How To Educate Total Intravenous Anesthesia To The Trainees Who Have Never Experienced Anesthesia Management

How To Educate Total Intravenous Anesthesia To The Trainees Who Have Never Experienced Anesthesia Management; An Importance Of Imprinting Effect

Yoshimi Inagaki, MD, PhD., Hiroshi Adachi, MD, Yuichi Ishibe, MD, PhD.

Department of Anesthesiology and Critical Care Medicine, Tottori University Faculty of Medicine, Yonago, Tottori 683-8504, Japan

Introduction:

The more total intravenous anesthesia (TIVA) using target-controlled infusion (TCI) technique has been applied in the clinical anesthesia, the more opportunities also have increased to teach this technique to the trainees. However, there are few reports on education of TIVA using TCI for the beginners (1). We conducted a prospective randomized study to clarify whether an initial training program affect the choice of anesthesia method in the trainees.

Methods:

After obtaining approval of IRB, forty-five trainees, who have never experienced anesthesia management, were enrolled to this study between July 2002 and February 2004. The trainees were randomly assigned to the two study groups according to the month in which they started the program; trainees in an inhalation anesthesia (IA) group (n=25) learned general anesthesia with either sevoflurane or isoflurane and fentanyl for the first month and TIVA with propofol and fentanyl using TCI technique for the second month, and chose either anesthesia method freely in consideration of patient’s profile at the third month; trainees in an TIVA group (n=20) learned both anesthetic methods in the reversed manner for two months and chose freely at the third month. Eight instructors taught both anesthesia methods using the same educational standard throughout the study. At the end of the third month, the trainees were asked with a questionnaire that involved number of cases undergoing each anesthesia technique in the third month, clinical applicability of TIVA (1[very difficult] to 5 [very easy]), necessity of BIS monitoring (1[absolutely unnecessary] to 5 [absolutely necessary]), and so on. Eight instructors also were asked the degree of achievement of each anesthesia technique in all trainees at the end of the third month (1 [poor] to 5 [excellent]). Data was analyzed by the Mann-Whitney test and Chi-square test. P<0.05 was considered statistically significant.

Results:

At the third month, a ratio of patients undergoing TIVA with TCI technique to all patients undergoing general anesthesia with/without regional anesthesia was 0.362 (192/530) in the inhalation group and 0.516 (265/514) in the TIVA group, respectively. Percentage of choice of TIVA was significantly more (p<0.0001) in the TIVA group. The clinical applicability of TIVA in the TIVA group was 3 (2-4) (median [25 percentile to 75 percentile]) without regional anesthesia and 3.5 (3-4) with regional anesthesia, while that in the IA group was 2 (2-3) and 3 (3-3), respectively. Impression of TIVA was significantly better (p=0.0215 without regional anesthesia and p=0.0166 with regional anesthesia) in the TIVA group. Necessity of BIS monitoring was significantly lower (p=0.0182) in the TIVA group (3 [2.5-4]) than in the IA group (4 [3-4]) when they administered TIVA but was similar when they administered volatile anesthetic. The instructors rated the trainees of the TIVA group (3 [3-4]) significantly higher (p=0.0278) than those of the IA group (3 [2-3]) about the achievement of TIVA skill.

Discussion:

The results indicated that an initial training program of anesthesia played an important role in the choice of anesthesia method for the trainees who have never experienced anesthetic management. TIVA skill would not be familiar for the trainees receiving an inhalation anesthesia technique initially. However, clinical applicability of TIVA was higher in the trainees first receiving TIVA training program. This finding may be provided by the imprinting effect on the trainees.

Conclusion:

An initial training program of anesthesia was likely to affect strongly the choice of anesthesia method in the following training period.

Reference:

1. Ann Fr Anesth Reanim 2001; 20:228-45.