An assessment of the awareness of local anesthetic systemic toxicity among multi-specialty postgraduate residents.

Abstract

Local anesthetics (LAs) are extensively used in clinical practice by both anesthesiologists and non-anesthesiologists and are often associated with systemic toxicity. We hypothesize that this awareness is inadequate among medical specialists and entails a risk of misdiagnosis and underreporting of such events. We therefore conducted a cross-sectional questionnaire-based study to assess the level of understanding of LA use and effective management of systemic toxicity among 200 postgraduate residents of various specialties (with the exception of anesthesiology) in a tertiary care hospital in India from October to December 2013. Among those residents who had used LAs (193/200), 27 and 25% of responders correctly identified the toxic doses of lidocaine and of lidocaine + adrenaline, respectively. Of the responders, 70% always performed a negative aspiration of blood before injecting the drug, 27% sometimes aspirated and the remaining 3% never aspirated. The majority of the responders (93%) were unaware of the toxic dose of bupivacaine. Only 70% of responders believed that LAs could be toxic [95 % confidence interval (CI) 65.5-74.5%], and 81% of these correctly identified the signs and symptoms of cardiotoxicity. Only 2% of responders knew that lipid emulsion is a part of its treatment (95 % CI 0.6-3.4%). Based on these results, there is a definite need to increase the awareness of detection and treatment of local anesthetic toxicity among all medical practitioners who regularly use LAs.