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Local anesthetic systemic toxicity

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https://www.readbyqxmd.com/read/29303925/local-anesthetic-systemic-toxicity-a-review-of-recent-case-reports-and-registries
#1
Marina Gitman, Michael J Barrington
This review summarizes presenting features, management, and outcomes of local anesthetic systemic toxicity (LAST) from published cases and those submitted to online registries capturing use of intravenous lipid emulsion (ILE) therapy. The results of single-center and multicenter registries and epidemiologic studies complement this information. Between March 2014 and November 2016, 47 separate cases of LAST were described in 35 peer-reviewed articles. Local anesthetic systemic toxicity events occurred as a result of penile blocks (23%), local infiltration (17%), and upper/lower extremity, torso, and neuraxial blockade...
January 5, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29295799/profound-prolonged-bradycardia-and-hypotension-after-interscalene-brachial-plexus-block-with-bupivacaine
#2
Mathew Nelson, Alexandra Reens, Lara Reda, David Lee
BACKGROUND: Interscalene brachial plexus blocks have been a routinely performed method of anesthesia for shoulder surgery that decreases the need for general anesthesia, length of stay, and recovery time. We describe a case of bupivacaine toxicity after an interscalene block. CASE REPORT: The patient was a 66-year-old man who presented to our Emergency Department by emergency medical services from an ambulatory surgery center where he had undergone rotator cuff surgery, with bradycardia and hypotension...
December 30, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29284860/effect-of-locally-administered-dexmedetomidine-as-adjuvant-to-levobupivacaine-in-supraclavicular-brachial-plexus-block-double-blind-controlled-study
#3
Bikash Bisui, Swastika Samanta, Sumanta Ghoshmaulik, Amit Banerjee, Tirtha R Ghosh, Suman Sarkar
Context: Brachial plexus block is effective with good postoperative analgesia in upper limb surgery has gained importance as it safe, low cost, and maintains stable hemodynamics intraoperatively. To decrease the onset time and prolong the duration of nerve block bicarbonate, opioids (morphine, fentanyl, etc.), sympathomimetic agents (epinephrine, phenylephrine, etc.), α-2 agonists (clonidine and dexmedetomidine), calcium channel blocker (verapamil), magnesium sulfate, etc., were studied with local anesthetics and their isomers...
October 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29280923/local-anesthetic-systemic-toxicity-in-total-joint-arthroplasty-incidence-and-risk-factors-in-the-united-states-from-the-national-inpatient-sample-1998-2013
#4
Daniel S Rubin, Monica M Matsumoto, Guy Weinberg, Steven Roth
BACKGROUND: Local anesthetic systemic toxicity (LAST) is a rare and potentially devastating complication of regional anesthesia. Single-institution registries have reported a decreasing incidence, but these results have limited broad applicability. A recent study using a US database found a relatively high incidence of LAST. We used the National Inpatient Sample, a US database of inpatient admissions, to identify the national incidence and associated risk factors for LAST in total joint arthroplasties...
December 26, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29239940/prolonged-duration-local-anesthesia-using-liposomal-bupivacaine-combined-with-liposomal-dexamethasone-and-dexmedetomidine
#5
Alina Y Rwei, Robert T Sherburne, David Zurakowski, Bruce Wang, Daniel S Kohane
BACKGROUND: The relatively short duration of effect of local anesthetics has been addressed by encapsulation in drug delivery systems. Codelivery with a single compound that produces an adjuvant effect on nerve block but without intrinsic local anesthetic properties can further prolong the nerve block effect. Here, we investigated whether codelivery of more than 1 encapsulated adjuvant compound can further enhance nerve blockade. METHODS: Liposomes loaded with bupivacaine (Bup), dexamethasone phosphate (DexP), or dexmedetomidine (DMED) were synthesized and its in vitro drug release profiles were determined...
December 11, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29200065/cardiac-arrest-in-the-operating-room-part-2-special-situations-in-the-perioperative-period
#6
Matthew D McEvoy, Karl-Christian Thies, Sharon Einav, Kurt Ruetzler, Vivek K Moitra, Mark E Nunnally, Arna Banerjee, Guy Weinberg, Andrea Gabrielli, Gerald A Maccioli, Gregory Dobson, Michael F O'Connor
As noted in part 1 of this series, periprocedural cardiac arrest (PPCA) can differ greatly in etiology and treatment from what is described by the American Heart Association advanced cardiac life support algorithms, which were largely developed for use in out-of-hospital cardiac arrest and in-hospital cardiac arrest outside of the perioperative space. Specifically, there are several life-threatening causes of PPCA of which the management should be within the skill set of all anesthesiologists. However, previous research has demonstrated that continued review and training in the management of these scenarios is greatly needed and is also associated with improved delivery of care and outcomes during PPCA...
November 30, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29169795/paravertebral-block-for-thoracic-surgery
#7
REVIEW
Francine D'Ercole, Harendra Arora, Priya A Kumar
Local anesthetic injected into a wedge-shaped space lateral to the spinal nerves as they emerge from the intervertebral foramina produces somatosensory and sympathetic nerve blockade effective for anesthesia and for managing pain of unilateral origin from the chest and abdomen. Paravertebral blockade (PVB) is versatile and may be applied unilaterally or bilaterally. Unlike thoracic epidural, the PVB technique may be used to avoid contralateral sympathectomy, thereby minimizing hypotension and leading to better preservation of blood pressure...
October 4, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29107256/local-anesthetic-systemic-toxicity
#8
Diana L Wadlund
Local anesthetics are commonly used in the perioperative environment to facilitate surgical procedures or to provide postoperative pain management for patients. The use of local anesthetics, however, introduces the risk of complications resulting from local anesthetic systemic toxicity and the risks of increased morbidity and mortality for the surgical patient. Systemic toxicity from the injection or overdose of local anesthetics is a rare but potentially fatal complication that occurs in less than 1 in 1,000 patients...
November 2017: AORN Journal
https://www.readbyqxmd.com/read/29042063/-pharmacokinetic-and-clinical-effects-of-two-bupivacaine-concentrations-on-axillary-brachial-plexus-block
#9
Leonardo H C Ferraro, Alexandre Takeda, Cleber N Barreto, Bernadete Faria, Nilson A Assunção
INTRODUCTION: The risk of systemic bupivacaine toxicity is a persistent problem, which makes its pharmacokinetic study fundamental for regional anesthesia safety. There is little evidence of its influence on plasma peak at different concentrations. The present study compares two bupivacaine concentrations to establish how the concentration affects this drug plasma peak in axillary brachial plexus block. Postoperative latency and analgesia were also compared. METHODS: 30 patients were randomized...
October 14, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28982145/encapsulation-of-ropivacaine-in-a-combined-donor-acceptor-ionic-gradient-liposomal-system-promotes-extended-anesthesia-time
#10
Camila Morais Gonçalves da Silva, Michelle Franz-Montan, Cíntia Elisabeth Gomez Limia, Lígia Nunes de Morais Ribeiro, Mário Antônio Braga, Viviane Aparecida Guilherme, Camila Batista da Silva, Bruna Renata Casadei, Cíntia Maria Saia Cereda, Eneida de Paula
Ropivacaine is a local anesthetic with similar potency but lower systemic toxicity than bupivacaine, the most commonly used spinal anesthetic. The present study concerns the development of a combined drug delivery system for ropivacaine, comprised of two types of liposomes: donor multivesicular vesicles containing 250 mM (NH4)2SO4 plus the anesthetic, and acceptor large unilamellar vesicles with internal pH of 5.5. Both kinds of liposomes were composed of hydrogenated soy-phosphatidylcholine:cholesterol (2:1 mol%) and were prepared at pH 7...
2017: PloS One
https://www.readbyqxmd.com/read/28953509/procaine-and-local-anesthetic-toxicity-a-collaboration-between-the-clinical-and-basic-sciences
#11
James Seth Jacob, Anthony L Kovac
In 1924, the Therapeutic Research Committee of the American Medical Association appointed a special committee to investigate deaths following the administration of local anesthetics. The Committee for the Study of Toxic Effects of Local Anesthetics found procaine, although a safer clinical alternative to cocaine, was capable of causing death when large doses were injected into tissues and advised that it should be used with caution. This article describes a collaboration beginning in 1928 between Dr John Lundy of the Mayo Clinic and Dr Robert Isenberger of the University of Kansas, which arose from a controversy surrounding systemic adverse reactions to procaine...
November 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28919152/erector-spinae-plane-esp-block-in-the-management-of-post-thoracotomy-pain-syndrome-a-case-series
#12
Mauricio Forero, Manikandan Rajarathinam, Sanjib Adhikary, Ki Jinn Chin
BACKGROUND AND AIMS: Post thoracotomy pain syndrome (PTPS) remains a common complication of thoracic surgery with significant impact on patients' quality of life. Management usually involves a multidisciplinary approach that includes oral and topical analgesics, performing appropriate interventional techniques, and coordinating additional care such as physiotherapy, psychotherapy and rehabilitation. A variety of interventional procedures have been described to treat PTPS that is inadequately managed with systemic or topical analgesics...
October 2017: Scandinavian Journal of Pain
https://www.readbyqxmd.com/read/28917061/use-of-lipid-emulsion-therapy-in-local-anesthetic-overdose
#13
Ozgur Karcioglu
The use of intravenous lipid emulsion (ILE) therapy as antidote in systemic toxicity of certain agents has gained widespread support. There are increasing data suggesting use of ILE in reversing from local anesthetic-induced systemic toxicity severe, life-threatening cardiotoxicity, although findings are contradictory. Efficiency of ILE was demonstrated in animal studies in the treatment of severe impairment of cardiac functions, via a mechanism for trapping lipophilic drugs in an expanded plasma lipid compartment ("lipid sink")...
October 2017: Saudi Medical Journal
https://www.readbyqxmd.com/read/28881313/lc-ms-ms-method-for-preclinical-pharmacokinetic-study-of-qx-oh-a-novel-long-acting-local-anesthetic-in-sciatic-nerve-blockade-in-rats
#14
YuJun Zhang, DeYing Gong, QingShan Zheng, Jin Liu, WenSheng Zhang
QX-OH, a new synthetic local anesthetic, produced concentration-dependent, reversible, and long-acting local anesthesia in animal models, with moderate local toxicity. As part of preclinical research for drug development, we developed and validated a method for the determination of QX-OH in the plasma, muscle, and sciatic nerve using liquid chromatography-mass spectrometry. After a simple protein precipitation procedure, analysis was performed on an Extend C18 column (100mm×3mm, 3.5μm) by isocratic elution with 0...
November 30, 2017: Journal of Pharmaceutical and Biomedical Analysis
https://www.readbyqxmd.com/read/28844768/systemic-safety-of-liposomal-bupivacaine-in-simultaneous-bilateral-total-knee-arthroplasty
#15
Bryan D Springer, J Bohannon Mason, Susan M Odum
BACKGROUND: Intraoperative periarticular injections (PAIs) with local anesthetic are an important component of multimodal pain control in total joint arthroplasty. Liposomal bupivacaine is an extended-release formulation of bupivacaine designed to provide extended pain relief, approved for use in a single surgical site. The systemic safety profile for use in simultaneous bilateral TKA (bTKA) with a full dose in each knee has not been evaluated. The purpose of this study was to determine the safety and pharmacokinetics of bilateral full-dose PAI liposomal bupivacaine in the blood collected in patients undergoing simultaneous bTKA...
August 1, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28745230/bupivacaine-s75-r25-loaded-in-nanostructured-lipid-carriers-factorial-design-hplc-quantification-method-and-physicochemical-stability-study
#16
Gustavo Henrique Rodrigues Da Silva, Ligia Nunes de Moraes Ribeiro, Viviane Guilherme, Simone Ramos de Castro, Márcia Cristina Breitkreitz, Eneida de Paula
Bupivacaine is the most used local anesthetic in surgical procedures, producing prolonged anesthesia. The major limiting factor for the clinical use of bupivacaine comes from its systemic toxicity. Nanostructured lipid carriers (NLC) are vehicles for sustained drug delivery that are able to minimize the toxicity and to increase the action time of lipophilic drugs. This work reports a 22 factorial design, which elucidate the role of the lipids mixture in the NLC, towards an optimized formulation. It also provides a new method for Bupivacaine S75:R25 (BVCS75) quantification in NLC...
July 26, 2017: Current Drug Delivery
https://www.readbyqxmd.com/read/28692439/lipid-emulsion-in-local-anesthetic-toxicity
#17
Martyn Harvey, Grant Cave
PURPOSE OF REVIEW: Enthusiasm for regional anesthesia has been driven by multimodal benefits to patient outcomes. Despite widespread awareness and improved techniques (including the increasing use of ultrasound guidance for block placement), intravascular sequestration and the attendant risk of local anesthetic systemic toxicity (LAST) remains. Intravenous lipid emulsion (ILE) for the treatment of LAST has been endorsed by anesthetic regulatory societies on the basis of animal study and human case report data...
October 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28652958/lidocaine-induced-systemic-toxicity-a-case-report-and-review-of-literature
#18
Badar Hasan, Talal Asif, Maryam Hasan
For the past 50 years, local anesthetics such as lidocaine have been commonly used in various clinical settings. Its use is not just limited to anesthesia and surgery but is also frequently utilized in internal medicine and in primary care setting for bedside procedures. Despite its widespread use, most physicians are not familiar with the life-threatening manifestations of lidocaine toxicity and its treatment. Our case demonstrates a successful resuscitation after cardiac arrest in a healthy 33-year-old female with systemic lidocaine toxicity after she received lidocaine as a local anesthetic...
May 25, 2017: Curēus
https://www.readbyqxmd.com/read/28611004/an-in-situ-forming-phospholipid-based-phase-transition-gel-prolongs-the-duration-of-local-anesthesia-for-ropivacaine-with-minimal-toxicity
#19
Hanmei Li, Tao Liu, Yuxuan Zhu, Qiang Fu, Wanxia Wu, Jie Deng, Li Lan, Sanjun Shi
An injectable, phospholipid-based phase transition gel (PPTG) has been developed for prolonging the release of ropivacaine (RO) for local anesthesia. PPTG was prepared by mixing phospholipids, medium-chain triglyceride and ethanol. Prior to injection, the PPTG is in a sol state with low viscosity. After subcutaneous injection, the PPTG rapidly forms a gel in situ, which acts as a drug release depot as verified by in vitro release profiles and in vivo pharmacokinetics. Administering RO-PPTG to rats led to a significantly smaller initial burst release than administering RO solution or RO base suspension...
June 10, 2017: Acta Biomaterialia
https://www.readbyqxmd.com/read/28550928/effectiveness-of-continuous-wound-infusion-of-local-anesthetics-after-abdominal-surgeries
#20
RANDOMIZED CONTROLLED TRIAL
Baskaran Dhanapal, Sarath Chandra Sistla, Ashok Shankar Badhe, Sheikh Manwar Ali, Niranjan T Ravichandran, Indira Galidevara
BACKGROUND: To assess the effectiveness of continuous preperitoneal wound infusion of local anesthetic drug bupivacaine in providing pain relief, reducing opioid consumption, and enhancing postoperative recovery. METHODS: Eligible patients were randomly allocated to two groups (study group: bupivacaine and control group: normal saline). There were 47 patients in each group. The patients received continuous infusion of either 0.25% bupivacaine or 0.9% normal saline at 6 mL/h, for 48 h, based on their group allocation, through a multiholed wound infiltration catheter placed preperitoneally...
May 15, 2017: Journal of Surgical Research
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