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Local anesthetics toxicity

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https://www.readbyqxmd.com/read/28514346/-systemic-toxicity-of-local-anesthetics
#1
S A Rabinovich, L A Zavodilenko
The paper presents characteristics of local anesthetics used in dentistry and maxillofacial surgery taking into account their effectiveness and toxicity. We described the main clinical symptoms of manifestation of systemic toxicity and measures for prevention of local anesthesia complications, as well as the detailed protocol of 'lipid rescue' and resuscitation at manifestation of systemic toxic reaction of local anesthetics with the mechanism of the fatty emulsion action.
2017: Stomatologii︠a︡
https://www.readbyqxmd.com/read/28489457/adverse-events-associated-with-a-large-dose-of-intravenous-lipid-emulsion-for-suspected-local-anesthetic-toxicity
#2
Daniel J Corwin, Alexis Topjian, Brenda L Banwell, Kevin Osterhoudt
BACKGROUND: Intravenous lipid emulsion (ILE) has gained favor as a rescue treatment for cardiovascular collapse due to intravenous local anesthetic overdose, however, goals of ILE therapy are still being defined. We describe a case of a girl given 66 mL/kg of 20% lipid emulsion (ILE) in the treatment of presumed mepivacaine toxicity. CASE REPORT: An 11-year-old girl weighing 55.6 kg developed pallor, rolling back of the eyes, and rhythmic muscle twitching after receiving a mandibular nerve block injection with a 1...
July 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28467236/letter-in-response-to-lipid-emulsion-improves-survival-in-animal-models-of-local-anesthetic-toxicity-a-meta-analysis
#3
Lotte C G Hoegberg, Robert S Hoffman, Bryan D Hayes, Valéry Lavergne, Sophie Gosselin
No abstract text is available yet for this article.
May 3, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28431423/blood-bupivacaine-concentrations-after-a-combined-single-shot-sciatic-block-and-a-continuous-femoral-nerve-block-in-pediatric-patients-a-prospective-observational-study
#4
Santhanam Suresh, Gildasio S De Oliveira
We evaluated blood bupivacaine concentrations in children having a single-shot sciatic and continuous femoral blocks after anterior cruciate ligament repair. Dried blood spot samples were analyzed for bupivacaine levels at 0, 5, 15, 30, 60, and 120 minutes and 4, 24, and 48 hours. The highest 99% upper confidence interval limit was 135 ng/mL at the 4-hour evaluation point. The 99% upper confidence interval was below potentially toxic levels (1500 ng/mL) across all sampling times. The risk of local anesthetic toxicity in pediatric patients receiving single-shot sciatic and continuous femoral nerve blocks is very low...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28374060/possible-utility-of-contrast-enhanced-ultrasonography-for-detecting-spread-of-local-anesthetic-in-nerve-block
#5
Hideaki Sasaki, Masanori Yamauchi, Takafumi Ninomiya, Haruyuki Tatsumi, Michiaki Yamakage
PURPOSE: This study demonstrated the effects of perfluorobutane (Sonazoid(®)) with contrast-enhanced ultrasonography (CEUS) to identify the spread of local anesthetics in ultrasound-guided nerve block. METHODS: This study consists of simulation, cadaveric, and animal studies. In a simulation study, 1% lidocaine with 10- to 1000-fold diluted Sonazoid(®), a US-specific contrast agent to diagnose hepatic and breast cancers (0.5 mL), was injected into a resin-based phantom to determine the optimal concentration for ultrasound-guided peripheral nerve block...
April 3, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28356688/comparing-hemodynamic-and-glycemic-response-to-local-anesthesia-with-epinephrine-and-without-epinephrine-in-patients-undergoing-tooth-extractions
#6
Paramjot Kaur, Rashi Bahl, Sameer Kaura, Sumit Bansal
INTRODUCTION: Lignocaine with epinephrine as local anesthetic (LA) provides hemostasis and decreases the risk of systemic toxicity. The purpose of the present study was to investigate and compare the response of lignocaine with and without epinephrine to evaluate hemodynamic and metabolic response in normotensive and type II controlled diabetic patients. MATERIAL AND METHODS: A total of 50 patients (25 healthy and 25 controlled type II diabetics) undergoing multiple tooth extractions (age group of 20-80 years) were included in this prospective, randomised, clinical study...
July 2016: National Journal of Maxillofacial Surgery
https://www.readbyqxmd.com/read/28346007/lipid-emulsion-improves-survival-in-animal-models-of-local-anesthetic-toxicity-a-meta-analysis
#7
Michael R Fettiplace, Daniel J McCabe
INTRODUCTION: The Lipid Emulsion Therapy workgroup, organized by the American Academy of Clinical Toxicology, recently conducted a systematic review, which subjectively evaluated lipid emulsion as a treatment for local anesthetic toxicity. We re-extracted data and conducted a meta-analysis of survival in animal models. METHODS: We extracted survival data from 26 publications and conducted a random-effect meta-analysis based on odds ratio weighted by inverse variance...
February 17, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28321983/chloroprocaine-for-epidural-anesthesia-in-infants-and-children
#8
REVIEW
Giorgio Veneziano, Joseph D Tobias
Continuous epidural infusions are an effective and safe method of providing anesthesia and postoperative analgesia in infants and children with multiple advantages over systemic medications, including earlier tracheal extubation, decreased perioperative stress response, earlier return of bowel function, and decreased exposure to volatile anesthetic agents with uncertain long-term neurocognitive effects. Despite these benefits, local anesthetic toxicity remains a concern in neonates and infants because of their decreased metabolic capacity for amide local anesthetics...
June 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28298772/effect-of-dexmedetomidine-as-an-adjuvant-to-0-75-ropivacaine-in-interscalene-brachial-plexus-block-using-nerve-stimulator-a-prospective-randomized-double-blind-study
#9
H D Rashmi, H K Komala
BACKGROUND: Ropivacaine, a newer local anesthetic (LA), has been increasingly used nowadays in different concentrations for peripheral nerve blocks. It has lesser cardiac toxicity and higher safety margin when compared to bupivacaine. Dexmedetomidine, a novel α2 agonist, is widely used as adjuvant to LA in peripheral nerve blocks to decrease the time of onset and increase the duration of the block. In this study, we evaluated the effect of dexmedetomidine as an adjuvant with 0.75% ropivacaine for interscalene brachial plexus block using nerve stimulator...
January 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28291185/efficacy-of-surgical-site-multimodal-drug-injection-following-operative-management-of-femoral-fractures-a-randomized-controlled-trial
#10
RANDOMIZED CONTROLLED TRIAL
Daniel Koehler, J Lawrence Marsh, Matthew Karam, Catherine Fruehling, Michael Willey
BACKGROUND: Multimodal analgesia inclusive of periarticular injection with a local anesthetic agent has been rapidly assimilated, with demonstrated safety and efficacy, into the care of patients undergoing elective lower-extremity arthroplasty. The present study was performed to evaluate the efficacy and safety of a surgical-site, multimodal drug injection for postoperative pain control following operative management of femoral fractures. METHODS: There were 102 patients undergoing operative intervention (plate fixation, intramedullary device, or arthroplasty) for a broad range of femoral fracture patterns who were prospectively randomized either to receive an intraoperative, surgical-site injection into the superficial and deep tissues containing ropivacaine, epinephrine, and morphine or to receive no injection...
March 15, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28289821/single-dose-local-anesthetics-exhibit-a-type-dose-and-time-dependent-chondrotoxic-effect-on-chondrocytes-and-cartilage-a-systematic-review-of-the-current-literature
#11
REVIEW
Peter Cornelius Kreuz, Matthias Steinwachs, Peter Angele
PURPOSE: Many studies have shown that local anesthetics may impede chondrocyte metabolism. However, the influence of a single-dose local anesthetics is controversial. The aim of this metaanalysis was to review the literature for studies investigating the cytotoxic effects of single-dose local anesthetics on chondrocytes and cartilage. METHODS: A comprehensive literature search was performed using established search engines (Medline, Embase) to identify studies, investigating the influence of single-dose local anesthetics on cartilage...
March 13, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/28267672/local-anesthetic-effects-of-bupivacaine-loaded-lipid-polymer-hybrid-nanoparticles-in-vitro-and-in-vivo-evaluation
#12
Pengju Ma, Ting Li, Huaixin Xing, Suzhen Wang, Yingui Sun, Xiugui Sheng, Kaiguo Wang
PURPOSE: There is a compelling need for prolonged local anesthetic that would be used for analgesia with a single administration. However, due to the low molecular weight of local anesthetics (LA) (lidocaine, bupivacaine, procaine, dibucaine, etc), they present fast systemic absorption. METHODS: The aim of the present study was to develop and evaluate bupivacaine lipid-polymer hybrid nanoparticles (BVC LPNs), and compared with BVC loaded PLGA nanoparticles (BVC NPs)...
May 2017: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/28217061/sequestrated-caudal-catheter-in-a-child-an-anesthetic-nightmare-and-surgical-dilemma
#13
Chong Soon Eu, Shyamala V Kumar, Saedah Ali, Shamsul Kamalrujan Hassan
The usage of epidural infusion for intraoperative and postoperative pain relief is widely used in certain pediatric anesthetic practice because of the effectiveness and advantages. However, there is drawback for these techniques due to its potential complications such as inadvertent intrathecal placement, local anesthetic toxicity, catheter migration, infection, and breakage of epidural catheter. Though occur infrequently, epidural catheters have been known to snap during insertion or removal. The retained catheter tip may lead to multiple complications, including nerve injury, infection, and even catheter migration...
January 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/28214316/pre-and-perioperative-aspects-of-dermatosurgery
#14
Cornelia S L Müller, Wakiko Hubner, Sigrid Thieme-Ruffing, Claudia Pföhler, Thomas Vogt, Thomas Volk, Barbara C Gärtner, Patric Bialas
Dermatosurgery occupies an exceptional position among all surgical disciplines. Above all, this includes the fact that, with very few exceptions, the vast majority of surgical interventions can be performed under local or regional anesthesia, usually in smaller procedure rooms that are spatially separated from larger operating suites. Thus, peri- and postinterventional patient monitoring is the responsibility of the dermatosurgeon and his team. Though inherently smaller, this team still has to observe numerous perioperative requirements that - in larger surgical specialties - would be attended to by a host of various specialists working in concert...
February 2017: Journal der Deutschen Dermatologischen Gesellschaft, Journal of the German Society of Dermatology: JDDG
https://www.readbyqxmd.com/read/28208809/a-lipid-emulsion-reverses-toxic-dose-bupivacaine-induced-vasodilation-during-tyrosine-phosphorylation-evoked-contraction-in-isolated-rat-aortae
#15
Seong-Ho Ok, Soo Hee Lee, Seong-Chun Kwon, Mun Hwan Choi, Il-Woo Shin, Sebin Kang, Miyeong Park, Jeong-Min Hong, Ju-Tae Sohn
The goal of this in vitro study was to examine the effect of a lipid emulsion on toxic-dose bupivacaine-induced vasodilation in a model of tyrosine phosphatase inhibitor sodium orthovanadate-induced contraction in endothelium-denuded rat aortae and to elucidate the associated cellular mechanism. The effect of a lipid emulsion on vasodilation induced by a toxic dose of a local anesthetic during sodium orthovanadate-induced contraction was examined. In addition, the effects of various inhibitors, either bupivacaine alone or a lipid emulsion plus bupivacaine, on protein kinase phosphorylation induced by sodium orthovanadate in rat aortic vascular smooth muscle cells was examined...
February 13, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28183570/unusual-presentation-of-local-anesthetic-toxicity
#16
Nitin Hayaran, Rashi Sardana, Hamse Nandinie, Aruna Jain
The local anesthetic systemic toxicity can be due to increased blood lignocaine levels or due to increased sensitivity to lignocaine. Several cases of lignocaine-induced central nervous system toxicity have been noted, but none have reported only loss of consciousness without any seizure-like activity. Intravenous lipid emulsion administration for the treatment of local anesthetic systemic toxicity is an emerging topic of discussion, and there are case reports where they had successfully been used. However, majority of them were used in the treatment of cardiovascular manifestations of local anesthetic toxicity...
February 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28099175/two-for-one-a-case-report-of-intravenous-lipid-emulsion-to-treat-local-anesthetic-systemic-toxicity-in-term-pregnancy
#17
Jonathan Dun-Chi Lin, Eellan Sivanesan, Terese T Horlocker, Andres Missair
Combined spinal-epidural (CSE) analgesia is a frequently used method of labor analgesia. Although it is considered safe and effective, CSE can be complicated by local anesthetic systemic toxicity (LAST), a potentially life-threatening condition. We present a case of LAST that developed in a primigravida 50 minutes after uneventful placement of a CSE. Her symptoms resolved within 10 minutes of administering intralipid emulsion. She subsequently underwent cesarean delivery under spinal anesthesia for failure to progress without sequelae in the mother or infant...
January 17, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28089496/cell-toxicity-in-fibroblasts-tenocytes-and-human-mesenchymal-stem-cells-a-comparison-of-necrosis-and-apoptosis-inducing-ability-in-ropivacaine-bupivacaine-and-triamcinolone
#18
Anja Z Zhang, Andreas Ficklscherer, Mehmet F Gülecyüz, Alexander C Paulus, Thomas R Niethammer, Volkmar Jansson, Peter E Müller
PURPOSE: To analyze the ability of ropivacaine, bupivacaine, and triamcinolone to induce apoptosis and necrosis in fibroblasts, tenocytes, and human mesenchymal stem cells. METHODS: Human dermal fibroblasts, adipose-derived human mesenchymal stem cells (hMSCs), and tenocytes gained from the rotator cuff tendon were seeded with a cell density of 0.5 × 10(4)/cm(2). One specimen of ropivacaine, bupivacaine, and triamcinolone was tested separately on the cells with separate concentrations of 0...
January 12, 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/28079735/incidence-of-local-anesthetic-systemic-toxicity-in-orthopedic-patients-receiving-peripheral-nerve-blocks
#19
Eva E Mörwald, Nicole Zubizarreta, Crispiana Cozowicz, Jashvant Poeran, Stavros G Memtsoudis
BACKGROUND AND OBJECTIVES: Peripheral nerve blocks are increasingly used. However, despite low complication rates, concerns regarding local anesthetic systemic toxicity remain. Although recent studies suggest that this severe complication has decreased considerably, there is a paucity of data about it on a national level. We sought to elucidate the incidence of local anesthetic systemic toxicity on a national level and therefore provide guidance toward the need for preparedness in daily anesthetic practice...
January 9, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28079261/effect-of-parthanatos-on-ropivacaine-induced-damage-in-sh-sy5y-cells
#20
Ting Zheng, Chun-Ying Zheng, Xiao-Chun Zheng, Ruo-Guang Zhao, Yan-Qing Chen
Ropivacaine is one of the most common but toxic local anesthetics, and the mechanisms underlying its neurotoxicity are still largely unknown. This study was conducted to prepare a ropivacaine-induced neuronal injury model and research the effects of ropivacaine on PARP-1 activation and NAD(+) depletion. The cell death and apoptosis of ropivacaine-induced SH-SY5Y cells were detected with flow cytometry. The lactate dehydrogenase cycling reaction measured the NAD(+) level, and Western blots were used to analyze the expression levels of PARP-1 and AIF after ropivacaine treatments with different concentrations and durations...
January 12, 2017: Clinical and Experimental Pharmacology & Physiology
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