Urfalıoğlu Aykut, Urfalıoğlu Selma, Öksüz Gözen
Sütçü İmam University Faculty of Medicine, Department of Anesthesiology and Reanimation, Kahramanmaraş, Turkey.
Necip Fazıl State Hospital, Opthalmology Clinic, Kahramanmaraş, Turkey.
Turk J Ophthalmol. 2017 Dec;47(6):320-325. doi: 10.4274/tjo.79446. Epub 2017 Dec 25.
To evaluate the knowledge of ophthalmologists regarding local anesthesia toxicity syndrome (LATS) and intravenous lipid emulsion used in treatment, and to raise awareness of this issue.
A questionnaire comprising 14 questions about demographics, local anesthesia (LA) use, toxicity, and treatment methods was administered to ophthalmologists at different hospitals.
The study included 104 ophthalmologists (25% residents, 67.3% specialists, 7.7% faculty members) with a mean age of 35.71±6.53 years. The highest number of participants was from state hospitals (65.4%), and 34.6% of the physicians had been working in ophthalmology for more than 10 years. Seventy-six percent of the participants reported using LA every day or more than twice a week, but 56.7% had received no specific training on this subject. No statistically significant difference was observed between different education levels and the rates of training (p=0.419). Bupivacaine was the most preferred LA and the majority of respondents (97.1%) did not use a test dose. Allergy (76%) and hypotension (68.3%) were the most common responses for early findings of LATS, while cardiac arrest (57.4%) and hepatotoxicity (56.4%) were given for late findings. The most common responses concerning the prevention of LATS included monitorization (72.4%) and use of appropriate doses (58.2%). Symptomatic treatment was selected by 72.4% of respondents and cardiopulmonary resuscitation and antihistamine treatment by 58.8%. Of the ophthalmologists in the study, 62.5% had never encountered LATS. The use of 20% intravenous lipid emulsion therapy for toxicity was known by 65% of the physicians, but only 1 participant stated having used it previously.
The importance of using 20% lipid emulsion in LATS treatment and having it available where LA is administered must be emphasized, and there should be compulsory training programs for ophthalmologists on this subject.
评估眼科医生对局部麻醉中毒综合征（LATS）及用于治疗的静脉注射脂质乳剂的了解情况，并提高对此问题的认识。
向不同医院的眼科医生发放一份包含14个问题的问卷，内容涉及人口统计学、局部麻醉（LA）的使用、毒性及治疗方法。
该研究纳入了104名眼科医生（25%为住院医师，67.3%为专科医生，7.7%为教员），平均年龄为35.71±6.53岁。参与人数最多的来自公立医院（65.4%），34.6%的医生从事眼科工作超过10年。76%的参与者报告每天或每周使用LA超过两次，但56.7%的人未接受过关于该主题的特定培训。不同教育水平与培训率之间未观察到统计学上的显著差异（p = 0.419）。布比卡因是最常用的LA，大多数受访者（97.1%）未使用试验剂量。过敏（76%）和低血压（68.3%）是LATS早期发现的最常见反应，而心脏骤停（57.4%）和肝毒性（56.4%）是晚期发现的最常见反应。关于预防LATS的最常见反应包括监测（72.4%）和使用适当剂量（58.2%）。72.4%的受访者选择对症治疗，58.8%的受访者选择心肺复苏和抗组胺治疗。在该研究的眼科医生中，62.5%从未遇到过LATS。65%的医生知道使用20%静脉注射脂质乳剂治疗毒性，但只有1名参与者表示之前使用过。
必须强调在LATS治疗中使用20%脂质乳剂并在实施LA的地方备有该药物的重要性，并且应该为眼科医生制定关于该主题的强制性培训计划。
