Review P3 (1993): Major Regional Anaesthesia

1. GENERAL PRINCIPLES

1.1 Major Regional Anaesthesia is an anaesthetic technique which can produce significant physiological changes or local anaesthetic toxicity and which may cause patient morbidity or mortality (eg epidural or spinal blockade, pleus blockade, intravenous regional blockade).



1.2 Major regional anaesthesia should be undertaken only by medical practitioners with adequate experience in the technique or by those in a supervised training programme. Such persons must understand the releant anatomy, physiology, pharmacology and complications of the particular block. They must be able to recognise and promptly treat any complications of the block.



1.3 The Australian and New Zealand College of Anaesthetists does not approve of one person assuming the dual responsibility of both the operator and the anaesthetist for any forms of major regional anaesthesia.


1.4 Management of major regional anaesthesia should include secure intravenous access, patient monitoring in accordance with Policy Document P18 "Monitoring During Anaesthesia" and appropriate sedation.



1.5 The anaesthetist should be in attendance throughout the procedure, or until the block is successful, the condition of the patient is stableand the potential for acute toxicity of the local anaesthetic has passed.



1.6 To ensure that standards of patient care are satisfactory, equipment and staffing of the area in which the patient is being managed should satisfy the requirements of the following Australian and New Zealand College of Anaesthetists Policy Documents:

T1 "Recommended Minimum Facilities for Safe Anaesthetic Practice in Operating Suites"


T6 "Recommended Minimum Facilities for Safe Anaesthetic Practice in Delivery Suites"


P2 "Privilees in Anaesthesia"


P4 "Guidelines for the Care of Patients Recovering from Anaesthesia"


P9 "The Use of Sedation for Diagnostic and Minor Surgical Procedures"

2. SPECIFIC PRINCIPLES FOR POSTOPERATIVE EPIDURAL ANALGESIA MANAGEMENT

The placement of an epidural catheter and the administration of the initial dose of local anaesthetic or opiod is the responsibility of the anaesthetist performing the procedure.

2.1 Should the anaesthetist deleate the further administration of epidural analgesia to another person it is the responsibility of the anaesthetist to hand over properly the patient's management to that person and to satisfy himself or herself of the competence of that person to manage the epidural analgesia and carry out the administration procedures. Adequate medical records documenting the time, dose and subsequent effects must be kept.



2.2 Competency should be established by:


2.2.1 a form of accreditation which certifies that the person who will be performing the epidural administration has carried out a sufficient number of similar administrations satisfactorily under supervision,


and


2.2.2 enquiry of the person to establish familiarity with and knowlege of the procedure and subsequent management, including the management of complications.



2.3 No person should be required to carry out any such procedure if uncertain of their competence to do so.



2.4 All patients must have secure intravenous access throughout the duration of the epidural analgesia.

February 1993

© This document is copyright and cannot be reproduced in wholeor in part without prior permission.