Pawa Amit, El-Boghdadly Kariem
Department of Anaesthesia, Guy's & St Thomas' NHS Foundation Trust.
King's College London, London, UK.
Curr Opin Anaesthesiol. 2018 Oct;31(5):586-592. doi: 10.1097/ACO.0000000000000643.
As the evidence supporting the notion that regional anesthesia improves patient outcomes grows, utilization of regional anesthesia techniques has similarly increased. Best care should not be restricted by the background of care providers, however, the evidence replicating benefits of regional anesthesia when it is delivered by nonanesthesiologists is unclear. In this review, the provision of regional anesthesia by nonanesthesiologists is discussed so that readers can come to their own conclusions.
Regional anesthesia procedures are performed by nonanesthesiology physicians such as emergency physicians, critical care specialists, and surgeons. Patients benefit from the provision of regional anesthesia by these groups, but inconsistencies exist in training, service provision, and collaboration between these specialties and anesthesiologists. Nonphysician anesthesia providers also provide regional anesthesia. There are limited data on outcomes or benefits of this nonphysician-provided service, but consideration of team-based care and alternative models of care based upon geographical need is worthwhile.
The provision of regional anesthesia requires the accumulation of a suitable knowledge, skills, and behaviors that can be taught. Whilst it may not be appropriate for all techniques to be performed by all individuals, the possession of these competencies with the appropriate training and quality assurance means that more patients may ultimately benefit from the provision of regional anesthesia services.
随着支持区域麻醉可改善患者预后这一观点的证据不断增加，区域麻醉技术的应用也相应增多。然而，最佳医疗不应受医疗服务提供者背景的限制，目前尚不清楚非麻醉医生实施区域麻醉时能否复制其益处。在本综述中，将讨论非麻醉医生实施区域麻醉的情况，以便读者自行得出结论。
区域麻醉操作由非麻醉科医生进行，如急诊科医生、重症监护专家和外科医生。这些群体实施区域麻醉使患者受益，但这些专业与麻醉医生之间在培训、服务提供及协作方面存在不一致之处。非医生麻醉提供者也提供区域麻醉。关于这种非医生提供服务的结果或益处的数据有限，但基于地域需求考虑团队式医疗和替代医疗模式是值得的。
实施区域麻醉需要积累可传授的适当知识、技能和行为。虽然并非所有技术都适合所有人操作，但具备这些能力并接受适当培训和质量保证意味着更多患者最终可能从区域麻醉服务中受益。
