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Availability of Lipid Emulsion in United States Obstetric Units
Abstract Number: F-13
Abstract Type: Original Research
Background –The incidence of local anesthetic systemic toxicity (LAST) following epidural anesthesia is 4 per 100,000 placements. Although the risk of LAST with neuraxial labor analgesia is low, the possibility remains, particularly during epidural anesthesia, TAP block analgesia, and as a result of drug error. Treatment guidelines for LAST recommend the availability and use of lipid emulsion therapy. The objective of this study was to identify the current level of lipid emulsion availability in U.S. obstetric units.
Methods – A survey was developed addressing lipid emulsion availability, and was electronically sent to United States obstetric anesthesia directors in June 2011. Responses were collected and evaluated with univariate statistics.
Results – Of the 104 academic anesthesiology directors invited, 72 completed the survey. Overall, 88% of respondents reported availability of lipid emulsion on the unit, including 82% of units that had lipid emulsion available prior to the 2010 ASRA guideline publication (Figure 1). Seven respondents who did not have lipid emulsion on their units felt the risk for LAST was low. 71% reported having an algorithm to treat LAST within their institution, which included the administration of lipid emulsion. The estimated time to obtain lipid emulsion was <10 minutes in 70 hospitals, and 10-30 minutes in the remaining two.
Conclusions - The availability of lipid emulsion is a patient safety issue. The majority of the United States academic obstetric anesthesia units who responded to the survey have lipid emulsion on their unit, an algorithm to treat LAST in their institution and all units could obtain lipid emulsion within 30 minutes.
1. Mulroy, M.F., Systemic toxicity and cardiotoxicity from local anesthetics: incidence and preventive measures. Reg Anesth Pain Med, 2002. 27(6): p. 556-61.
2. Neal, J.M., et al., ASRA practice advisory on local anesthetic systemic toxicity. Reg Anesth Pain Med, 2010. 35(2): p. 152-61.