Special Considerations of Regional Anesthesia in Pediatric Patients

2021 ◽  
pp. 67-70
Author(s):  
Anna Clebone
Keyword(s):  
Peripheral Nerve ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Local Anesthetic ◽  
Pediatric Patients ◽  
Systemic Toxicity ◽  
Large Database ◽  
Indwelling Catheter ◽  
Neurologic Deficits ◽  
Local Anesthetic Systemic Toxicity

Chapter 7 reviews special considerations associated with the use of regional anesthesia in pediatric patients. The chapter covers the safety of regional anesthesia under general anesthesia, the risk for local anesthetic systemic toxicity under general anesthesia, and the safety of placing an indwelling catheter to anesthetize a peripheral nerve. The safety of regional anesthesia in children by expert practitioners is well established. Large database studies show that local anesthetic systemic toxicity and transient neurologic deficits are rare. Regional anesthesia should always be performed with all safety precautions taken, and by those practitioners with expert training in the technique.

Local Anesthetic Systemic Toxicity Treatment

2021 ◽  
pp. 191-196
Author(s):  
Anna Clebone
Keyword(s):  
Cardiac Arrest ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Local Anesthetic ◽  
Hemodynamic Instability ◽  
Systemic Toxicity ◽  
Chest Compressions ◽  
Membrane Oxygenation ◽  
Systemic Adverse Reaction ◽  
Local Anesthetic Systemic Toxicity

Local anesthetic systemic toxicity is a systemic adverse reaction to the administration of a local anesthetic. Children are at particular risk for local anesthetic systemic toxicity given their smaller body weight. In cases of cardiac arrest from local anesthetic systemic toxicity, prolonged chest compressions or extracardiac membrane oxygenation may be indicated because cardiac toxicity may last for several hours. Under general anesthesia, some of the early central nervous system signs of local anesthetic systemic toxicity, such as altered consciousness and seizures, may be masked, and the first indicator of local anesthetic systemic toxicity may be hemodynamic instability or cardiac arrest. Nevertheless, in a multicenter database of more than 100,000 consecutive pediatric regional anesthetics, local anesthetic systemic toxicity did not occur more often in pediatric patients undergoing regional anesthesia under general anesthesia compared with patients undergoing regional anesthesia awake or under sedation, and was overall very rare (2.2/10,000 and 15.2/10,000, respectively). In cases of cardiac arrest from local anesthetic systemic toxicity, prolonged chest compressions or extracardiac membrane oxygenation (ECMO) may be required because toxicity may last for several hours or more. Aggressive resuscitation and early administration of intralipid are the most important steps.

scholarly journals The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity

2018 ◽  
Vol 43 (2) ◽  
pp. 113-123 ◽  
Author(s):  
Joseph M. Neal ◽  
Michael J. Barrington ◽  
Michael R. Fettiplace ◽  
Marina Gitman ◽  
Stavros G. Memtsoudis ◽  
...  
Keyword(s):  
Regional Anesthesia ◽  
Local Anesthetic ◽  
Systemic Toxicity ◽  
Pain Medicine ◽  
The Third ◽  
Practice Advisory ◽  
Local Anesthetic Systemic Toxicity ◽  
American Society

scholarly journals American Society of Regional Anesthesia and Pain Medicine Local Anesthetic Systemic Toxicity checklist: 2020 version

2020 ◽  
Vol 46 (1) ◽  
pp. 81-82
Author(s):  
Joseph M Neal ◽  
Erin J Neal ◽  
Guy L Weinberg
Keyword(s):  
Regional Anesthesia ◽  
Local Anesthetic ◽  
Medical Knowledge ◽  
User Feedback ◽  
Systemic Toxicity ◽  
Simulation Studies ◽  
Pain Medicine ◽  
Cognitive Aids ◽  
Local Anesthetic Systemic Toxicity ◽  
American Society

The American Society of Regional Anesthesia and Pain Medicine (ASRA) periodically updates its practice advisories and associated cognitive aids. The 2020 version of the ASRA Local Anesthetic Systemic Toxicity checklist was created in response to user feedback, simulation studies and advances in medical knowledge. This report presents the 2020 version and discusses the rationale for its update.

Cardiac Arrest and Seizures Caused by Local Anesthetic Systemic Toxicity After Peripheral Nerve Blocks

2016 ◽  
Vol 41 (1) ◽  
pp. 5-21 ◽  
Author(s):  
Spencer S. Liu ◽  
Sarah Ortolan ◽  
Miguel Vizarreta Sandoval ◽  
Jodie Curren ◽  
Kara G. Fields ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Peripheral Nerve ◽  
Local Anesthetic ◽  
Systemic Toxicity ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Local Anesthetic Systemic Toxicity
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