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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2009 January-February;75(1-2):13-9
A survey of 1000 consecutive epidural catheter placements performed by inexperienced anesthesia trainees
Dalsasso M., Grandis M., Innocente F., Veronese S., Ori C.
Department of Anesthesiology and Intensive Care, University of Padoa, Padoa, Italy
Background. Education is the core activity of academic anaesthesia departments. One of the main difficulties appears to be the development of realistic high-quality 'training' practices that are safe for patients. The aim of this study was to determine the incidence of complications occurring after epidural catheter placement by inexperienced anaesthesia trainees and their possible relationship with the experience of the operator.
Methods. In a period covering 16 months, we performed a survey of 1,000 consecutive epidural placements performed by inexperienced anaesthesia residents under the direction of staff members in Padoa University Hospital, Italy. Neurological and cardiovascular complications as well as side effects were assessed and analyzed in terms of the experience levels of the trainees.
Results. Complications during epidural catheter placement included dural puncture (2.2%), epidural vascular damage (1.7%), and paresthesias (0.9%). Postoperative complications and side effects comprised local bleeding at the catheter insertion point (0.7%), catheter malfunction (0.4%), cardiovascular side effects (2.0%) and persistent postoperative paresthesias not caused by local anaesthetic infusion (1.7%). One patient suffered a transient radiculopathy. The overall incidence of complications was similar for each experience level examined.
Conclusion. Epidural catheterization performed under supervision by inexperienced anaesthesia residents is not associated with a significantly greater number of complications than reported in the literature. Moreover, at the early stage of training, we could not demonstrate any correlation between the experience of the operator and the incidence of complications incidence.