Patel Samir, Le Noah D, Carter John, Melott Nick, Kalnow Andrew, Hawkins Camille D, Luong Alexander, Franzen Matthias
Anesthesiology and Perioperative Medicine, OhioHealth Doctors Hospital, Columbus, USA.
Anesthesiology, Ohio University Heritage College of Osteopathic Medicine, Dublin, USA.
Cureus. 2025 Jan 20;17(1):e77712. doi: 10.7759/cureus.77712. eCollection 2025 Jan.
Background Epidural anesthesia is a commonly used procedure in obstetrics for managing labor pain, with a potential complication of high neuraxial blockade. Proficiency in performing epidural or spinal anesthesia and promptly recognizing and managing high neuraxial blockade are critical components of anesthesiology residency training. Methods A simulated case was designed involving a 21-year-old female in labor receiving epidural anesthesia. After the administration of local anesthetic, she develops symptoms of nausea, hypotension, and respiratory distress, progressing to high neuraxial blockade. The simulation environment included a labor and delivery suite setup, an epidural cart, airway supplies, a Laerdal SimMan 3G PLUS mannequin (Laerdal Medical, Stavanger, Norway), and an M43B Kyoto Kagaku Lumbar Puncture Simulator II (Kyoto Kagaku, Kyoto, Japan). Post-simulation, participants completed surveys via REDCap (Vanderbilt University, Nashville, USA) to assess their comfort levels in recognizing and managing high neuraxial blockades. Results Nine participants, including anesthesiology residents (PGY1-4) and student registered nurse anesthetists (SRNAs), completed the pilot simulation. Survey feedback was collected to evaluate the simulation's impact on participants' learning and confidence. Discussion Participants provided positive feedback, highlighting the simulation's value in their training and its realism. Suggestions for improvement included using an actual labor and delivery bed to better mimic real-world challenges. A limitation of the study is the small sample size, additional sessions with future cohorts will help further assess the simulation's efficacy. Plans are in place to incorporate this simulation annually into the anesthesiology residency curriculum at the institution. Conclusion Simulation-based training in anesthesiology residency programs enables learners to practice managing complex and high-stakes scenarios in a controlled environment. This simulation effectively reinforced critical skills, including endotracheal intubation, epidural catheter placement, and the management of a hemodynamically unstable pregnant patient. Furthermore, it provided valuable experience in recognizing and treating high neuraxial blockade, a serious but rare complication of epidural anesthesia.
背景 硬膜外麻醉是产科常用的分娩镇痛方法，但存在发生高位椎管内阻滞的潜在并发症。熟练掌握硬膜外或脊髓麻醉操作，并能及时识别和处理高位椎管内阻滞，是麻醉学住院医师培训的关键内容。方法 设计了一个模拟病例，一名21岁的分娩期女性接受硬膜外麻醉。给予局部麻醉药后，她出现恶心、低血压和呼吸窘迫症状，进而发展为高位椎管内阻滞。模拟环境包括产房设置、硬膜外麻醉车、气道用品、Laerdal SimMan 3G PLUS模拟人（挪威斯塔万格的Laerdal Medical公司）和M43B京都科学生产的腰椎穿刺模拟器II（日本京都的京都科学公司）。模拟结束后，参与者通过REDCap（美国纳什维尔范德比尔特大学）完成调查问卷，以评估他们在识别和处理高位椎管内阻滞方面的舒适度。结果 9名参与者完成了试点模拟，包括麻醉学住院医师（PGY1 - 4）和注册护士麻醉专业学生（SRNA）。收集了调查反馈，以评估模拟对参与者学习和信心的影响。讨论 参与者提供了积极反馈，强调了模拟在他们培训中的价值及其真实性。改进建议包括使用实际的产床，以更好地模拟现实世界中的挑战。该研究的一个局限性是样本量小，未来对更多参与者进行更多场次的模拟将有助于进一步评估模拟的效果。该机构已计划每年将此模拟纳入麻醉学住院医师课程。结论 麻醉学住院医师培训中的基于模拟的训练使学习者能够在可控环境中练习处理复杂和高风险的情况。该模拟有效地强化了关键技能，包括气管插管、硬膜外导管置入以及对血流动力学不稳定的孕妇患者的管理。此外，它还提供了识别和治疗高位椎管内阻滞的宝贵经验，高位椎管内阻滞是硬膜外麻醉一种严重但罕见的并发症。
