Safety timeout for local and regional anesthesia

Our anesthesia practices are always based on patient safety in WHO surgical and anesthesia guidelines. Those guidelines are interpreted in checklists and protocols that could be applied in daily routine in every standard operating theaters. A surgical patient would be notified and identified during the surgery by all member of the operating room including the anesthesiolo- gist through a specialized checklists which was called a safety surgical checklist usually done in the preparation room, signing in, 5 minutes for timeout before the incision, and the last sign out before closure stitching. Anesthesia conduct and monitoring is viewed as a part of the whole surgery practice. 1 Lately, Indonesian anesthesiologists were horrified of several cases related with adverse events in regional anesthesia. Some of them were proven to be related with false medication and the other were remain unknown. Some experts concluded that it would be related with local anesthetic systemic toxicity (LAST) while others reported that they might be related with adju- vants or added preservatives in local anesthetic mixtures. The Indonesian Society of Anesthesiologists have already issued an Advise Letter considering scattered adverse events and incidents to ensure every anesthesiologists to raise concern about patient pre-anesthetic evaluation, pre-block evalua- tion of patient and local anesthetics, and also quick recognition of side effects and unwanted adverse events. Years before, in 2013, American Society of Regional Anesthesia and Pain Medicine had appointed a task force of its senior members dr. Greg Liguori, Robert Weller, and Michael F. Mulroy to review current practices, external guides, and the sense of the membership to see if a relatively ‘standard’ preblock checklist to include all the mandated items could be drafted, recognizing that any such document would need modification for local customs. Then in May 2014, they issued a pre-block checklist intended for regional anesthesia. The steps of the proposed ASRA Pre-Block checklist are intended to remind clinicians of basic minimum requirements for safety and quality of care for patients receiving a regional block, and to prevent wrong-site blocks. They include guidance on site marking, asepsis, and monitoring based on guidance from the Joint Commission, FDA, ASA, and ASRA. It is antic- ipated that the checklist will be followed from the first contact with the patient (identification) but that the actual review of the completion of the items will be confirmed at the ‘timeout (pause)’ mandated by the Universal Protocol to precede needle insertion. Implementation of the checklist must be dictated by local departmental guidelines, and must necessarily adapt to local practice patterns. The ASRA Regional Block Pre-Procedural Checklist is listed in nine points below: 2-4