study by Edwards et al at demonstrated an overall deficit in knowledge on LAST (including ILE therapy) in a Maternity unit in a UK Hospital. However, teaching programmes led to a significant improvement in knowledge [23] . A Danish study in 2011, conducted among anaesthetists, revealed that around 50% knew about lipid therapy but were not aware how to acquire ILE and that it was not available at places where LA was administered [24] .…”

Section: Discussionmentioning

confidence: 99%

Study of knowledge and practices of local anaesthetic systemic toxicity among Doctors in Sri Lanka

Munasinghe

Arambepola

Subramaniam

et al. 2021

Preprint

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Background Local anaesthetic systemic toxicity (LAST) could be potentially life threatening. This study focused on describing the knowledge and practices of use of local anaesthetics (LA) among the doctors in Sri Lanka and the ability to detect and manage an event of LAST. Materials and methods A descriptive cross-sectional study was conducted among doctors in Sri Lanka using an online self-administered questionnaire based on AAGBI guidelines (2010). Descriptive statistics were analyzed by cross-tabulations and presented as numbers and percentages using IBM-SPSS 25. Results The response rate was 60% out of 600. Majority were males (58%) while 45% of the respondents were anesthetists. Ultrasound was used by 47.4% during LA. The majority considered total body weight for dose calculations. Around 50% of respondents identified bupivacaine as the most cardiotoxic. The majority utilized some form of monitoring and were knowledgeable on identification, prevention and initial management of LAST. Approximately 45% identified Intralipid (ILE) as the definitive treatment of LAST, out of which, 66.8% knew the correct dose and 77.2% and 26.5%, the availability and location of storage, respectively. Conclusion The basic knowledge on LAST was satisfactory among the respondents. A statistically significant difference on knowledge on maximum safe doses of LA, ILE in established LAST, its dosage and the availability was identified between anaesthetic and non-anaesthetic doctors and post graduate trainees and the rest of the doctors. Overall, significant lapses were noted with regard to the use of total body weight for dose calculations, use of ultrasound during LA administration and dosage, availability and storage of the definitive therapy, ILE, suggesting updates in these key areas.

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“…A previous study by Edwards et al which aimed to improve LAST awareness showed that the average baseline (preassessment) scores were 3.87/14 with a standard deviation of 3.18. Average postvideo presentation scores were 6.57 with a standard deviation of 3.52 [ 9 ]. Thus, the difference in mean response was 2.7.…”

Section: Methodsmentioning

confidence: 99%

“…As such, any practitioner, not limited to the anaesthesiologist, who administers these agents should be familiar with the prevention, identifcation, and treatment of LAST. Despite the limited data, several studies have shown that knowledge of LA doses and awareness of LAST remains poor among clinicians [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…As such, any practitioner, not limited to the anaesthesiologist, who administers these agents should be familiar with the prevention, identification, and treatment of LAST. Despite the limited data, several studies have shown that knowledge of LA doses and awareness of LAST remains poor among clinicians [ 9 – 12 ]. The occurrence of LAST is rare, with various retrospective reviews between 1998 and 2014 showing an incidence rate between 0.87 and 1.8 per 1000 peripheral nerve blocks [ 13 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Awareness of Local Anaesthetic Systemic Toxicity (LAST) among Postgraduate Trainees

Surani

Budiman

Azman

et al. 2022

International Journal of Clinical Practice

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Introduction. Although uncommon, local anaesthetic systemic toxicity (LAST) may impose fatal risk to the patients. We investigated the awareness of LAST and knowledge on local anaesthetics among our postgraduate trainees. Materials and Methods. A total of 134 postgraduate trainees from the departments of general surgery (Surgical), orthopaedic surgery (Ortho), otorhinolaryngology (ENT), obstetrics and gynaecology (OBGYN), as well as anaesthesiology and intensive care (Anaesth) were recruited. A validated questionnaire was used to assess awareness and knowledge. All participants attended a medical-education session and completed the questionnaire as preassessment and postassessment. Data were analysed, and comparisons between disciplines were conducted. Results. The trainees’ awareness of LAST was overall poor at preassessment which improved almost 6-folds at postassessment. Surprisingly, only 20 (45.5%) participants from the anaesthesiology group had awareness of LAST at preassessment, and none of the participants were from surgical, orthopaedic, and obstetrics and gynaecology departments. Preassessment scores were significantly higher in the anaesth group as compared to all other groups; with a difference in the average score for Anaesth vs Surgical of 3.46 (95%, CI:2.17, 4.74), Anaesth vs Ortho of 3.64 (95%, CI:2.64, 4.64), Anaesth vs ENT of 3.43 (95%, CI:2.20, 4.67), and Anaesth vs OBGYN of 6.93 (95%, CI:5.64, 8.21). However, there was no significant difference of awareness scores between all participants at postassessment scores. Conclusion. The overall level of awareness was poor. However, the implementation of an education session significantly improved the knowledge and awareness across all disciplines.

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Improving local anaesthetic systemic toxicity (LAST) awareness in maternity care using tailored educational tools

Cited by 8 publications

References 8 publications

An online study of knowledge and practices of local anesthetic systemic toxicity among doctors in Sri Lanka

An online study of knowledge and practices of local anesthetic systemic toxicity among doctors in Sri Lanka

Study of knowledge and practices of local anaesthetic systemic toxicity among Doctors in Sri Lanka

Assessment of Awareness of Local Anaesthetic Systemic Toxicity (LAST) among Postgraduate Trainees

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