scholarly journals Intensive therapy systemic toxicity of local anesthetics (clinical guidelines)

2016 ◽  
Vol 10 (3) ◽  
pp. 197-204
Author(s):  
Roman E. Lakhin ◽  
V. A Koryachkin ◽  
D. N Uvarov ◽  
G. E Ulrikh ◽  
E. M Shifman ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Local Anesthetics ◽  
Lipid Emulsion ◽  
Intensive Therapy ◽  
Systemic Toxicity ◽  
Clinical Protocols ◽  
Recommended Dosage ◽  
Mechanisms Of Toxicity ◽  
Care Protocol ◽  
Helsinki Declaration

Development of the systemic toxicity of local anesthetics can quickly lead to severe bradycardia and hypotension, up to cardiac arrest. The presented clinical recommendations designed to optimize medical care and are included in the list of mandatory clinical protocols according to the Helsinki Declaration on Patient Safety in Anaesthesiology. This review summarizes the main mechanisms of toxicity when using local anesthetics. The guidelines set out criteria and signs of systemic toxicity, recommendations for its prevention. The algorithm of action and recommended dosage of drugs. An intensive care protocol systemic toxicity of local anesthetics including the use of lipid emulsion.

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

scholarly journals Mechanisms and Efficacy of Intravenous Lipid Emulsion Treatment for Systemic Toxicity From Local Anesthetics

2021 ◽  
Vol 8 ◽  
Author(s):  
Yang Liu ◽  
Jing Zhang ◽  
Peng Yu ◽  
Jiangfeng Niu ◽  
Shuchun Yu
Keyword(s):  
Local Anesthetics ◽  
Lipid Emulsion ◽  
Life Support ◽  
Clinical Symptoms ◽  
Advanced Cardiac Life Support ◽  
Systemic Toxicity ◽  
The Body ◽  
Research Progress ◽  
Intravenous Lipid Emulsion ◽  
Perioperative Analgesia

Local anesthetics are widely used clinically for perioperative analgesia to achieve comfort in medical treatment. However, when the concentration of local anesthetics in the blood exceeds the tolerance of the body, local anesthetic systemic toxicity (LAST) will occur. With the development and popularization of positioning technology under direct ultrasound, the risks and cases of LAST associated with direct entry of the anesthetic into the blood vessel have been reduced. Clinical occurrence of LAST usually presents as a series of severe toxic reactions such as myocardial depression, which is life-threatening. In addition to basic life support (airway management, advanced cardiac life support, etc.), intravenous lipid emulsion (ILE) has been introduced as a treatment option in recent years and has gradually become the first-line treatment for LAST. This review introduces the mechanisms of LAST and identifies the clinical symptoms displayed by the central nervous system and cardiovascular system. The paper features the multimodal mechanism of LAST reversal by ILE, describes research progress in the field, and identifies other anesthetics involved in the resuscitation process of LAST. Finally, the review presents key issues in lipid therapy. Although ILE has achieved notable success in the treatment of LAST, adverse reactions and contraindications also exist; therefore, ILE requires a high degree of attention during use. More in-depth research on the treatment mechanism of ILE, the resuscitation dosage and method of ILE, and the combined use with other resuscitation measures is needed to improve the efficacy and safety of clinical resuscitation after LAST in the future.

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.

Management of Local Anesthetics Systemic Toxicity In A 78 Year Old Man Undergoing Remove Of Inplate

2021 ◽  
Vol 2 (3) ◽  
pp. 112-115
Author(s):  
Wike Yuliana ◽  
◽  
Heri Dwi Purnomo ◽  
Keyword(s):  
Local Anesthetics ◽  
Lipid Emulsion ◽  
Vital Signs ◽  
Systemic Circulation ◽  
Open Reduction Internal Fixation ◽  
Systemic Toxicity ◽  
Clinical Practices ◽  
Normal Limits ◽  
Breath Sounds ◽  
Threatening Condition

Background: Local anesthetics have been widely used over the past 50 years in many clinical practices, ranging from emergency departments to operating rooms. Local anesthetics systemic toxicity (LAST) is a life-threatening condition when the effects of local anesthetics reach the systemic circulation with an incidence of 0.03% or 0.27 incidence of 1000 episodes of Peripheral nerve block (PNB). Case: We report a 78-year-old male who underwent of remove of inplate (ROI) and open reduction internal fixation (ORIF) reconstruction. Preoperative physical examination revealed GCS E4V5M6, blood pressure 195/76, other vital signs within normal limits, SpO2 99% in the supine position. On examination of the lungs, there were increased bronchial breath sounds and rough crackles, especially in the 2-5 left intercostal space. Other physical and laboratory examinations were within normal limits. The patient was hemodynamically stable after infusion lipid emulsion. The main principle of LAST management is to ensure adequate ventilation and organ perfusion with sufficient oxygen-rich blood to reach the brain, heart, and kidneys to prevent acidosis until lipid emulsion therapy. Conclusion: LAST management requires prompt and precise diagnosis and treatment to get a good outcome.

Intravenous Lipids: Antidotal Therapy for Drug Overdose and Toxic Effects of Local Anesthetics

2014 ◽  
Vol 34 (5) ◽  
pp. 62-66 ◽  
Author(s):  
Dana Bartlett
Keyword(s):  
Cardiac Arrest ◽  
Critical Care ◽  
Local Anesthetics ◽  
Lipid Emulsion ◽  
Case Reports ◽  
Psychotropic Medications ◽  
Critical Care Nurses ◽  
Toxic Effects ◽  
Intravenous Lipids ◽  
Antidotal Therapy

Intravenous lipid emulsion is an accepted therapy for the treatment of severe cardiac toxic effects caused by local anesthetics. Lipid emulsion therapy has also been used successfully to treat cardiac arrest and intractable arrhythmias caused by overdoses of antiepileptic drugs, cardiovascular drugs, and psychotropic medications, but experience with intravenous lipids as antidotal therapy in these clinical situations is limited. However, intravenous lipids are relatively safe, widely available, and easy to administer, and many published case reports document their dramatic effectiveness. Patients who have not responded to standard therapies have been quickly revived by administration of intravenous lipids. Use of lipids most likely will increase, and critical care nurses should be familiar with lipid therapy.

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.

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