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Background: 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.Methods: 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.Results: 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.Conclusions: 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. Citation: Feng-Xian Li, Hua-Li Xu, Hui-Qun Chen, Hong-Yi Lei, Zhi-Jian You, Xu-Zhong Xu, et al. Local anesthetic delivery and resuscitation for systemic toxicity in China: a survey of 250 hospitals. J Anesth Perioper Med 2017; x: x-x. doi:10.24015/JAPM.2017.0021This 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/.

To observe the influences upon the degree of diaphragmatic excursion during deep cervical plexus block at the third cervical vertebra (C3) and compare the safety and anesthetic effect of modified cervical plexus block by ultrasonic guidance and blocking of cervical plexus at one point.Part I: 30 patients of ASA (American society of anesthesiologists) I-II scheduled for thyroid surgery were selected for bilateral cervical plexus block at C3 and bilateral skin nerve branches via ultrasonic guidance. Diaphragmatic excursion was recorded. Part II: 80 patients of ASAI-II scheduled for thyroid surgery were randomly divided into 2 groups: experimental group (Group U) and control group (Group C). In Group U, modified cervical plexus block was used to fix both sides of C3 and skin nerve branches. The anesthetic mixture with 2% lidocaine and 0.75% ropivacaine was injected. And anesthetic effects and complications were detected. In control group, traditional one-point method for blocking cervical plexus was employed.High-frequency Doppler sonography could clearly visualize important neck structures and precisely guide the injection of mixture to the transverse process of C3. Diaphragmatic excursion decreased significantly at 15 and 30 min post-blocking (P0.05). And no paralysis of diaphragmatic muscle occurred. Hoverer 3 cases had partial diaphragmatic paralysis. Both blood pressure and heart rate increased significantly post-blocking in both groups (P0.05 or 0.01). In comparison with Group C, the range of blood pressure was notably lower at 10 and 20 min in Group U. And heart rate was notably lower at 5, 10, 20 and 30 min (P0.05 or 0.01). Furthermore the onset time of skin nerve branches was significantly shorter in Group U (P0.01). And the anesthetic effect score was better than that in Group C (P0.01). The incidence of complications, such as hoarseness, was significantly lower in Group U (12 cases in Group C but none in Group U, P0.01) and Horner's syndrome (2 cases in Group C). The number of cases requiring hypotensor and heart rate control drug was significantly smaller in Group U than that in Group C (P0.01).The improving effect of ultrasound-guided cervical plexus block upon the degree of diaphragmatic movement is within the compensatory range of body. In comparison with the traditional one-point blocking of cervical plexus, the modified cervical plexus block with ultrasonic guidance offers better anesthetic effects, fewer complications and convenient anesthetic localization. Thus it may be clinically applicable.

To investigate the optimal dose of local anesthetic mixture in ultrasound-guided infraclavicular brachial plexus block via coracoid approach.160 patients scheduled for surgery of the hand or forearm were randomly divided into 4 equal groups (Groups A, B, C, and D). To receive 8, 7, 6, or 5 ml of anesthetic mixture of 0.75% ropivacaine and 2% lidocaine for radial nerve, axillary nerve, median nerve, ulnar nerve, median cutaneous nerve of arm, median antebrachial cutaneous nerve, and lateral antebrachial cutaneous nerve respectively ultrasound-guided infraclavicular brachial plexus block via coracoid approach. The time for anesthesia taking effect, anesthesia maintenance time, and quality of sensory block were observed.Anesthesia took effect about 4 minutes after injection in these 4 groups without significant differences among then (all P0.05). The good analgesic effect rates of Groups A, B, and C were all 100%, all significantly higher than that of Group D (87.5%, P = 0.027). The block maintenance times of Groups A, B, and C were (377 +/- 111) min, (369 +/- 135) min, and (351 +/- 112) min respectively, all significantly longer than that of Group D [(296 +/- 101) min, P = 0.024]. No anesthesia-related complication was found in these 4 groups.Ultrasound-guided infraclavicular brachial plexus block via coracoid approach can reduce the volume of local anesthetic mixture. The dose of 6 ml local anesthetic mixture for each nerve fascicle, totally 18 ml, provides good analgesic effect and does not seem to affect the time for anesthesia taking effect.

To compare the anesthesia efficacy, hemodynamics, recovery of passage of gas by anus and bladder function in elderly patients with operation of intertrochanteric femoral fracture with epidural or lumbar plexus block.Sixty patients with intertrochanteric femoral fracture, aged 65-97, were randomly divided into 3 equal groups: lumbar plexus group (Group A, undergoing posterior lumbar plexus block) and epidural group (Group B, undergoing epidural block at L(1-2) interspace). The block onset time, anesthesia efficacy, transfusion amount during operation, blood pressure and heart rate change 1 h after anesthesia, and recovery after anesthesia were observed.The block onset time on femoral nerve, lateral cutaneous nerve of thigh, obturator nerve, and saphenous nerve of Group A were (2.7 +/- 2.0) min, (3.1 +/- 3.4) min, (3.5 +/- 3.3) min, and (3.7 +/- 3.1) min respectively, all significantly shorter than those of Group B [(13.5 +/- 2.1) min, (13.5 +/- 2.1) min, (13.5 +/- 2.1) min, and (13.5 +/- 2.1) min respectively, all P0.01]. The duration of postoperative analgesia of Group A was (420 +/- 152) min, significantly longer than that of Group B [(204 +/- 44) min, P0.05]. There were no significant differences in the change of blood pressure and heart rate between these 2 groups. The blood pressure decreased significantly 10 - 60 min after anesthesia in Group B, and remained stable in Group A. The transfusion amount of Group A was (773 +/- 353) ml, significantly fewer than that in Group B [(1483 +/- 444) ml, P0.01]. Passage of gas by anus started (1.1 +/- 0.6) h after operation in Group A, a time significantly shorter than that in Group B (5.9 +/- 1.2) h, P0.01). Urinary retention was seen in 8 patients of Group B, however, no patient in Group A showed incidence of urinary retention (P0.01). Forty-eight patients, 20 in Group A and 28 in Group B got excellent anesthesia effect, and 12 of them, 10 in Group A and 2 in Group B, got relatively good anesthesia (P0.05).Both lumbar plexus block and epidural block provide satisfactory anesthetic efficacy for operation of intertrochanteric femoral fracture in elderly patients. Epidural block provide better efficacy, and lumbar plexus block shows faster recovery of digestive system and urinary system after operation.

To investigate the clinical effects and safety of the technique of axillary approach brachial plexus blocking by ultrasound-guided four points via one-puncture.Eighty patients scheduled for elective operation were randomly divided into 2 equal groups to undergo axillary approach brachial plexus blocking by ultrasound-guided four points via one-puncture technique (Group U) or nerve stimulator-guided brachial plexus blocking (Group N). The main branches of brachial plexus (radial, median, ulnar, and musculocutaneous nerves) were localized by ultrasound-guided or nerve stimulator-guided techniques. In Group U 8 ml of mixed anesthetic solution containing isovolumetric 0.75% ropivacaine and 2% lidocaine was injected into the 4 main branches of brachial plexus, with a total volume of 32 ml. The ultrasonic manifestations of the brachial plexus and its surrounding tissues were observed. The values of diameter and depth of the 4 nerves and the distance of the musculocutaneous nerve to the midpoint of axillary artery were measured. The manipulation time, onset time, maintaining time, efficacy of blocking, and incidence of complication were recorded.The manipulation time of Group U was 5.2 +/- 2.1 min, significantly shorter than that of Group N (14.6 +/- 3.2 min, P = 0.000), The onset times of the median, radial, and ulnar nerves of Group U were 3.3 +/- 1.9 min, 3.0 +/- 1.7 min, and 3.4 +/- 1.9 min respectively, all significantly shorter than those of Group N (4.6 +/- 2.0 min, 7.3 +/- 7.4 min, and 6.4 +/- 6.1 min respectively, P0.01 or P0.05). The anesthetic success rate of Group U was 100%, significantly higher than that of Group N (77.5%, P = 0.005). The rate of accidental puncture to blood vessel of Group U was 0, significantly lower than that of Group N (40%, P = 0.000).With significantly higher anesthetic success rate, shorter manipulation time and onset time, and lower complication rate, the technique of axillary approach brachial plexus blocking by ultrasound-guided four points via one-puncture is a safe and reliable blocking method in comparison with the nerve stimulator-guided method.