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Local anesthesia intoxication

Alexander P Schwoerer, Hanno Scheel, Patrick Friederich
BACKGROUND: Intoxication with local anesthetics may induce cardiac arrhythmias by interaction with ion channels. Ropivacaine has been introduced into clinical anesthesia as a safer alternative to bupivacaine, which is associated with a relatively high risk of cardiac arrhythmias. Diverging safety profiles may result from differences in the mode of interaction with cardiac Na(+) channels. We conducted this study to test this hypothesis and to provide experimental basis for the ongoing discussion regarding the cardiotoxic profiles of these local anesthetics...
June 2015: Anesthesia and Analgesia
E Doye, F-P Desgranges, D Stamm, M de Queiroz, F V Valla, E Javouhey
Local anesthetic intoxication is an uncommon complication of regional anesthesia. We report the case of a 4-month-old infant who presented with generalized tonic-clonic seizure complicated by cardiac arrest secondary to a severe intoxication to local anesthesia. These complications were observed after a bilateral dorsal penile nerve block with lidocaine for circumcision in a non-hospital setting. This report emphasizes the potential risk of local anesthetic systemic toxicity in such circumstances and describes its treatment...
March 2015: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Jacqueline Mauch, Simone K Ringer, Nelly Spielmann, Markus Weiss
BACKGROUND: Early epinephrine administration in cardiac arrest seems to be advantageous to achieve return of spontaneous circulation (ROSC). Because intravenous (i.v.) or intraosseous access is not always immediately available, this study compares efficacy of early intramuscular (i.m.) epinephrine administration with early and delayed i.v. epinephrine injection in an animal cardiac arrest model. METHODS: Piglets anesthetized with sevoflurane were intoxicated by an i...
October 2013: Paediatric Anaesthesia
F Reisig, M Neuburger, Y A Zausig, B M Graf, J Büttner
BACKGROUND: In the context of regional anesthesia procedures adverse events rarely occur but are predominantly systemic intoxication due to local anesthetics (0.01-0.035 %), nerve injuries (0.01-1.7 %) and infections (0-3.2 %). MATERIALS AND METHODS: In a level 1 trauma centre data from all continuous peripheral nerve blocks (cPNB) were prospectively acquired over a period of 8 years (2002-2009) in an observational study (n = 10,549). The acquisition of data was carried out in an intranet-based data bank which was accessible for 24 h on every anesthesia workstation...
February 2013: Der Anaesthesist
Bin Yu, Xiaoqing Zhang, Peili Sun, Shuqi Xie, Qiying Pang
OBJECTIVE: To investigate the feasibility of a non-stimulation needle with an external indwelling cannula for upper-limb surgery and acute postoperative pain management. METHODS: 62 patients undergoing either scheduled or emergency upper-limb surgery received brachial plexus block of modified interscalene or axillary brachial and then postoperative patient-controlled analgesia (PCA) with local analgesics using a specially designed non-stimulation needle with an external indwelling cannula...
2012: International Journal of Medical Sciences
Tonia C Onyeka, Humphrey A Ezike, Ogochukwu M Nwoke, Emeka A Onyia, Elias C Onuorah, Samson U Anya, Timothy E Nnacheta
BACKGROUND: Utilization of herbal medicines in the preoperative period by Nigerian patients booked for day case surgery has not been explored. METHODS: Cross-sectional survey of 60 patients presenting for day-case surgery at a tertiary healthcare institution over a 3-week period in August 2011 was conducted. Using a structured questionnaire, inquiries were made concerning use of herbal medicines in the immediate preoperative period. Socio-demographic characteristics, information on use of concurrent medical prescriptions, types of herbs used, reasons for use, perceived side effects and perceived efficacy were obtained...
2012: BMC Complementary and Alternative Medicine
J Mauch, M Weiss
Caudal block is a safe procedure commonly used for pediatric perioperative analgesia. Complications are extremely rare but nevertheless local and systemic contraindications must be excluded. Optimal safety and quality result when strict attention is paid to technical details. A local anesthetic (LA) containing epinephrine allows early detection of inadvertent intravascular LA administration; therefore an epinephrine/LA mixture is recommended at least for the test dose. In terms of safety the choice of LA itself is probably of secondary importance...
August 2012: Der Schmerz
J Mauch, M Weiss
Caudal block is a safe procedure commonly used for pediatric perioperative analgesia. Complications are extremely rare but nevertheless local and systemic contraindications must be excluded. Optimal safety and quality result when strict attention is paid to technical details. These are discussed in detail in this review. A local anesthetic (LA) containing epinephrine allows early detection of inadvertent intravascular LA administration; therefore an epinephrine/LA mixture is recommended at least for the test dose...
June 2012: Der Anaesthesist
Iván Marcelo Cueva Galárraga
INTRODUCTION: Liposuction is a highly sought after surgical procedure. Despite its popularity, not all of the factors associated with its execution are well understood. No well-established guidelines exist for plastic surgeons regarding the subcutaneous infiltration of fluid and, thus, the procedure is often performed subjectively. OBJECTIVE: To establish the usefulness of the Quito formula (infiltrate volume = weight [kg] × percentage of body surface to be liposuctioned × 2...
2011: Canadian Journal of Plastic Surgery, Journal Canadien de Chirurgie Plastique
M Neuburger, J Büttner
Peripheral regional anesthesia is a commonly used and safe procedure and eneral complications or side effects are generally rare. Nerve damage has an incidence <0.1% depending on the definition and the prognosis is good. To avoid bleeding complications the national standards of block performance under antithrombotic therapy should be respected. Intoxication is mainly the result of accidental intravenous administration and is difficult to treat but higher doses of intravenous lipid emulsions can improve the outcome...
November 2011: Der Anaesthesist
Jacqueline Mauch, Olga Martin Jurado, Nelly Spielmann, Regula Bettschart-Wolfensberger, Markus Weiss
OBJECTIVES: Local anesthetic (LA) intoxication with cardiovascular arrest is a potential fatal complication of regional anesthesia. Lipid resuscitation has been recommended for the treatment of LA-induced cardiac arrest. Aim of the study was to compare four different rescue regimens using epinephrine and/or lipid emulsion and vasopressin to treat cardiac arrest caused by bupivacaine intoxication. METHODS: Twenty-eight piglets were randomized into four groups (4 × 7), anesthetized with sevoflurane, intubated, and ventilated...
February 2012: Paediatric Anaesthesia
F Reisig, J Breitbarth, B Ott, J Büttner
In the past years intoxication with local anesthetics, damage to nerves, vessels and other accompanying structures as well as infectiological events have been discussed more and more as complications accompanying peripheral nerve blocks (PNB). The following case report highlights a complication which seems to rarely occur and deals with a sheared continuous PNB, where a fragment of the catheter remained in the patient. The possible causes for the damage are discussed and recommendations on the clinical management of such a case are made...
October 2011: Der Anaesthesist
Marie-Eve Bergeron, Pascale Ouellet, Emmanuel Bujold, Maxime Cote, Caroline Rhéaume, Daniel Lapointe, Christine Beaudet, Madeleine Lemyre, Philippe Laberge
BACKGROUND: Operative hysteroscopy requires the use of a distension medium and its absorption can lead to serious consequences from intravascular volume overload and water intoxication. We compared the impact of 2 types of anesthesia (general anesthesia and local anesthesia with sedation) on the absorption of glycine solution in operative hysteroscopy. METHODS: A randomized controlled trial was conducted over a 17-month period. Eligible patients undergoing operative hysteroscopy for abnormal uterine bleeding were randomized in 2 groups: a general anesthesia group and a local anesthesia with sedation group...
October 2011: Anesthesia and Analgesia
J Mauch, A P N Kutter, O Martin Jurado, N Spielmann, A Frotzler, R Bettschart-Wolfensberger, M Weiss
BACKGROUND: Several reports have confirmed the efficacy of Intralipid® (containing soya bean oil, egg phospholipids, glycerin and water) in the therapy of systemic local anesthetic intoxication. Pretreatment with Intralipid® shifted the dose-response to bupivacaine-induced asystole in rats. Whether intravenous anesthesia with propofol in the widely used medium chain triglyceride lipid emulsion increases the therapeutic range of systemically administered bupivacaine or not is unknown and was investigated in this study...
September 2011: Der Anaesthesist
Martin Skjønnemand, Jens Damgaard-Jensen, Bo Gottschau
OBJECTIVE: To draw attention to the use of intravenous lipids in the treatment of cardiac arrests caused by overdosage of lipophilic drugs. Case reports and animal studies have shown beneficial use of lipids in severe intoxication. The literature is reviewed. CONCLUSION: Lipids have a place in the treatment of severe cardiac events caused by local analgesics for regional anaesthesia. Lipids should be readily available when regional anaesthesia is performed. National guidelines should be prepared...
January 10, 2011: Ugeskrift for Laeger
Akira Kudoh
Schizophrenic patients are at increased risk for perioperative complications such as hypotension and hypothermia during anesthesia, postoperative ileus, confusion and pneumonia. In addition, schizophrenic patients are predisposed to developing pulmonary thromboembolism, torsade de pointes, water intoxication and rhabdomyolysis. The increased complications are associated with physical disorders, antipsychotic agents, hazardous health behaviors, and interactions between antipsychotic agents and anesthetic drugs...
September 2010: Masui. the Japanese Journal of Anesthesiology
Artur Udelsmann, William Adalberto Silva, Ana Cristina de Moraes, Elisabeth Dreyer
PURPOSE: To compare the hemodynamic effects following a toxic dose of either agent after intravenous injection in swines, as might accidentally occur during regional anesthesia in humans. METHODS: Large White pigs were anesthetized with thiopental, tracheal intubation was performed and mechanical ventilation was instituted. Hemodynamic variables were recorded with invasive pressure monitoring and pulmonary artery catheterization. After a 30-minute resting period, the animals were randomly divided into two groups in a double-blinded fashion and received a bolus intravenous injection of 4 mg...
July 2009: Acta Cirúrgica Brasileira
H Pagès, B de la Gastine, J Quedru-Aboane, M-G Guillemin, V Lelong-Boulouard, B Guillois
Pudendal nerve block may be indicated during instrumental delivery in situations where peridural anesthesia is unavailable. We report three cases of neonatal lidocaine intoxication following maternal pudendal block during delivery. Clinical features were hypotonia, pupillary mydriasis fixed to light, apnea, cyanosis and seizures. Two neonates required mechanical ventilation. Lidocaine was found in the serum of two babies. In all three cases, recovery was complete. The pharmacokinetics of lidocaine in a highly vascularized perineum during labor increase the risk of neonatal intoxication...
June 2008: Journal de Gynécologie, Obstétrique et Biologie de la Reproduction
Valéry Blasco, Lionel Pellegrini, Pierre Visintini, Marc Leone, François Antonini, Jacques Albanèse, Claude Martin
INTRODUCTION: Simple serous renal cysts are an often asymptomatic benign disease, sometimes treated with ethanol sclerotherapy. We report a case of iatrogenic acute alcohol intoxication following percutaneous injection of alcohol into a renal cyst under local anesthesia. CASE: The percutaneous injection was guided by computed tomography. At the end of the procedure, the patient went into a coma due to alcohol intoxication: the cyst ruptured and ethanol was resorbed into the systemic circulation...
April 2008: La Presse Médicale
Artur Udelsmann, Sílvia Elaine Rodolfo de Sá Lorena, Samira Ubaid Girioli, William Adalberto Silva, Ana Cristina de Moraes
BACKGROUND: Racemic bupivacaine has been the local anaesthetic of choice in regional blocks due to quality and duration of anesthesia. However its cardiovascular toxicity has been a source of concern and research has been made for lesser impact drugs. One choice is its levogyre isomer, levobupivacaine, apparently less cardiotoxic due a lower affinity to the heart sodium channels. In Brazil, a drug containing 75% of levogyre isomer and 25% of dextrogyre isomer, called enantiomeric excess mixture, is available...
November 2007: Revista da Associação Médica Brasileira
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