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Have anaesthetists' concerns about anaesthesia associates finally been justified?
Anaesthesia ( IF 7.5 ) Pub Date : 2024-08-07 , DOI: 10.1111/anae.16402
Andreas Sotiriou 1 , Stuart Edwardson 2 , Sarah Marsden 3
Affiliation  

We congratulate Cook et al. on the publication of their important article [1] produced with data from the 7th National Audit Project (NAP7) from the Royal College of Anaesthetists [2]. The topic of anaesthesia associates remains highly controversial in UK anaesthesia and has suffered from a relative lack of objective data to inform discussion. We feel this documented window into the clinical activity of anaesthesia associates reinforces our concerns on patient safety and parallels with training of anaesthetists.

It is now clear that anaesthesia associates are working outside the original 2016 scope of practice [3]. This includes the provision of anaesthetic care of patients undergoing paediatric, obstetric, neurosurgical and vascular surgeries [1]. Carrying this out under the auspices of ‘local governance’ is mentioned in the 2016 scope document [3]; however, a restriction to these extended roles is now reflected in position statements from the Royal College of Anaesthetists and the Association of Anaesthetists. Updated guidance is awaited but it seems that, if this practice is already embedded within some departments, it may be difficult to reverse.

Scope of practice supervision levels were also not consistently followed. Supervising consultants were not always immediately available and, in 63 cases, the anaesthesia associate was identified as the most senior anaesthetic provider [1]. This concern has been raised in a recent publication by Evans et al. [4]. If the standard of practice for anaesthetists in training and non-autonomous Specialty doctor and Associate Specialist was applied to this (via the use of the Cappuccini test [5]), the supervision of anaesthesia associates would frequently be inadequate.

The proposed expansion of anaesthesia associates risks negatively impacting the training of anaesthetists. The well-used argument against this has traditionally been that they only take part in the care of healthy patients in limited scenarios. The clinical activity data in this publication disproves this by showing activity across all acuity and comorbidity levels. The potential for the reduction of clinical experience in anaesthetic training is, therefore, significant.

Anaesthesia is a field of medicine still fraught with risk and remaining aware of one's unknowns guards against complacency. It is, therefore, concerning to read that anaesthesia associates felt they did not need more training in the management of peri-operative cardiac arrest and were confident in existing guidelines [1]. Peri-operative cardiac arrest must be viewed as a distinct entity, the management of which is not adequately covered as part of current Advanced Life Support courses.

Drawing firm conclusions from this article about the role anaesthesia associates play in UK anaesthesia is difficult, given that the authors have explicitly warned against this. However, this evidence reinforces the idea that regulation is a pressing necessity, and serious questions must be asked regarding the utility of anaesthesia associates in a profession that prioritises patient safety and quality of care in an increasingly older and comorbid patient population [6].



中文翻译:


麻醉师对麻醉助理的担忧终于得到了证明吗?



我们祝贺 Cook 等人发表了他们的重要文章 [1],该文章使用皇家麻醉师学院 [2] 的第 7 次国家审计项目 (NAP7) 的数据制作。麻醉助理的话题在英国麻醉中仍然存在很大争议,并且相对缺乏客观数据来为讨论提供信息。我们认为这个记录在案的麻醉助理临床活动的窗口加强了我们对患者安全的担忧,并与麻醉师的培训相似。


现在很明显,麻醉助理的工作范围超出了 2016 年最初的实践范围 [3]。这包括为接受儿科、产科、神经外科和血管外科手术的患者提供麻醉护理 [1]。2016 年的范围文件 [3] 中提到了在“地方治理”的支持下执行这项工作;然而,对这些扩展角色的限制现在反映在皇家麻醉师学院和麻醉师协会的立场声明中。正在等待更新的指南,但似乎如果这种做法已经嵌入到某些部门中,则可能很难逆转。


实践范围监督级别也没有得到一致遵循。监督顾问并不总是立即可用,在 63 例病例中,麻醉助理被确定为最高级的麻醉提供者 [1]。Evans 等人 [4] 最近的一篇出版物中提出了这一担忧。如果将受训麻醉师和非自主专科医生和副专家的实践标准应用于此(通过使用卡布奇尼测试 [5]),则对麻醉助理的监督经常不足。


拟议的麻醉助理扩展可能会对麻醉师的培训产生负面影响。传统上,反对这一点的常用论点是,他们只在有限的情况下参与对健康患者的护理。本出版物中的临床活动数据通过显示所有急性和合并症水平的活动来反驳这一点。因此,减少麻醉培训临床经验的潜力是显着的。


麻醉是一个仍然充满风险的医学领域,保持对未知事物的了解可以防止自满。因此,令人担忧的是,麻醉助理认为他们不需要更多的围手术期心脏骤停管理培训,并且对现有指南充满信心 [1]。围手术期心脏骤停必须被视为一个独特的实体,其管理并未作为当前高级生命支持课程的一部分得到充分涵盖。


鉴于作者已经明确警告不要这样做,因此很难从这篇文章中得出关于麻醉助理在英国麻醉中的作用的确切结论。然而,这一证据强化了监管是迫切必要性的观点,必须严肃地质疑麻醉助理在优先考虑患者安全和护理质量的职业中的效用,因为患者群体年龄越来越大,共病患者群体也是如此[6]。

更新日期:2024-08-07
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