Local anesthetic systemic toxicity
- PMID: 20151342
- DOI: 10.1007/s12630-010-9275-7
Local anesthetic systemic toxicity
Abstract
Purpose: The practice of regional anesthesia has been revitalized of late with the popularization of ultrasound-guided techniques. Advocates must be vigilant for the effects of unintentionally high blood levels of local anesthetic. Systemic local anesthetic toxicity, though rare, is a potentially devastating occurrence. This narrative review summarizes the effects of local anesthetic toxicity. We highlight how these toxic effects have motivated the search for a safe and long-acting local anesthetic. We outline current prevention and treatment options and appraise an emerging therapy in light of unfolding evidence.
Sources: A search of the English language literature was conducted using the PubMed database from the National Library of Medicine. Bibliographies of retrieved articles were used to retrieve additional articles.
Principal findings: The advent of multiple safety steps has led to a dramatic reduction in the incidence of local anesthetic toxicity over the past 30 years. Rising plasma levels of local anesthetic lead to a progressive spectrum of neurological and cardiac effects. Seizure activity may herald the onset of myocardial depression and ventricular arrhythmias that are often refractory to treatment. In addition to specific measures, such as lipid emulsion therapy, general supportive measures are warranted, for example, Advanced Life Support Guidelines.
Conclusion: Vigilance during the performance of regional anesthesia and immediate intervention at the earliest sign of toxicity improve the chances of successful treatment.
Comment in
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Thirty years after the bupivacaine controversy: what have we learned?Can J Anaesth. 2010 Apr;57(4):289-92. doi: 10.1007/s12630-010-9276-6. Can J Anaesth. 2010. PMID: 20107942 English, French. No abstract available.
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Hemodynamic effects of lipid emulsion after local anesthetic intoxication may be due to a direct effect of fatty acids on myocardial voltage-dependent calcium channels.Can J Anaesth. 2010 Oct;57(10):947. doi: 10.1007/s12630-010-9352-y. Epub 2010 Aug 11. Can J Anaesth. 2010. PMID: 20700681 No abstract available.
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