We read with interest the article by O’Connor and Wilson. However, we also have questions about the authors’ methodology. Although the case reports presented are largely supportive of ILE’s success, there is no rationale presented to explain how these cases were selected for discussion. In our recent systematic review on nonlocal anesthetic poisoning, we found quite a number of cases in which ILE was either of no clear benefit or even harmful. These cases were omitted by O’Connor and Wilson.

The article contributes to publication bias surrounding ILE by its failure to discuss 4 studies3–6  that were unable to demonstrate any meaningful clinical benefit of ILE therapy in oral nonlocal anesthetic poisoning. As a result of the very low quality of evidence for benefit and the real and potential adverse effects,7,8  several groups, including a...

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