Knowledge of Emergency Medicine Physicians about Local Anesthetic Toxicity and Intravenous Lipid Treatment


  • Özlem Güler
  • Hakan Hakkoymaz Assistant professor, Kahramanmaraş Sütçü İmam University School of Medicine Department of Emergency Medicine, Kahramanmaraş, Turkey
  • Fatih Nazmi Yaman Assistant professor, Kahramanmaraş Sütçü İmam University School of Medicine Department of Emergency Medicine, Kahramanmaraş, Turkey
  • Evren Ekingen Medical Doctor, Batman State Hospital Department of Emergency Medicine Batman, Turkey


Objective: To evaluate the knowledge of emergency medicine doctors regarding local anesthetic systemic toxicity (LAST) and intravenous lipid emulsion (LE) used in treatment, and to raise awareness of this issue.

Materials and Methods: A questionnaire consisted of 17 questions about demographics, local anesthetic (LA) use, toxicity, and treatment methods was administered to emergency medicine doctors working at different hospitals.

Results: 181 doctors were included in this survey. Most of the (137 participants, 75.7%) participants were working in state hospitals. Professional experiences of the participants varied. The majority of participants (103 participants, 56.9%) stated that they had not received any training about the use of LAs during their education. Lidocaine was the most preferred local anesthetic agent (75.5%). Majority of the participants stated that their knowledge about the LAs they used was insufficient. Forty-one (22.7%) participants answered that they know the indications and route of LE administration. Nine (5%) participants reported that they have encountered LA toxicity and have used LE. One hundred eighteen participants (65.2%) stated that they do not have LE in their emergency department.

Conclusion: Knowledge about the  LA toxicity  and   lipid  emulsion  usage  in the treatment of LAST is insufficient among emergency doctors. More efforts must be made to improve this issue.

Author Biography

Özlem Güler

Assistant professor, Kahramanmaraş Sütçü İmam University School of Medicine Department of Emergency Medicine, Kahramanmaraş, Turkey


- Hasan B, Asif T, Hasan M. lidocaine-ınduced systemic toxicity: acase report and review of literature. Cureus. 2017;9:e1275.

- Dickerson DM, Apfelbaum JL. Local anesthetic systemic toxicity. Aesthet Surg J. 2014;34:1111-9.

- Sklar DP. Local anesthetics. Ann Emerg Med. 1996;27:464-5.

- Sagir A, Goyal R. An assessment of the awareness of local anesthetic systemic toxicity among multi-specialty postgraduate residents. J Anesth. 2015;29:299-302.

- Yaddanapudi S. Prevention of local anesthetic systemic toxicity. J Anaesthesiol Clin Pharmacol. 2011;27:438-9.

-Collins S, Neubrander J, Vorst Z, Sheffield B. Lipid emulsion in treatment of local anesthetic toxicity. J Perianesth Nurs. 2015;30:308-20.

-Neal JM, Woodward CM, Harrison TK. The American Society of Regional Anesthesia and Pain Medicine Checklist for Managing Local Anesthetic Systemic Toxicity 2017 Version. Reg Anesth Pain Med. 2018;43:150-3.

-El-Boghdadly K, Chin KJ. Local anesthetic systemic toxicity: continuing professional development. Can J Anaesth. 2016;63:330-49.

-Noble KA. Local anesthesia toxicity and lipid rescue. J Perianesth Nurs. 2015;30:321-35.

-Sekimoto K, Tobe M, Saito S. Local anesthetic toxicity: acute and chronic management. Acute Med Surg. 2017;4:152-60.

- Barrington MJ, Kluger R. Ultrasound guidance reduces the risk of local anesthetic systemic toxicity following peripheral nerve blockade. Reg Anesth Pain Med. 2013;38:289-99.

-Fettiplace MR, Weinberg G. Past, present, and future of lipid resuscitation therapy. PEN J Parenter Enteral Nutr. 2015;39:72S-83S.

-Başaranoğlu G, Teker MG, Saidoğlu L, Muhammedoğlu N, Özdemir H. Lokal anestezik kullanan hekimlerin toksisite ve intralipid tedavisi hakkında bilgileri. J Turk Anaest Int Care. 2010;38:262-7.

-Karasu D, Yılmaz C, Özgünay ŞE, Dayıoğlu M, Baytar Ç, Korfalı G. Knowledge of the research assistants regarding local anaesthetics and toxicity. Turk J Anaesthesiol Reanim. 2016;44:201-5.

-Urfalıoğlu A, Urfalıoğlu S, Öksüz G. The Knowledge of Eye Physicians on Local Anesthetic Toxicity and Intravenous Lipid Treatment: Questionnaire Study. Turk J Ophthalmol. 2017;47:320-5.

-Tierney KJ, Murano T, Natal B. Lidocaine-induced cardiac arrest in the emergency department: effectiveness of lipid therapy. J Emerg Med. 2016;50:47-50.






Original Research