Lipid emulsion treatment of local anesthetic systemic toxicity in pediatric patients

2021 ◽  
Author(s):  
Ju-Tae Sohn
Keyword(s):  
Local Anesthetic ◽  
Lipid Emulsion ◽  
Pediatric Patients ◽  
Systemic Toxicity ◽  
Local Anesthetic Systemic Toxicity

scholarly journals Local Anesthetic Systemic Toxicity following Peribulbar Block: A Case Report

2020 ◽  
Vol 3 (2) ◽  
pp. 67-68
Author(s):  
Abdul Nasser ◽  
Faheem Raja
Keyword(s):  
Case Report ◽  
Cataract Surgery ◽  
Local Anesthetic ◽  
Lipid Emulsion ◽  
Early Recognition ◽  
Systemic Toxicity ◽  
Peribulbar Block ◽  
Local Anesthetic Systemic Toxicity ◽  
Symptoms And Signs

ABSTRACT Cataract surgery is performed routinely under regional orbital blocks including retrobulbar and peribulbar blocks. Several complications have been reported while performing these blocks, the most significant of which is the local anesthetic systemic toxicity (LAST). The symptoms and signs present in a varied spectrum, but every such case requires early recognition and immediate resuscitation to avoid long-term morbidity and even death. Lipid emulsion therapy forms the mainstay of treatment. We present a case of a 49-year-old man who planned to undergo cataract surgery under the peribulbar block, who developed LAST and was successfully treated with 20% lipid emulsion without any adverse sequelae. How to cite this article Nasser A, Raja F. Local Anesthetic Systemic Toxicity following Peribulbar Block: A Case Report. J Med Acad 2020;3(2):67–68.

Local Anesthetics for Neuraxial and Regional Techniques

2018 ◽  
Author(s):  
Michael J Schontz ◽  
Krystina Geiger
Keyword(s):  
Pain Relief ◽  
Adverse Effects ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Lipid Emulsion ◽  
Systemic Toxicity ◽  
Duration Of Action ◽  
Liposomal Bupivacaine ◽  
Provide Pain Relief ◽  
Local Anesthetic Systemic Toxicity

Local anesthetics are used with neuraxial and regional techniques to provide pain relief, most commonly postoperatively. Each agent is a sodium-channel blocker, although each agent differs in onset of action, potency, duration of action, and safety profile. Chemical structure and lipophilicity are the main determinants of these characteristics. The agents may be used alone or in combination with an additive which alters the local anesthetic’s properties . Clinically, local anesthetics provide pain relief in a multimodal approach. This reduces opiate consumption, opiate-related adverse effects, and length of stay. Additional benefits when using neuraxial techniques include decreases in mortality, venous thromboembolism, myocardial infarction, pneumonia, respiratory depression, and duration of ileus. Although there are many adverse effects, the most serious include neurologic and cardiovascular. Seizures and cardiac arrest may result from local anesthetic systemic toxicity when systemic levels are elevated or the patient is predisposed. Dose adjustment, removal, or reversal of the agent may be clinically indicated. Lipid emulsion therapy is a reversal agent which acts as a sequestering vehicle for the local anesthetic. Liposomal bupivacaine, the newest formulation of local anesthetic, may provide an increased duration of action compared with standard formulations, although more evidence is needed. This review contains 5 figures, 5 tables, and 59 references. Keywords: amide, ester, epidural, local anesthetic, local anesthetic systemic toxicity, lipid emulsion therapy, liposomal bupivacaine, peripheral nerve block

Local Anesthetic Systemic Toxicity: Diagnosis, Prevention, and Management

2018 ◽  
Author(s):  
Alexandra Dubikovsky Golden ◽  
David Dickerson
Keyword(s):  
Local Anesthetic ◽  
Lipid Emulsion ◽  
Outpatient Setting ◽  
Systemic Toxicity ◽  
Tumescent Anesthesia ◽  
Local Anesthetic Systemic Toxicity ◽  
Protective Strategies ◽  
Delays In Diagnosis

Local anesthetic systemic toxicity is a major concern in both the inpatient and the outpatient setting, especially with the current increased use of regional, local, and tumescent anesthesia. Lack of protective strategies, delays in diagnosis, and the inability to provide timely lipid emulsion treatment are among the leading preventable causes to contribute to patients’ harm.

scholarly journals Lipid Emulsion for Treating Local Anesthetic Systemic Toxicity

2018 ◽  
Vol 15 (7) ◽  
pp. 713-722 ◽  
Author(s):  
Seong-Ho Ok ◽  
Jeong-Min Hong ◽  
Soo Hee Lee ◽  
Ju-Tae Sohn
Keyword(s):  
Local Anesthetic ◽  
Lipid Emulsion ◽  
Systemic Toxicity ◽  
Local Anesthetic Systemic Toxicity

scholarly journals Cardiac arrest after small doses ropivacaine: Local Anesthetic Systemic Toxicity in the course of continuous femoral nerve blockade

2020 ◽  
Author(s):  
Wojciech Gola ◽  
Szymon Bialka ◽  
Marek Zajac ◽  
Jacek Smereka ◽  
Lukasz Szarpak
Keyword(s):  
Cardiac Arrest ◽  
Total Knee Replacement ◽  
Local Anesthetic ◽  
Lipid Emulsion ◽  
Femoral Nerve ◽  
Systemic Toxicity ◽  
Nerve Blockade ◽  
Replacement Surgery ◽  
Total Knee ◽  
Local Anesthetic Systemic Toxicity

Abstract Background: The paper presents a case report of an episode of local anesthetic systemic toxicity (LAST) with cardiac arrest after continuous femoral nerve blockade in a 74-year-old female patient after elective total knee replacement surgery. Case presentation: A 74-year-old patient burdened with hypertension, osteoarthritis, underwent elective total knee replacement surgery (TKR). After surgery, a continuous femoral nerve blockade was performed and an infusion of a local anesthetics (LA) was started using an elastomeric pump. Five hours after surgery, the patient had an episode of generalized seizures followed by cardiac arrest. After resuscitation, spontaneous circulation was restored and the patient was transferred to the Intensive Care Unit. 20% lipid emulsion was used in the treatment. On day 2 of the ICU stay, the patient was fully cardiovascularly and respiratorily stable without neurological deficits and was discharged to the orthopedic department to continue treatment. Conclusion: Systemic toxicity of LA is a serious and potentially fatal complication of the use of LA in clinical practice. The incidence of LAST is underestimated, although in recent years there has been a significant decrease in the incidence of this serious complication. It should be noted that in nearly 40% of patients, LAST deviates from the classic and typical course and may have an atypical manifestation, and the first symptoms may appear with a long delay, especially when continuous blockades are used. Therefore, proper supervision of the patient and the developed procedure in the event of LAST is undoubtedly important here. If the first serious symptoms of LAST appear, current guidelines recommend early application of 20% lipid emulsion.

scholarly journals How we did it - an easy and feasible experimental rat model of protective role of Lipid Emulsion in Ropivacaine induced Local Anesthetic Systemic Toxicity - technique presentation and preliminary results

2021 ◽  
Vol 67 (2) ◽  
pp. 90-94
Author(s):  
Alexandra Lazar ◽  
Marcel Perian ◽  
Bogdan Cordoș ◽  
Mircea Gherghinescu ◽  
Bianca Liana Grigorescu
Keyword(s):  
Cardiac Arrest ◽  
Inferior Vena Cava ◽  
Local Anesthetic ◽  
Rat Model ◽  
Lipid Emulsion ◽  
Inferior Vena ◽  
Vena Cava ◽  
Systemic Toxicity ◽  
Starting Point ◽  
Local Anesthetic Systemic Toxicity

Abstract Introduction: Local Anesthetic Systemic Toxicity (LAST) is the most feared local anesthesia accident. As the cardiac arrest determined by LAST is mostly refractory to known resuscitation protocols, due local anesthetic blockade produced in the cardiac cells, the Lipid Emulsion (L.E) has been proved to be beneficial in resuscitating the cardiac arrest determined by local anesthetic. The aim for this presentation is to ease future studies on this topic, to ensure a starting point for next related research on LAST and LE mechanism of action. Method: Under genaral anesthesia we induced Local Anesthetic Systemic Toxicity to a rat model, by injecting Ropivacaine into the inferior vena cava. We monitored the cardiac activity of the subjects during the experiment. We used 4 groups of rats, control group- no intervention, lipid group- lipid emulsion was adminsitered, local anesthetic group- local anesthetic was administered and local anesthetic and lipid emulsion group- a dose of lipid emulsion was adminsitered before administering the local anesthetic. Results: After a few attemps to incannulate teh peripheral veins we tried the more complex approach of inferior vena cava, which ensured a secure access which allowed us to repetedly adminster the local anesthetic and the lipid emulsion. Conclusion: The presented experimental animal model of induced LAST and the protective effects of LE is one of the few described in the literature, is a reproducible model, feasible, simple, low cost and can be used as starting point in future LAST research.

scholarly journals Lipid Emulsion for Local Anesthetic Systemic Toxicity

2012 ◽  
Vol 2012 ◽  
pp. 1-11 ◽  
Author(s):  
Sarah Ciechanowicz ◽  
Vinod Patil
Keyword(s):  
Local Anesthetic ◽  
Local Anaesthetic ◽  
Local Anesthetics ◽  
Lipid Emulsion ◽  
Convincing Evidence ◽  
Systemic Toxicity ◽  
Initial Management ◽  
Preventative Measures ◽  
Accidental Overdose ◽  
Local Anesthetic Systemic Toxicity

The accidental overdose of local anesthetics may prove fatal. The commonly used amide local anesthetics have varying adverse effects on the myocardium, and beyond a certain dose all are capable of causing death. Local anesthetics are the most frequently used drugs amongst anesthetists and although uncommon, local anaesthetic systemic toxicity accounts for a high proportion of mortality, with local anaesthetic-induced cardiac arrest particularly resistant to standard resuscitation methods. Over the last decade, there has been convincing evidence of intravenous lipid emulsions as a rescue in local anesthetic-cardiotoxicity, and anesthetic organisations, over the globe have developed guidelines on the use of this drug. Despite this, awareness amongst practitioners appears to be lacking. All who use local anesthetics in their practice should have an appreciation of patients at high risk of toxicity, early symptoms and signs of toxicity, preventative measures when using local anesthetics, and the initial management of systemic toxicity with intravenous lipid emulsion. In this paper we intend to discuss the pharmacology and pathophysiology of local anesthetics and toxicity, and the rationale for lipid emulsion therapy.

Sign in / Sign up

Export Citation Format

Share Document