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Local anesthetics toxicity

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https://www.readbyqxmd.com/read/27885103/no-support-for-lipid-rescue-in-oral-poisoning-a-systematic-review-and-analysis-of-160-published-cases
#1
M Forsberg, S Forsberg, G Edman, J Höjer
Lipid rescue is used as treatment of various poisonings despite weak scientific evidence. Some experimental studies have indicated a positive effect, but others have not. Clinical studies are lacking, wherefore a systematic review of virtually all published human case reports is presented. The case reports were searched for in PubMed and Web of Science and examined by two experts according to an assessment form grading the probability for a causal connection between lipid rescue and improved symptoms. A total of 160 cases were finally included, of which 30 had no positive effect of lipid rescue...
November 24, 2016: Human & Experimental Toxicology
https://www.readbyqxmd.com/read/27876104/a-cohort-study-of-unstable-overdose-patients-treated-with-intravenous-lipid-emulsion-therapy
#2
Shazma Mithani, Kathryn Dong, Ashlea Wilmott, Heather Podmoroff, Nadim Lalani, Rhonda J Rosychuk, Ryan Chuang, Mark C Yarema
OBJECTIVES: Intravenous lipid emulsion (ILE) has been used increasingly over the last decade for a range of drug overdoses. Although the use of ILE in local anesthetic toxicity (LAST) is well established, the hemodynamic effectiveness of ILE in non-LAST poisonings is still unclear. Thus, the primary objective of this study was to examine a cohort of poisoned patients in whom ILE was administered. METHODS: Consecutive patients were identified by calls to a regional poison center from May 1, 2012 to May 30, 2014...
November 23, 2016: CJEM
https://www.readbyqxmd.com/read/27871587/peripheral-nerve-blocks-in-the-management-of-postoperative-pain-challenges-and-opportunities
#3
REVIEW
Girish Joshi, Kishor Gandhi, Nishant Shah, Jeff Gadsden, Shelby L Corman
Peripheral nerve blocks (PNBs) are increasingly used as a component of multimodal analgesia and may be administered as a single injection (sPNB) or continuous infusion via a perineural catheter (cPNB). We undertook a qualitative review focusing on sPNB and cPNB with regard to benefits, risks, and opportunities for optimizing patient care. Meta-analyses of randomized controlled trials have shown superior pain control and reductions in opioid consumption in patients receiving PNB compared with those receiving intravenous opioids in a variety of upper and lower extremity surgical procedures...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27871512/case-report-management-of-differential-diagnosis-and-treatment-of-severe-anaphylaxis-in-the-setting-of-spinal-anesthesia
#4
Brian M Osman, Joni M Maga, Sebastian M Baquero
The purpose of this case report is to educate fellow anesthesiologists of a complicated differential diagnosis for sudden cardiovascular collapse after spinal anesthesia. We report a case where anaphylaxis occurred while under spinal anesthesia and resulted in difficult resuscitation. A 58-year-old woman undergoing bilateral knee replacements under spinal anesthesia experienced sudden seizure and cardiovascular collapse from acute anaphylactic shock while administering a cephalosporin. Local anesthetic toxicity, high spinal, and anaphylaxis were considered due to overlapping of symptoms...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27870742/thoracic-paravertebral-nerve-blocks-in-pediatric-patients-safety-and-clinical-experience
#5
Tricia Vecchione, David Zurakowski, Karen Boretsky
Thoracic paravertebral nerve blocks (PVNBs) provide excellent analgesia for many surgeries. The primary aim was to estimate the complication rate, and secondary aims were to provide information on the potential clinical application of PVNBs. Data on 2390 PVNBs were collected. A total of 625 catheters were performed on 468 patients, and 1765 single-injection PVNBs were performed on 403 patients. There was 1 case of local anesthetic systemic toxicity for a major complication rate of 1 per 2390 PVNBs. The minor complication rate was 13...
December 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27833486/a-comparative-study-of-dexmedetomidine-and-fentanyl-as-adjuvants-to-levobupivacaine-for-caudal-analgesia-in-children-undergoing-lower-limb-orthopedic-surgery
#6
S M Elfawal, W A Abdelaal, M R Hosny
BACKGROUND: Levobupivacaine is an effective local anesthetic agent with less systemic toxicity than racemic bupivacaine, but it has short postoperative analgesic duration. Dexmedetomidine and fentanyl are promising adjuncts to provide excellent and prolonged postoperative caudal analgesia. This study compared the effects of caudal levobupivacaine plus dexmedetomidine and levobupivacaine plus fentanyl for postoperative analgesia and sedation in children undergoing lower limb orthopedic surgery...
October 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27831940/pseudo-bullous-dermatosis-induced-by-topical-anesthetic-agent-clues-to-this-localized-toxic-reaction
#7
Christopher R Kieliszak, John R Griffin, Tess H Pollinger, Jacqueline M Junkins-Hopkins
Eutectic mixture of 2.5% lidocaine and 2.5% prilocaine (EMLA AstraZeneca, DE) is a widely used topical anesthetic cream for preprocedural cutaneous analgesia. In addition to potential clinical cutaneous and systemic adverse effects, EMLA may also induce microscopic changes detectable by light and electron microscopy leading to difficulty in accurate diagnosis. We report the case of a biopsy demonstrating EMLA-induced histopathologic changes. The biopsy was taken from the back of a 5-month-old infant and submitted to rule out psoriasis...
October 26, 2016: American Journal of Dermatopathology
https://www.readbyqxmd.com/read/27828797/intranasal-medication-administration-using-a-squeeze-bottle-atomizer-results-in-overdosing-if-deployed-in-supine-patients
#8
Jordan E Goldhammer, Mark A Dobish, Joshua T McAnulty, Todd J Smaka, Richard H Epstein
BACKGROUND: Vasoconstrictors and local anesthetics are commonly administered using a squeeze bottle atomizer to the nasal mucosa to reduce edema, limit bleeding, and provide analgesia. Despite widespread use, there are few clinical guidelines that address technical details related to safe administration. The purpose of this study was to quantify, via simulation, the amount of liquid delivered to the nasal mucosa when patients are in the supine and upright positions and administration parameters that would reliably provide the desired amount of medication per spray...
November 8, 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27778324/intraneural-injection-of-a-test-dose-of-local-anesthetic-in-peripheral-nerves-does-it-induce-histological-changes-in-nerve-tissue
#9
T Wiesmann, T Steinfeldt, M Exner, W Nimphius, J De Andres, H Wulf, U Schwemmer
BACKGROUND & OBJECTIVES: Most anesthesiologists use the injection of a test dose of local anesthetic in order to evaluate the final needle tip position. Thus, the intraneural injection of a full dose can be avoided. The aim of this study was to analyze whether an intraneural injection of a test dose of bupivacaine could trigger histological changes. METHODS: Intraneural injections under direct vision were performed in 40 brachial plexus nerves in seven anesthetized pigs...
October 25, 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/27746542/a-randomized-controlled-study-between-fentanyl-and-butorphanol-with-low-dose-intrathecal-bupivacaine-to-facilitate-early-postoperative-ambulation-in-urological-procedures
#10
Arvind Kumar, Ritesh Kumar, Vinod Kumar Verma, Chandrakant Prasad, Rajesh Kumar, Shashi Kant, Gunjan Kumar, Neha Singh, Rupam Kumari
INTRODUCTION: Opioids are widely used in conjunction with local anesthetics as they permit the use of lower dose of local anesthetics while providing adequate anesthesia and analgesia. It both provides adequate anesthesia as well as lower drug toxicity neuraxial administration of opioids in conjunction with local anesthetics improves the quality of intraoperative analgesia and prolongs the duration of postoperative analgesia. Bupivacaine is the most commonly used drug for subarachnoid block due to its lesser side effects...
September 2016: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/27738501/lipid-emulsion-inhibits-vasodilation-induced-by-a-toxic-dose-of-bupivacaine-by-suppressing-bupivacaine-induced-pkc-and-cpi-17-dephosphorylation-but-has-no-effect-on-vasodilation-induced-by-a-toxic-dose-of-mepivacaine
#11
Hyunhoo Cho, Seong Ho Ok, Seong Chun Kwon, Soo Hee Lee, Jiseok Baik, Sebin Kang, Jiah Oh, Ju-Tae Sohn
BACKGROUND: The goal of this in vitro study was to investigate the effect of lipid emulsion on vasodilation caused by toxic doses of bupivacaine and mepivacaine during contraction induced by a protein kinase C (PKC) activator, phorbol 12,13-dibutyrate (PDBu), in an isolated endothelium-denuded rat aorta. METHODS: The effects of lipid emulsion on the dose-response curves induced by bupivacaine or mepivacaine in an isolated aorta precontracted with PDBu were assessed...
October 2016: Korean Journal of Pain
https://www.readbyqxmd.com/read/27731571/local-anesthetics-systemic-toxicity
#12
R Jayanthi, Ksga Nasser, K Monica
Lidocaine Hydrochloride is an amide ester, which is widely used local anesthetic agent that is well tolerated but what is less known is the occurrence of systemic toxicity which manifests in the central nervous and cardiovascular systems. We report here 3 cases of Lidocaine associated Seizures.
March 2016: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/27688429/medical-emergencies-in-pediatric-dentistry
#13
REVIEW
Dubravka Negovetić Vranić, Josipa Jurković, Jesenka Jeličić, Antonija Balenović, Gordana Stipančić, Ivana Čuković-Bagić
Medical emergencies that are life threatening can occur in dental practice. Complications may arise because of an underlying disease or a reaction to medication. Reactions to medications may be allergic and toxic. The most common reactions are toxic reactions to local anesthetics, whereas allergies occur mainly as a consequence of the application of antibiotics, usually penicillin. In response to stress, vasovagal syncope typically occurs. Other causes may be related to an underlying disease-specific pathology (such as acute asthma attack, diabetic ketoacidosis, hypoglycemia, or seizures) or accidents (aspiration of a foreign body causing obstruction of the respiratory system)...
March 2016: Acta Stomatologica Croatica
https://www.readbyqxmd.com/read/27608281/evidence-based-recommendations-on-the-use-of-intravenous-lipid-emulsion-therapy-in-poisoning
#14
Sophie Gosselin, Lotte C G Hoegberg, Robert S Hoffman, Andis Graudins, Christine M Stork, Simon H L Thomas, Samuel J Stellpflug, Bryan D Hayes, Michael Levine, Martin Morris, Andrea Nesbitt-Miller, Alexis F Turgeon, Benoit Bailey, Diane P Calello, Ryan Chuang, Theodore C Bania, Bruno Mégarbane, Ashish Bhalla, Valéry Lavergne
BACKGROUND: Although intravenous lipid emulsion (ILE) was first used to treat life-threatening local anesthetic (LA) toxicity, its use has expanded to include both non-local anesthetic (non-LA) poisoning and less severe manifestations of toxicity. A collaborative workgroup appraised the literature and provides evidence-based recommendations for the use of ILE in poisoning. METHODS: Following a systematic review of the literature, data were summarized in four publications: LA and non-LA poisoning efficacy, adverse effects, and analytical interferences...
September 8, 2016: Clinical Toxicology
https://www.readbyqxmd.com/read/27559966/minimum-effective-local-anesthetic-volume-for-surgical-anesthesia-by-subparaneural-ultrasound-guided-popliteal-sciatic-nerve-block-a-prospective-dose-finding-study
#15
Seung Uk Bang, Dong Ju Kim, Jin Ho Bae, Kyudon Chung, Yeesuk Kim
Because of its rapid onset time, recent years have seen an increase in the use of ultrasound (US)-guided popliteal sciatic nerve block (PSNB) via subparaneural injection for induction of surgical anesthesia. Moreover, in below-knee surgery, combined blocks, as opposed to sciatic nerve block alone, have become more common. These combined blocks often require a large volume of local anesthetic (LA), thus increasing the risk of local-anesthetic systemic toxicity (LAST). Thus, to decrease the risk of LAST, it is important to know the minimum effective volume (MEV) required for an adequate block...
August 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27518726/retrolaminar-block-analgesic-efficacy-and-safety-evaluation
#16
Takeshi Murouchi, Michiaki Yamakage
PURPOSE: Retrolaminar block (RLB) is a thoracic truncal block that can produce analgesia for the thoracic and abdominal wall. However, the characteristics of RLB are not well known. The aim of this study was to determine analgesic efficacy by measuring postoperative consume of patient-controlled analgesia (PCA), additional nonsteroidal antiinflammatory drug (NSAID) rescue, and opioid rescue. Our secondary analysis included assessment of the chronological change in arterial levobupivacaine concentrations after the block...
August 12, 2016: Journal of Anesthesia
https://www.readbyqxmd.com/read/27489108/the-receptor-site-and-mechanism-of-action-of-sodium-channel-blocker-insecticides
#17
Yongqiang Zhang, Yuzhe Du, Dingxin Jiang, Caitlyn Behnke, Yoshiko Nomura, Boris S Zhorov, Ke Dong
Sodium channels are excellent targets of both natural and synthetic insecticides with high insect selectivity. Indoxacarb, its active metabolite DCJW, and metaflumizone (MFZ) belong to a relatively new class of sodium channel blocker insecticides (SCBIs) with a mode of action distinct from all other sodium channel-targeting insecticides, including pyrethroids. Electroneutral SCBIs preferably bind to and trap sodium channels in the inactivated state, a mechanism similar to that of cationic local anesthetics...
September 16, 2016: Journal of Biological Chemistry
https://www.readbyqxmd.com/read/27485090/availability-and-readability-of-online-patient-education-materials-regarding-regional-anesthesia-techniques-for-perioperative-pain-management
#18
Gunjan Kumar, Steven K Howard, Alex Kou, T Edward Kim, Alexander J Butwick, Edward R Mariano
OBJECTIVE : Patient education materials (PEM) should be written at a sixth-grade reading level or lower. We evaluated the availability and readability of online PEM related to regional anesthesia and compared the readability and content of online PEM produced by fellowship and nonfellowship institutions. METHODS : With IRB exemption, we constructed a cohort of online regional anesthesia PEM by searching Websites from North American academic medical centers supporting a regional anesthesiology and acute pain medicine fellowships and used a standardized Internet search engine protocol to identify additional nonfellowship Websites with regional anesthesia PEM based on relevant keywords...
August 2, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/27477225/the-in-vitro-and-in-vivo-effects-of-a-fast-dissolving-mucoadhesive-bi-layered-strip-as-topical-anesthetics
#19
Jiyeon Roh, Mira Han, Kyoung-Nam Kim, Kwang-Mahn Kim
To overcome pain on injection, the dentist can apply a topical anesthetic spray. Despite the convenience, it is not easy to apply it locally. So, we developed an oral mucoadhesive bi-layer film containing an anesthetic. We used polyvinylpyrrolidone (PVP)/hydroxypropyl methylcellulose (HPMC) and HPMC-only layer as the drug-containing layer and ethyl cellulose (EC) as the backing layer. The lidocaine released was tested in vitro together with the adhesion time and cytotoxicity of the film. Mucosa permeability was tested in vivo...
2016: Dental Materials Journal
https://www.readbyqxmd.com/read/27442683/ultrasound-guided-bilateral-combined-inguinal-femoral-and-subgluteal-sciatic-nerve-blocks-for-simultaneous-bilateral-below-knee-amputations-due-to-bilateral-diabetic-foot-gangrene-unresponsive-to-peripheral-arterial-angioplasty-and-bypass-surgery-in-a-coagulopathic
#20
Sung Hye Byun, Jonghoon Lee, Jong Hae Kim
BACKGROUND: Patients on antiplatelet therapy following percutaneous coronary intervention can become coagulopathic due to infection. Performing regional anesthesia for bilateral surgery in such cases is challenging. We report a case of successful combined inguinal femoral and subgluteal sciatic nerve blocks (CFSNBs) for simultaneous bilateral below-knee amputations in a coagulopathic patient on antiplatelet therapy. METHODS: A 70-year-old male patient presented with pain in both feet due to diabetic foot syndrome...
July 2016: Medicine (Baltimore)
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