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Regional Anesthesia in Anesthetized or Heavily Sedated Patients
  1. Christopher M. Bernards, M.D.a,b,
  2. Admir Hadzic, M.D., Ph.D.c,d,
  3. Santhanam Suresh, M.D.e,f and
  4. Joseph M. Neal, M.D.a,b
  1. aDepartment of Anesthesiology, Virginia Mason Medical Center, Seattle, WA
  2. bDepartment of Anesthesiology, University of Washington, Seattle, WA
  3. cDepartment of Anesthesiology, St. Luke's—Roosevelt Hospital Center, New York, NY
  4. dDepartment of Anesthesiology, Columbia University, New York, NY
  5. eDepartment of Anesthesiology, Children's Memorial Hospital, Chicago, IL
  6. fDepartment of Anesthesiology, Northwestern University, Chicago, IL


The American Society of Regional Anesthesia and Pain Medicine (ASRA) Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine includes an evidence- and expert opinion-based section on performing procedures on anesthetized or heavily sedated patients. This practice advisory is based on existing scientific literature, pathophysiological principles, and expert opinion. The advisory panel examined the ability of anesthetized or heavily sedated patients to recognize and report intravascular injection of local anesthetic or impending neurologic injury. The advisory panel also considered whether or not the ability to recognize and report symptoms could actually affect the occurrence of nerve injury or local anesthetic systemic toxicity. The advisory contains recommendations pertaining to both adult and pediatric patients.

  • Nerve injury
  • Regional anesthesia
  • Pain medicine
  • Local anesthetic toxicity
  • Peripheral nerve block

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  • Reprint requests: Christopher M. Bernards, M.D., Department of Anesthesiology, B2-AN, VMMC, 1100 Ninth Avenue, Seattle WA 98101-2756. E-mail: chrisb{at}

  • This work was presented in part, at the American Society of Regional Anesthesia and Pain Medicine Annual Spring Meeting, April 23, 2005, Toronto, Canada.