Proposal for a Registry:
The concept of a registry for events of local anesthetic and related toxic events is not new. However, the clinical success of LipidRescue has had the unintended effect of increasing the number and scope of clinical reports of local anesthetic toxicity. I believe that in the aggregate these reports warrant a reevaluation of the need for such a database. There are significant limits to what one can learn and the experience one can access through the standard medical literature and this is the topic of an upcoming editorial in Anesthesia and Analgesia. The many published case reports of successful lipid resuscitation have allowed a new understanding of this iatrogenic complication. Nevertheless, many successful resuscitations for many reasons are never reported and, perhaps more importantly, unsuccessful cases are even less likely to be published. Physicians have no incentive to publish bad outcomes thereby depriving the medical community of a wealth of important information about what does and doesn't work in resuscitation. For example, I have recently learned of a compelling instance where LA toxicity was fatal despite extremen resuscitative attempts including lipid emulsion infusion; I'm sure there are other such cases. However, it will be difficult to ascertain the cause of such failures without very careful examination of these events. Patient factors such as underlying cardiac disease or specific aspects of the resuscitation, including the dosing of lipid, epinephrine or other drugs could be important determinants....we just don't know. There are large hurdles to overcome in establishing such a registry, but my intent with this proposal is to initiate a discussion of the topic. Perhaps with sufficient input and ideas we can develop a robust data set that will help improve resuscitation in these settings and lead to better patient safety in regional anesthesia and in clinical toxicology in general. Please feel free to comment.