Bihani Pooja, Paliwal Naveen, Jaju Rishabh, Rajpurohit Vikas
Department of Anaesthesiology, All India Institute of Medical Sciences, Bhubaneswar, India.
Department of Emergency Medicine, Dr. S.N. Medical College, Jodhpur, India.
Anesth Pain Med (Seoul). 2025 Apr;20(2):166-174. doi: 10.17085/apm.24146. Epub 2025 Jan 8.
Local anesthetic systemic toxicity (LAST) is a rare life-threatening complication of regional anesthesia. Simulation-based training offers an effective educational approach to improve the management of infrequent events. This quasi-experimental study assessed the impact of a multidisciplinary simulation-based educational intervention on managing LAST as a real peri-operative team.
Twelve anesthesia trainees and eight nursing staff members participated in the study. The intervention included pre-course learning materials, cognitive aids, and immersive simulation scenarios. Simulation scenarios were conducted at baseline (O1), one week after a boot camp (O2), and six months later (O3). Participants' reactions to the training were evaluated using a 5-point Likert scale, while knowledge acquisition was measured through pre- and post-test questionnaires. Team-based skills acquisition and retention were assessed using a modified checklist from the simulation team assessment tool. Data were analyzed using paired t-tests, with P < 0.05 considered statistically significant.
All participants rated the LAST curriculum as satisfactory to very satisfactory. Significant improvements in both technical and non-technical skills were observed post-intervention (O2), with checklist scores increasing from an average of 39 (4.2) (95% confidence interval [CI], 34.88; 43.11) at O1 to 83.5 (5.7) (95% CI, 77.91; 89.08) at O2 (mean difference, 44.5; P < 0.001). At six months (O3), skill retention was indicated by an average score of 72 (7.8) (95% CI, 62.36; 77.64).
Multidisciplinary, simulation-based educational interventions remarkably improve knowledge and skills related to LAST management, with effective skill retention observed at six months when implemented by multiprofessional teams in real-world settings.
局部麻醉药全身毒性反应（LAST）是区域麻醉一种罕见但危及生命的并发症。基于模拟的培训提供了一种有效的教育方法，可改善对罕见事件的管理。这项准实验研究评估了多学科基于模拟的教育干预措施对作为实际围手术期团队管理LAST的影响。
12名麻醉学员和8名护理人员参与了该研究。干预措施包括课前学习材料、认知辅助工具和沉浸式模拟场景。模拟场景在基线时（O1）、新兵训练营后一周（O2）和六个月后（O3）进行。使用5点李克特量表评估参与者对培训的反应，同时通过课前和课后问卷测量知识获取情况。使用模拟团队评估工具中的修改清单评估基于团队的技能获取和保留情况。使用配对t检验分析数据，P<0.05被认为具有统计学意义。
所有参与者对LAST课程的评价为满意至非常满意。干预后（O2）观察到技术和非技术技能均有显著改善，清单分数从O1时的平均39（4.2）（95%置信区间[CI]，34.88；43.11）增加到O2时的83.5（5.7）（95%CI，77.91；89.08）（平均差异，44.5；P<0.001）。在六个月时（O3），技能保留表现为平均分数72（7.8）（95%CI，62.36；77.64）。
多学科、基于模拟的教育干预措施显著提高了与LAST管理相关的知识和技能，当多专业团队在实际环境中实施时，六个月时观察到有效的技能保留。
