scholarly journals Private Practitioners Knowledge of Local Anaesthetic Systemic Toxicity (LAST)

2021 ◽  
Vol 10 (41) ◽  
pp. 3571-3576
Author(s):  
Neha Yadav ◽  
Reshu Madan Sanan ◽  
Shefali Phogat ◽  
Nisha Yadav ◽  
Nupur Dabas ◽  
...  
Keyword(s):  
Local Anaesthetic ◽  
Anaesthetic Agent ◽  
Nerve Impulse ◽  
Local Anaesthetics ◽  
Systemic Toxicity ◽  
Blood Levels ◽  
Private Practitioners ◽  
Adequate Knowledge ◽  
Online Mode ◽  
Administration Methods

BACKGROUND Local anaesthetics (LAs) by definition are drugs that reversibly block the transmission of a nerve impulse, causing reversible absence of pain sensations without affecting consciousness. As a complication of local anaesthetic administration, a condition called as local anaesthetic systemic toxicity (LAST) can occur which affects central nervous system (CNS) and cardiovascular system (CVS). Local anaesthetic systemic toxicity is a very serious condition that can cause death. In LAST, blood levels of anaesthetic agent exceed the maximum dose, usually as a result of multiple injections or an accidental injection into a vein. The main objective of this survey was to assess the knowledge of LAST among private practitioners and to spread awareness about this common but often neglected complication of local anaesthetic administration. METHODS A survey was conducted with a questionnaire comprising of 15 questions for 251 private practitioners (registered in Indian Dental Association, Gurugram). The survey was mailed to the participants and the response was collected through online mode only. Using Excel program, the results were organized in graphs and tables, and presented as descriptive statistics. RESULTS Of the 251 surveys sent online, 151 were completed, with a survey completion rate of 60 %. On an average, only 39.9 % of the participating dentists had adequate knowledge of local anaesthetic systemic toxicity. Based on the survey, only 3.3 % of participating dentists knew how to use lipid treatment and 55.6 % had no idea about lipid treatment. CONCLUSIONS If LAST occurs, the key is to recognize it immediately and institute appropriate management. Based on the survey, there is a need to create awareness about local anaesthetic systemic toxicity and its management among dentists. KEY WORDS Local Anaesthesia, Last, Complication, Toxicity, Overdose

Some misconceptions about diagnostic anaesthesia administered during lameness evaluation

UK-Vet Equine ◽  
2019 ◽  
Vol 3 (5) ◽  
pp. 169-174
Author(s):  
Jim Schumacher ◽  
Michael Schramme ◽  
John Schumacher
Keyword(s):  
Inflammatory Response ◽  
Local Anaesthetic ◽  
Skin Necrosis ◽  
Positive Response ◽  
Anaesthetic Agent ◽  
Local Anaesthetics ◽  
White Hair ◽  
Cutaneous Sensation ◽  
Perineural Injection

The notion that the accuracy of a nerve block correlates well with cutaneous sensation in the nerve's dermatome is false. A positive response to direct anaesthesia of a joint does not prove that the source of pain is within that joint or, conversely, that a negative response eliminates the joint as a source of pain. Local anaesthetics do appear to have the potential to cause long-term deleterious effects to joints when administered intra-articularly, in addition to the transient inflammatory response some are known to elicit. Administering epinephrine perineurally in combination with a local anaesthetic agent has been thought to have the potential to result in skin necrosis, subcutaneous swelling, and growth of white hair at the site of injection, but experience indicates that these complications are unlikely when epinephrine is administered at a concentration of 1:200 000 or less. The extent to which a local anaesthetic can migrate proximally following perineural injection can be underestimated.

scholarly journals Use of Phenol as a Local Anaesthetic for Adult Grommet Insertion in Resource-Limited Settings: A Preliminary Report

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
AbdulAkeem Adebayo Aluko
Keyword(s):  
Social Sciences ◽  
Local Anaesthetic ◽  
Preliminary Report ◽  
Anaesthetic Agent ◽  
Computer Software ◽  
Local Anaesthetics ◽  
Local Anaesthetic Agent ◽  
Resource Limited ◽  
Outpatient Procedures ◽  
Tertiary Hospitals

Background. Grommet insertion is one of the most commonly performed minor surgical procedures in otolaryngological practice. For such minor procedures in the outpatient, local anaesthetics are preferred; this is even more so in adults especially for grommet insertion. This study described our experience with the use of phenol as a local anaesthetic agent for grommet insertion in adults. Methods. Phenol was used as a local anaesthetic agent that was applied topically for grommet insertion in adult patients as outpatient procedures between January and September 2018 in two tertiary hospitals. Data collected were analyzed using the Statistical Package for Social Sciences (SPSS IBM) version 23.0 computer software. Results. Nineteen ear drums were operated in patients aged between 20 and 52 years. No pain or discomfort was reported by 89.5% and 94.7% had no bleeding. There was no vertigo in all the cases that completed the procedures. Conclusion. This preliminary result shows that the use of phenol as a topical local anesthetic is simple, safe, and effective especially in resource-limited environments.

scholarly journals ANATOMICAL MEASUREMENTS FOR THE BLOCKING SITES OF PARAVERTEBRAL REGIONAL ANAESTHESIA IN BLACK BENGAL DOE

1970 ◽  
Vol 8 (1) ◽  
pp. 81-86 ◽  
Author(s):  
S Sikder ◽  
SSU Ahmed ◽  
ASMG Kibria ◽  
MS Pallab ◽  
MB Uddin ◽  
...  
Keyword(s):  
Nerve Block ◽  
Local Anaesthetic ◽  
Regional Anaesthesia ◽  
Anaesthetic Agent ◽  
Transverse Process ◽  
Local Anaesthetics ◽  
Spinal Nerve ◽  
Dorsal Midline ◽  
Lateral Border ◽  
Lateral Angle

The study was conducted in 25 black Bengal does to determine the exact site of infiltration of local anaesthetics for the last thoracic (T13), first lumbar (L1) and second lumbar (L2) paravertebral spinal nerve block at the Dept. of Anatomy and Histology, Chittagong Veterinary and Animal Sciences University, Chittagong. The animals were anaesthetized with pentobarbital sodium @ 20 mg / kg body weight IM and bled to death by giving incision on the right common carotid artery and preserved by 10 % formalin and dissected carefully to visualize the spinal nerves for the determination of the exact site of infiltration of local anaesthetic at the perineural area for paravertebral nerve block. For the vertical or proximal approach, the T13 spinal nerve was located at 0.8 ± 0.17 cm caudally from head of the last rib, 0.7 ± 0.22 cm cranio-medially from cranio-lateral angle of L1 transverse process and 3.4 ± 0.20 cm laterally from dorsal midline; L1 spinal nerve was placed at 1.2 ± 0.40 cm medially from cranio-lateral angle of L2 transverse process and 3.5 ± 0.17 cm laterally from the dorsal midline; and L2 spinal nerve was situated at 1.6 ± 0.26 cm medially from cranio-lateral angle of L3 transverse process and 3.7 ± 0.14 cm laterally from the dorsal midline. In horizontal or distal approach, T13 spinal nerve was located at 0.5 ± 0.10 cm and 1.8 ± 0.63 cm cranially from the cranio-lateral and caudo-lateral angles of L1 transverse process respectively and 4.6 ± 0.30 cm laterally from dorsal midline at lateral border of L1 transverse process; L1 spinal nerve was placed at 0.4 ± 0.10 cm and 1.4 ± 0.28 cm caudally and cranially from the cranio-lateral and caudo-lateral angle of L2 transverse process respectively and 5.1 ± 0.20 cm laterally from dorsal midline at lateral border of L2 transverse process and L2 spinal nerve was situated at 2.5 ± 0.42 cm and 0.5 ± 0.10 cm caudally and cranially from the cranio-lateral and caudo-lateral angle of L3 transverse process respectively and 5.5 ± 0.28 cm laterally from dorsal midline at lateral border of L3 transverse process. These measurements will be helpful to determine of the exact site for the deposition of the local anaesthetic agent at the perineural area of the specific paravertebral spinal nerve during paravertebral regional anaesthesia in doe. DOI = 10.3329/bjvm.v8i1.8354 Bangl. J. Vet. Med. (2010). 8(1): 81-86

Local anaesthetic agents

2017 ◽  
Author(s):  
Malachy O. Columb
Keyword(s):  
Local Anaesthetic ◽  
Neuronal Damage ◽  
Scientific Evidence ◽  
Local Anaesthetics ◽  
Systemic Toxicity ◽  
Lipid Solubility ◽  
Blood Concentrations ◽  
Anaesthetic Agents ◽  
Weak Bases ◽  
Initiation And Propagation

Local anaesthetic agents cause a pharmacologically induced reversible neuropathy characterized by axonal conduction blockade. They act by blocking the sodium ionophore and exhibit membrane stabilizing activity by inhibiting initiation and propagation of action potentials. They are weak bases consisting of three components: a lipophilic aromatic ring, a link, and a hydrophilic amine. The chemical link classifies them as esters or amides. Local anaesthetics diffuse through the axolemma as unionized free-base and block the ionophore in the quaternary ammonium ionized form. The speed of onset of block is therefore dependent on the pKa of the agent and the ambient tissue pH. Esters undergo hydrolysis by plasma esterases and amides are metabolized by hepatic microsomal mixed-function oxidases. Local anaesthetics are bound in the blood to α‎1-acid glycoproteins. Pharmacological potency is dependent on the lipid solubility of the drug as is the potential for systemic toxicity. The blood concentrations required to cause cardiovascular system (CVS) collapse and early central nervous system (CNS) toxicity are used to quantify the CVS:CNS toxicity ratio. Local anaesthetics also have the potential to induce direct neuronal damage. Intravenous lipid emulsion is used for the treatment of systemic toxicity but the scientific evidence is inconsistent. With regard to the pipecoloxylidine local anaesthetics, early evidence indicated that the S- was less toxic than the R-enantiomer. However, clinical research using minimum local analgesic concentration designs suggests that reduced systemic toxicity and motor block sparing is mainly explained by potency rather than enantiomerism.

Updates in our understanding of local anaesthetic systemic toxicity: a narrative review

Anaesthesia ◽  
2021 ◽  
Vol 76 (S1) ◽  
pp. 27-39
Author(s):  
A. J. R. Macfarlane ◽  
M. Gitman ◽  
K. J. Bornstein ◽  
K. El‐Boghdadly ◽  
G. Weinberg
Keyword(s):  
Local Anaesthetic ◽  
Systemic Toxicity ◽  
Narrative Review

scholarly journals The effect of butacaine on adenine nucleotide binding and translocation in rat liver mitochondria

1975 ◽  
Vol 148 (3) ◽  
pp. 527-531 ◽  
Author(s):  
D R Fayle ◽  
G J Barritt ◽  
F L Bygrave
Keyword(s):  
Rat Liver ◽  
Local Anaesthetic ◽  
Binding Sites ◽  
Adenine Nucleotide ◽  
Adenine Nucleotides ◽  
Nucleotide Binding ◽  
Local Anaesthetics ◽  
Liver Mitochondria ◽  
Rat Liver Mitochondria ◽  
Mitochondrial Inner Membrane

The effect of the local anaesthetic, butacaine, on adenine nucleotide binding and translocation in rat liver mitochondria partially depleted of their adenine nucleotide content was investigated. The range of butacaine concentrations that inhibit adenine nucleotide translocation and the extent of the inhibition are similar to the values obtained for native mitochondria. Butacaine does not alter either the total number of atractyloside-sensitive binding sites of depleted mitochondria, or the affinity of these sites for ADP or ATP under conditions where a partial inhibition of the rate of adenine nucleotide translocation is observed. The data are consistent with an effect of butacaine on the process by which adenine nucleotides are transported across the mitochondrial inner membrane rather than on the binding of adenine nucleotides to sites on the adenine nucleotide carrier. The results are briefly discussed in relation to the use of local anaesthetics in investigations of the mechanism of adenine nucleotide translocation.

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