Analgesia during radial artery cannulation: Comparison of the effects of lidocaine applied by local injection or iontophoresis

Abstract

SummaryWe investigated the long-term effects on clinical practice of a simulation-based course in anaesthesia crisis management. A questionnaire was posted to all anaesthetists who had attended a course in the preceding year. The response rate was 69% (66 ⁄ 96). The crisis management course was valued highly by respondents, who perceive a change in practice as a result of the training. This change in practice was not limited to the specific clinical events simulated in the course, but applied to a wide range of events and to routine practice. The high rate of subsequent critical events reported in the survey supports the need for training in this area. This survey suggests that simulation-based training in crisis management is an effective form of continuing medical education for anaesthetists.

Interventions to reduce arterial puncture-related pain: A systematic review and meta-analysis

“…Similarly, although ultrasound-guided venipuncture was associated with a lower proportion of patients reporting high pain intensity (NRS > 3) ( Yamagata et al, 2018 ), our findings did not show a reduction in arterial puncture-related pain when ultrasonography was employed. The role of operator experience on ultrasonography-related procedural outcomes is still debated 1998; Rüsch et al, 2017 ) Withdrawn volume of blood ( n = 1) ( Wade et al, 2015 ) Time to maximize the benefit of the intervention ( n = 1) ( Kim et al, 2007 ) Skin reactions/local complications ( n = 9) ( Aaron et al, 2003;García García et al, 2005;Latsios et al, 2017;Ruetzler et al, 2012;Russell et al, 1988;Sherwin et al, 2003;Smith et al, 1990;Tran et al, 2002;Yee et al, 2015 ) Adverse events ( n = 6) ( Ballesteros-Peña et al, 2017;Baskın et al, 2014;Cortés-Télles et al, 2012;Ibrahim et al, 2015;Joly et al, 1998;Tatlı et al, 2018 ) Radial spasm ( n = 3) ( Joly et al, 1998;Latsios et al, 2017;Tatlı et al, 2018 ) Rate of hemolysis ( n = 1) ( Ibrahim et al, 2015 ) Variation in potassium values ( n = 1) ( Ibrahim et al, 2015 ) Wrist movement during the procedure ( n = 1) ( Wade et al, 2015 ) Blood samples rejected by the laboratory ( n = 1) ( Baskın et al, 2014 ) Need for additional anesthetic infiltration ( n = 1) ( Joly et al, 1998 ) Access site crossover ( n = 1) ( Tatlı et al, 2018 ) Healthcare professionals' perceived difficulty with performing the procedure ( n = 8)…”

“…Seven ( Patout et al, 2015 studies specifically involved patients with pulmonary diseases, and six ( Joly et al, 1998 included patients with cardiovascular diseases. Sample size was extremely variable across studies, ranging from less than 50 ( Aguilar et al, 2007;Hajiseyedjavady et al, 2012;L'Her et al, 2001;Matheson et al, 2014;Sherwin et al, 2003;Wade et al, 2015 ) to over 500 ( Baskın et al, 2014;Joly et al, 1998;Pagnucci et al, 2020 ) patients, with a median size of 90 patients. Study samples comprised fewer females than males, who represented about 60% of all patients involved.…”

“…Ten ( Joly et al, 1998, Rüsch et al, 2017 studies explored pain due to arterial catheterization; the others investigated pain due to blood collection for arterial blood gas analysis. When arterial catheterization was performed, a needle gage of 17.5 ( Russell et al, 1988 ), 18 ( Joly et al, 1998 ), or 20 ( Kim et al, 2007;Latsios et al, 2017;Olday et al, 2002;Ruetzler et al, 2012;Rüsch et al, 2017;Sherwin et al, 2003;Smith et al, 1990;Tatlı et al, 2018 ) was employed. Blood collection for arterial blood gas analysis was performed using a needle gage of 22 ( Giner et al, 1996, Guevara Sanz and Requena Castillo, 2011, 23 ( Patout et al, 2015, 25 ( Patout et al, 2015, Guevara Sanz and Requena Castillo, 2011 26, ( Micu et al, 2006), 27 ( Cortés-Télles et al, 2012, and 29 ( Hajiseyedjavady et al, 2012;Ibrahim et al, 2015;Lightowler and Elliott, 1997 ).…”

“…Only one ( Sherwin et al, 2003 ) small study on 30 patients undergoing radial artery cannulation explored the effectiveness of 10 min of iontophoresis prior to arterial puncture using lidocaine compared to lidocaine infiltration. No difference in arterial puncture-related mean pain or puncture attempts emerged between groups.…”