medigraphic.com
ISSN 3061-8142 (Electronic)
ISSN 0484-7903 (Print)

2022, Number 3

<< Back Next >>

Rev Mex Anest 2022; 45 (3)

Systemic intoxication by local anesthetics

Téllez-Peña DM, Martínez-González ME, Andrade-Caballero A

Language: Spanish
References: 19
Page: 207-211
PDF size: 247.03 Kb.


ABSTRACT

The local anesthesics are defined as medicaments that block the generation and spread of impulses in excitable fabrics, from bony marrow, nervous roots, peripheral nerves or other excitable fabrics as cardiac muscle, smooth muscle and brain. The systemic intoxication takes place due to the plasmatic concentrations raised after high doses or the intravenous inadvertent administration. The increasing use of technologies of anesthesia locorregional forces to bear in mind the systemic intoxication for local anesthesics as an anesthesic complication of low incident, but high morbi-mortality, beside constituting one of the more frequent reasons of cardiorespiratory unemployment of anesthesic origin. The clinical presentation of this complication is very variable and includes a great spectrum of symptoms related principally to the neurological and cardiovascular toxicity. Though infrequent, the reactions can be very serious, and to result in irreversible hurt or death of the patient. The prevention seems to have diminished the poisoning of the local anesthesics and is more effective than the treatment. The managing is based on measures of resuscitation cardiopulmonar advanced, the pharmacological treatment and the precocious employment of the lipid emulsions. I present a case of systemic intoxication using lidocaine simply as anesthesic local only one during the accomplishment of blockade of peripheral nerve in elective surgery.


REFERENCES

  1. Heavner JE, Local anesthetics. Curr Opin Anesthesiol. 2007;20:336-342.

  2. Kindler CH, Yost CE. Two-pore domain potassium channels: new sites of local anesthetic action and toxicity. Reg Anesth Pain Med: 2005;30:260-274.

  3. Hollmann MW, Herroeder S, Kurz KS, et al. Time-dependent inhibition of G-protein coupled receptor signaling by local anesthetics. Anesthesiology. 2004;100:852-860.

  4. Lui KC, Chow YF. Safe use of local anaesthetics: prevention and management of systemic toxicity. Hong Kong Med J. 2010;16:470-475.

  5. Fenten MG, Rohrbach A, Wymenga AB, et al. Systemic local anesthetic toxicity after local infiltration analgesia following a polyethylene tibial insert exchange: a case report. In Reg Anesth Pain Med. 2014:264-265.

  6. Barrington MJ, Weinberg GL, Neal JM. A call to all readers: educating all surgeons on preventing and treatment of local anaesthetic systemic toxicity. ANZ J Surg. 2016;86:636-637.

  7. Cheney FW, Posner KL, Lee LA, et al. Trends in anesthesia-related death and brain damage. A closed claims analysis. Anesthesiology. 2006;105:1081-1086.

  8. Merchant R, Chartrand D, Dain S, et al. Guidelines to the practice of anesthesia-revised. Can J Anaesth. 2015;62:54-67.

  9. Neal JM, Mulroy MF, Weinberg GL. American Society of Regional Anesthesia and Pain Medicine checklist for managing local anesthetic systemic toxicity. Reg Anesth Pain Med. 2012;37:16-18.

  10. Weinberg GL. Current concepts in resuscitation of patients with local anesthetic cardiac toxicity. Reg Anesth Pain Med. 2002;27:568-575.

  11. Ozcan MS, Weinberg G. Intravenous lipid emulsion for the treatment of drug toxicity. J Intensive Care Med. 2014;29:59-70.

  12. Ozcan MS, Weinberg G. Update on the use of lipid emulsions in local anesthesic systemic toxicity: a focus on differential efficacy and lipid emulsion as part of advanced cardiac life support. Int Anesthesiol Clin. 2011;49:91-103.

  13. Gitman M, Fettiplace M, Weinberg G, et al. Local anesthetic systemic toxicity: a narrative literature review and clinical update on prevention, diagnosis, and management. Plast Reconstr Surg. 2019;144:783-795.

  14. 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;43:113-123.

  15. Drasner K. Local anesthetic toxicity. ASA refresher courses in anesthesiology. 2011;39:33-40.

  16. Errando CL, Freijo JJ, Vila M, et al. Toxicidad de los anestésicos locales. Prevención y tratamiento. Rev Esp Anestesiol Reanim. 2013;60:65-72.

  17. Fuentes R, Molina I, Contreras J, et al. Toxicidad sistémica por anestésicos locales: consideraciones generales, prevención y manejo. ARS Méd. 2017;42:47-54.

  18. Manavi MV. Lipid infusión as a treatment for local anesthetic toxicity: a literature review. AANA J. 2010;78:69-78.

  19. Mazoit JX, Leguen R, Beloeil H, et al. Binding of long-lasting local anesthetics to lipid emulsions. Anesthesiology. 2008;106:1333-1336.




2020     |     www.medigraphic.com