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Regional anaesthesia practice for arteriovenous fistula formation surgery

We conducted a survey and semi‐structured qualitative interviews to investigate current anaesthetic practice for arteriovenous fistula formation surgery in the UK. Responses were received from 39 out of 59 vascular centres where arteriovenous access surgery is performed, a response rate of 66%. Thir...

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Autores principales: Armstrong, R. A., Wilson, C., Elliott, L., Fielding, C. A., Rogers, C. A., Caskey, F. J., Hinchliffe, R. J., Mouton, R., Rooshenas, L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7187449/
https://www.ncbi.nlm.nih.gov/pubmed/32030735
http://dx.doi.org/10.1111/anae.14983
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author Armstrong, R. A.
Wilson, C.
Elliott, L.
Fielding, C. A.
Rogers, C. A.
Caskey, F. J.
Hinchliffe, R. J.
Mouton, R.
Rooshenas, L.
author_facet Armstrong, R. A.
Wilson, C.
Elliott, L.
Fielding, C. A.
Rogers, C. A.
Caskey, F. J.
Hinchliffe, R. J.
Mouton, R.
Rooshenas, L.
author_sort Armstrong, R. A.
collection PubMed
description We conducted a survey and semi‐structured qualitative interviews to investigate current anaesthetic practice for arteriovenous fistula formation surgery in the UK. Responses were received from 39 out of 59 vascular centres where arteriovenous access surgery is performed, a response rate of 66%. Thirty‐five centres reported routine use of brachial plexus blocks, but variation in anaesthetic skill‐mix and practice were observed. Interviews were conducted with 19 clinicians from 10 NHS Trusts including anaesthetists, vascular access and renal nurses, surgeons and nephrologists. Thematic analysis identified five key findings: (1) current anaesthetic practice showed that centres could be classified as ‘regional anaesthesia dominant’ or ‘local anaesthesia/mixed’; (2) decision making around mode of anaesthesia highlighted the key role of surgeons as frontline decision makers across both centre types; (3) perceived barriers and facilitators of regional block use included clinicians’ beliefs and preferences, resource considerations and patients’ treatment preferences; (4) anaesthetists’ preference for supraclavicular blocks emerged, alongside acknowledgement of varied practice; (5) there was widespread support for a future randomised controlled trial, although clinician equipoise issues and logistical/resource‐related concerns were viewed as potential challenges. The use of regional anaesthesia for arteriovenous fistula formation in the UK is varied and influenced by a multitude of factors. Despite the availability of anaesthetists capable of performing regional blocks, there are other limiting factors that influence the routine use of this technique. The study also highlighted the perceived need for a large multicentre, randomised controlled trial to provide an evidence base to inform current practice.
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spelling pubmed-71874492020-04-29 Regional anaesthesia practice for arteriovenous fistula formation surgery Armstrong, R. A. Wilson, C. Elliott, L. Fielding, C. A. Rogers, C. A. Caskey, F. J. Hinchliffe, R. J. Mouton, R. Rooshenas, L. Anaesthesia Original Articles We conducted a survey and semi‐structured qualitative interviews to investigate current anaesthetic practice for arteriovenous fistula formation surgery in the UK. Responses were received from 39 out of 59 vascular centres where arteriovenous access surgery is performed, a response rate of 66%. Thirty‐five centres reported routine use of brachial plexus blocks, but variation in anaesthetic skill‐mix and practice were observed. Interviews were conducted with 19 clinicians from 10 NHS Trusts including anaesthetists, vascular access and renal nurses, surgeons and nephrologists. Thematic analysis identified five key findings: (1) current anaesthetic practice showed that centres could be classified as ‘regional anaesthesia dominant’ or ‘local anaesthesia/mixed’; (2) decision making around mode of anaesthesia highlighted the key role of surgeons as frontline decision makers across both centre types; (3) perceived barriers and facilitators of regional block use included clinicians’ beliefs and preferences, resource considerations and patients’ treatment preferences; (4) anaesthetists’ preference for supraclavicular blocks emerged, alongside acknowledgement of varied practice; (5) there was widespread support for a future randomised controlled trial, although clinician equipoise issues and logistical/resource‐related concerns were viewed as potential challenges. The use of regional anaesthesia for arteriovenous fistula formation in the UK is varied and influenced by a multitude of factors. Despite the availability of anaesthetists capable of performing regional blocks, there are other limiting factors that influence the routine use of this technique. The study also highlighted the perceived need for a large multicentre, randomised controlled trial to provide an evidence base to inform current practice. John Wiley and Sons Inc. 2020-02-06 2020-05 /pmc/articles/PMC7187449/ /pubmed/32030735 http://dx.doi.org/10.1111/anae.14983 Text en © 2020 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Articles
Armstrong, R. A.
Wilson, C.
Elliott, L.
Fielding, C. A.
Rogers, C. A.
Caskey, F. J.
Hinchliffe, R. J.
Mouton, R.
Rooshenas, L.
Regional anaesthesia practice for arteriovenous fistula formation surgery
title Regional anaesthesia practice for arteriovenous fistula formation surgery
title_full Regional anaesthesia practice for arteriovenous fistula formation surgery
title_fullStr Regional anaesthesia practice for arteriovenous fistula formation surgery
title_full_unstemmed Regional anaesthesia practice for arteriovenous fistula formation surgery
title_short Regional anaesthesia practice for arteriovenous fistula formation surgery
title_sort regional anaesthesia practice for arteriovenous fistula formation surgery
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7187449/
https://www.ncbi.nlm.nih.gov/pubmed/32030735
http://dx.doi.org/10.1111/anae.14983
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