ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Local anesthetic systemic toxicity: Rapid overview[1]

Local anesthetic systemic toxicity: Rapid overview[1]
Etiology
  • Unintended intravascular injection of LA
  • Systemic absorption of LA
Risk factors
  • Extremes of age (ie, <4 months or >79 years)
  • Cardiac conduction disease
  • Ischemic heart disease
  • Renal dysfunction
  • Hepatic dysfunction
  • Pregnancy
  • Carnitine deficiency
  • Highly vascular block site
Signs and symptoms* LAST can occur >15 minutes after injection of LA
  • CNS:
    • Tinnitus
    • Circumoral numbness
    • Metallic taste
    • Agitation
    • Dysarthria
    • Seizures
    • Loss of consciousness
    • Respiratory arrest
  • Cardiovascular:
    • Hypotension
    • Bradycardia
    • Ventricular arrhythmias
    • Cardiovascular collapse
Treatment*
  • Stop injection or infusion
  • Call for help and lipid emulsion
  • While stabilizing the patient, arrange for cardiopulmonary bypass
  • Airway management: Ventilate with 100% oxygen, prevent hypoxemia, hypercarbia, and acidosis
  • Suppress seizures: Benzodiazepines preferred (avoid large doses of propofol)
  • Manage arrhythmias and cardiac arrest per ACLS EXCEPT:
    • Reduce individual epinephrine boluses to ≤1 mcg/kg
    • Avoid vasopressin, calcium channel blockers, beta blockers, and LA
    • Administer amiodarone as the first line antiarrhythmic
  • Institute lipid emulsion therapy with 20% lipid emulsion
    • Adults >70 kg: Bolus 100 mL IV over 2 to 3 minutes, followed by infusion of 200 to 250 mL over 15 to 20 minutes
    • Children or Adults <70 kg: Bolus 1.5 mL/kg IBW IV over 2 to 3 minutes, followed by infusion at 0.25 mL/kg/minute
    • Repeat bolus once or twice and double infusion rate for persistent cardiovascular instability
    • Continue infusion for at least 10 minutes after hemodynamic stability is achieved
    • Maximum dose lipid emulsion approximately 12 mL/kg IV
    • Note: Propofol is not a substitute for lipid emulsion
  • Institute cardiopulmonary bypass for LAST unresponsive to lipid emulsion and ACLS
For further information, refer to UpToDate content on local anesthetic systemic toxicity.
LA: local anesthetic; LAST: local anesthetic systemic toxicity; CNS: central nervous system; TPN: total parenteral nutrition; ACLS: advanced cardiac life support; IBW: ideal body weight; IV: intravenous.
* Not all signs and symptoms occur in every patient.
¶ Cardiovascular collapse may occur without CNS signs or symptoms, especially with rapid intravascular injection.
Reference:
  1. Neal JM, Barrington MJ, Fettiplace MR, et al. The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: Executive Summary 2017. Reg Anesth Pain Med 2018; 43:113.
Graphic 107887 Version 7.0

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟