Local Anesthetic Delivery and Resuscitation for Systemic Toxicity in China: A Survey of 250 Hospitals

Abstract

Background: The optimized procedures for local anesthetic (LA) delivery and resuscitation for LA systemic toxicity (LAST) have improved the safety of regional anesthesia. Lipid emulsion (LE) has been the valid treatment for LAST. However, adoption of these revised procedures in developing countries remains unknown.Methods: We conducted a 17-question survey to access the basic knowledge of LA delivery, the practice procedures for LAST resuscitation and an overall understanding of LE usage in both academic and non-academic hospitals of the Chinese Society of Anesthesiology.Results: A total of 250 hospitals completed the survey. Ropivacaine was the most preferred long-acting LA for regional anesthesia. Among the responders, 10 hospitals did not apply test-dosing before epidural anesthesia, including more non-academic than academic hospitals (7.1% versus 1.4%, P=0.0223). 77.5% (107/138) of academic hospitals and 69.6% (78/112) of non-academic hospitals had a protocol for LAST resuscitation. Only 28.2% of academic and 18.8% of non-academic hospitals stated LE preference for LAST. Furthermore, 17% (22/132) academic hospitals and 13% (12/89) non-academic hospitals chose the recommended epinephrine dosage based on the guideline of ARSA for LA-induced cardiac arrest. Significantly higher proportion (1.6 times more, 95% CI 1.082-3.991) of academic hospitals considered LE as the resuscitation method for LA-induced seizure than non-academic hospitals (44.9% versus 28.2%, P=0.0269). Finally, LE was available in only half of the hospitals which adopted its feasibility for LAST resuscitation.Conclusions: The survey revealed the poor practice procedures for regional anesthesia and non-standard use of LE for LAST resuscitation in China, especially among non-academic hospitals. Citation: Feng-Xian Li, Hua-Li Xu, Hui-Qun Chen, Hong-Yi Lei, Zhi-Jian You, Xu-Zhong Xu, et al. Local anesthetic delivery and resuscitation for systemic toxicity in China: a survey of 250 hospitals. J Anesth Perioper Med 2017; x: x-x. doi:10.24015/JAPM.2017.0021This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.