Prevention and Treatment of Local Anesthetic Systemic Toxicity: A DNP Project

Abstract

Local anesthetic systemic toxicity (LAST) is an adverse event after the administration of local anesthetics that can lead to seizures, cardiac arrest, and death. While rare, this potentially catastrophic event requires immediate diagnosis and treatment. The purpose of this Doctor of Nursing Practice (DNP) quality improvement project is to assess CRNA perceptions of the adequacy of a LAST Quick Reference Guide designed to assist in identifying high-risk patients to quickly diagnose and appropriately treat LAST should it occur. A presentation and visual aids were given to the participating CRNAs, along with pre- and post-implementation surveys via anonymous Qualtrics links. The survey responses were collected and analyzed, showing mixed results. The results showed a net increase in the CRNA awareness of LAST (n=4). However, the overall confidence in maximum dosages of local anesthetics showed a decrease in confidence in the post-implementation responses. These results could be due to an immense amount of information on the QRG, a discrepancy between previous knowledge and what was learned from the QRG, or the possibility of having different participants in the pre- versus post- implementation surveys. The sample size from this project was small, so it is not possible to generalize the findings and further research is recommended. It is anticipated that knowledge gained from this project can be used in future quality improvement projects aimed at improving this rare but potentially catastrophic perioperative event at this facility.