J Anesth Perioper Med. 2017;4(6):250-259. https://doi.org/10.24015/ebcmed.japm.2017.0021

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

Feng-Xian Li1*, Hua-Li Xu1*, Hui-Qun Chen1, Hong-Yi Lei1, Zhi-Jian You3, Xu-Zhong Xu2, Shi-Yuan Xu1, and Hong-Fei Zhang1

From 1Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou, China; 2Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; 3Department of Anesthesiology, The Second Affiliated Hospital, Shantou University Medical College, Shantou, China.

*Contributed equally to this work.

Correspondence to Dr. Hong-Fei Zhang at hongfeiz2003@163.com, or Dr. Shi-Yuan Xu at shiyuanxu355@163.com.

EBCMED ID: ebcmed.japm.2017.0021 DOI: 10.24015/ebcmed.japm.2017.0021


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.

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.

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.

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. (Funded by the National Natural Science Foundation of China.)

Article Type
Original Article

Declaration of Interests
The authors declare no other potential conflicts of interest.

This work was supported by grants from National Natural Science Foundation of China (81471272 to Shi-Yuan Xu and 81501082 to Feng-Xian Li).

This 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/.