title: 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.
authors.affiliation: Department of Anesthesia and Critical Care, Armed Forces Medical College-Pune and Command Hospital (SC), Pune, India.
authors.forename: Afrin
authors.initials: A
authors.lastname: Sagir
authors.forename: Rakhee
authors.initials: R
authors.lastname: Goyal
mesh_terms: D000772:Anesthesia, Local / Q000009:adverse effects; D000776:Anesthesiology / Q000193:education*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D007722:Health Knowledge, Attitudes, Practice; D006331:Heart Diseases / Q000139:chemically induced / Q000503:physiopathology; D006801:Humans; D007396:Internship and Residency; D020258:Neurotoxicity Syndromes / Q000175:diagnosis / Q000503:physiopathology; D011795:Surveys and Questionnaires
chemical_list: D000779:Anesthetics, Local