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Regional anesthesia and lipid resuscitation for local anesthetic systemic toxicity in China: results of a survey by the orthopedic anesthesia group of the chinese society of anesthesiology

BACKGROUND: Intravenous lipid emulsions have been introduced for the management of patients with Local Anesthetic Systemic Toxicity (LAST). These emulsions have been stated as a first-line treatment in the guidelines of several international anesthesia organizations. Nevertheless, the adoption of li...

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Autores principales: Xu, Mao, Jin, Shanliang, Li, Zhengqian, Xu, Xuzhong, Wang, Xiuli, Zhang, Lan, Feng, Zeguo, Yu, Buwei, Liu, Jin, Guo, Xiangyang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700758/
https://www.ncbi.nlm.nih.gov/pubmed/26728368
http://dx.doi.org/10.1186/s12871-015-0163-0
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author Xu, Mao
Jin, Shanliang
Li, Zhengqian
Xu, Xuzhong
Wang, Xiuli
Zhang, Lan
Feng, Zeguo
Yu, Buwei
Liu, Jin
Guo, Xiangyang
author_facet Xu, Mao
Jin, Shanliang
Li, Zhengqian
Xu, Xuzhong
Wang, Xiuli
Zhang, Lan
Feng, Zeguo
Yu, Buwei
Liu, Jin
Guo, Xiangyang
author_sort Xu, Mao
collection PubMed
description BACKGROUND: Intravenous lipid emulsions have been introduced for the management of patients with Local Anesthetic Systemic Toxicity (LAST). These emulsions have been stated as a first-line treatment in the guidelines of several international anesthesia organizations. Nevertheless, the adoption of lipid rescue therapy by Chinese practitioners remains unknown. We, therefore, evaluated the current approaches to treat LAST and the use of lipid rescue therapy among anesthesiologists in China. METHODS: In September 2013, a 23-question survey on regional anesthesia practice and availability of lipid emulsions was sent by e-mail to directors or designated individuals at 41 academic anesthesiology departments listed by the orthopedic anesthesia group of the Chinese Society of Anesthesiology. RESULTS: Responses were received from 36 of the 41 (88 %) anesthesiology departments. To simplify the analysis, responses were divided into two groups according to the annual percentage of patients who received regional anesthesia (RA) for orthopedic anesthesia: 14 departments (39 %) with high-utilization (≥50 %) and 22 departments (61 %) low-utilization (<50 %) of RA. Ropivacaine and bupivacaine were the common drugs used for RA, which were independent of RA utilization. Interestingly, ultrasound-guided techniques were much more frequently used in low-utilization institutions than in high-utilization institutions (P = 0.025). Lipid emulsion was readily available in 8 of the 36 (22 %) responding institutions, with 7 of the other 28 (25 %) institutions planning to stock lipid emulsion. No differences in lipid availability and storage plans were observed between high- and low-utilization institutions. Lipid resuscitation was performed in five of the eight departments that had lipid emulsion. Eleven patients were successfully resuscitated and one was not. CONCLUSION: Lipid emulsion is not widely available in China to treat LAST resulted from RA for orthopedic patients. Efforts are required to promote lipid rescue therapy nationwide. TRIAL REGISTRATION: Chinese Clinical Trail Registry (Registration number # ChiCTR-EOR-15006960; Date of Retrospective Registration on August 23rd, 2015) http://www.chictr.org.cn/showproj.aspx?proj=11703. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12871-015-0163-0) contains supplementary material, which is available to authorized users.
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spelling pubmed-47007582016-01-06 Regional anesthesia and lipid resuscitation for local anesthetic systemic toxicity in China: results of a survey by the orthopedic anesthesia group of the chinese society of anesthesiology Xu, Mao Jin, Shanliang Li, Zhengqian Xu, Xuzhong Wang, Xiuli Zhang, Lan Feng, Zeguo Yu, Buwei Liu, Jin Guo, Xiangyang BMC Anesthesiol Research Article BACKGROUND: Intravenous lipid emulsions have been introduced for the management of patients with Local Anesthetic Systemic Toxicity (LAST). These emulsions have been stated as a first-line treatment in the guidelines of several international anesthesia organizations. Nevertheless, the adoption of lipid rescue therapy by Chinese practitioners remains unknown. We, therefore, evaluated the current approaches to treat LAST and the use of lipid rescue therapy among anesthesiologists in China. METHODS: In September 2013, a 23-question survey on regional anesthesia practice and availability of lipid emulsions was sent by e-mail to directors or designated individuals at 41 academic anesthesiology departments listed by the orthopedic anesthesia group of the Chinese Society of Anesthesiology. RESULTS: Responses were received from 36 of the 41 (88 %) anesthesiology departments. To simplify the analysis, responses were divided into two groups according to the annual percentage of patients who received regional anesthesia (RA) for orthopedic anesthesia: 14 departments (39 %) with high-utilization (≥50 %) and 22 departments (61 %) low-utilization (<50 %) of RA. Ropivacaine and bupivacaine were the common drugs used for RA, which were independent of RA utilization. Interestingly, ultrasound-guided techniques were much more frequently used in low-utilization institutions than in high-utilization institutions (P = 0.025). Lipid emulsion was readily available in 8 of the 36 (22 %) responding institutions, with 7 of the other 28 (25 %) institutions planning to stock lipid emulsion. No differences in lipid availability and storage plans were observed between high- and low-utilization institutions. Lipid resuscitation was performed in five of the eight departments that had lipid emulsion. Eleven patients were successfully resuscitated and one was not. CONCLUSION: Lipid emulsion is not widely available in China to treat LAST resulted from RA for orthopedic patients. Efforts are required to promote lipid rescue therapy nationwide. TRIAL REGISTRATION: Chinese Clinical Trail Registry (Registration number # ChiCTR-EOR-15006960; Date of Retrospective Registration on August 23rd, 2015) http://www.chictr.org.cn/showproj.aspx?proj=11703. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12871-015-0163-0) contains supplementary material, which is available to authorized users. BioMed Central 2016-01-04 /pmc/articles/PMC4700758/ /pubmed/26728368 http://dx.doi.org/10.1186/s12871-015-0163-0 Text en © Xu et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Xu, Mao
Jin, Shanliang
Li, Zhengqian
Xu, Xuzhong
Wang, Xiuli
Zhang, Lan
Feng, Zeguo
Yu, Buwei
Liu, Jin
Guo, Xiangyang
Regional anesthesia and lipid resuscitation for local anesthetic systemic toxicity in China: results of a survey by the orthopedic anesthesia group of the chinese society of anesthesiology
title Regional anesthesia and lipid resuscitation for local anesthetic systemic toxicity in China: results of a survey by the orthopedic anesthesia group of the chinese society of anesthesiology
title_full Regional anesthesia and lipid resuscitation for local anesthetic systemic toxicity in China: results of a survey by the orthopedic anesthesia group of the chinese society of anesthesiology
title_fullStr Regional anesthesia and lipid resuscitation for local anesthetic systemic toxicity in China: results of a survey by the orthopedic anesthesia group of the chinese society of anesthesiology
title_full_unstemmed Regional anesthesia and lipid resuscitation for local anesthetic systemic toxicity in China: results of a survey by the orthopedic anesthesia group of the chinese society of anesthesiology
title_short Regional anesthesia and lipid resuscitation for local anesthetic systemic toxicity in China: results of a survey by the orthopedic anesthesia group of the chinese society of anesthesiology
title_sort regional anesthesia and lipid resuscitation for local anesthetic systemic toxicity in china: results of a survey by the orthopedic anesthesia group of the chinese society of anesthesiology
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700758/
https://www.ncbi.nlm.nih.gov/pubmed/26728368
http://dx.doi.org/10.1186/s12871-015-0163-0
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