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 theunintended effect ofincreasing thenumber andscope of clinical reports of local anesthetic toxicity. I believe that in the aggregate these reportswarrant areevaluation of the need for such a database. There aresignificant limitstowhat one can learn and the experience one can accessthrough the standard medical literature and thisis the topic of an upcoming editorial in Anesthesiaand Analgesia. The many published case reports of successful lipid resuscitation have allowed a new understanding of this iatrogenic complication.Nevertheless, manysuccessful resuscitations for many reasons are never reportedand, perhaps more importantly, unsuccessful casesare even less likely tobe 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 recentlylearned of a compelling instance whereLA 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 ascertainthe cause of such failures without very careful examination of these events. Patient factors such as underlying cardiac diseaseor specificaspects 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 safetyin regional anesthesia and in clinical toxicology in general. Please feel free to comment.