This entry is a bit overdue but I sincerely hope it will inspire some spirited debate and exchange of ideas. It's been a very busy year for those interested local anesthetic toxicity. Since Spring, there have been two case reports of the successful use of lipid emulsion infusion used in patients who appeared to have failed standard resuscitation. One was accompanied by an editorial in Anesthesiology and there should be interesting follow-up commentary on both the editorial and case report.

In England, Drs. Picard and Meek have instigated a lively debate on this topic for which Dr. Bogod, the editor of Anaesthesia, has provided the forum. Basically, the opposing arguments are "lipid infusion isn't proven yet, so its use is premature" and "don't embrace a new therapy if it means compromising safe practice measures that prevent local anesthetic toxicity"; these are the 'con' arguments. The corresponding 'pro' arguments point out that  "case reports of lives saved support the applicability of the animal data, so its use, particularly to salvage otherwise lost causes, seems at least defensible" and "readiness to use lipid is not the same as advocating unsafe practice".

We do not view the availability of a possible antidote as license to lower standards of care. Unexpected consequences of regional anesthesia will inevitably occur, even when every reasonable measure is taken to prevent them. Hence, the move to promulgate, educate and disseminate the method even while continuing research to validate and improve it. Meanwhile, please respond and let us know what you're thinking about. I'll weigh in on a regular basis with thoughts on various aspects of the toxicity issue. Guy Weinberg