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.
abstract: 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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  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 .
authors.affiliation: Department of Anesthesiology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing, 100191, China.
authors.forename: Mao
authors.initials: M
authors.lastname: Xu
authors.affiliation: Department of Anesthesiology, No 3 People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Shanliang
authors.initials: S
authors.lastname: Jin
authors.affiliation: Department of Anesthesiology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing, 100191, China.
authors.forename: Zhengqian
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China.
authors.forename: Xuzhong
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Anesthesiology, the Third Hospital of Hebei Medical University, Hebei, China.
authors.forename: Xiuli
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, Sichuan Orthopedic Hospital, Sichuan, China.
authors.forename: Lan
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Anesthesia and Operation Center, Chinese PLA General Hospital and Medical School of Chinese PLA, Beijing, China.
authors.forename: Zeguo
authors.initials: Z
authors.lastname: Feng
authors.affiliation: Department of Anesthesiology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. yubuwei_2013@126.com.
authors.forename: Buwei
authors.initials: B
authors.lastname: Yu
authors.affiliation: Department of Critical Medicine and Anesthesiology, West China Hospital, Sichuan University, Sichuan Province, China. scujinliu@foxmail.com.
authors.forename: Jin
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing, 100191, China. puthmzk@163.com.
authors.forename: Xiangyang
authors.initials: X
authors.lastname: Guo
mesh_terms: D000765:Anesthesia, Conduction / Q000379:methods* / Q000639:trends; D000776:Anesthesiology / Q000379:methods / Q000639:trends; D000779:Anesthetics, Local / Q000009:adverse effects*; D002681:China / Q000453:epidemiology; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D010820:Physicians / Q000639:trends; D012151:Resuscitation / Q000379:methods* / Q000639:trends; D012955:Societies, Medical / Q000639:trends; D011795:Surveys and Questionnaires
chemical_list: D000779:Anesthetics, Local; D005217:Fat Emulsions, Intravenous