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Local anesthetic systemic toxicity

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
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
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)
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
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
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)
Pauline Dureau, Beny Charbit, Nathalie Nicolas, Dan Benhamou, Jean-Xavier Mazoit
BACKGROUND: Rapid intravenous administration of lipid emulsion has become the standard treatment of severe local anesthetic systemic toxicity. This experiment in volunteers aimed at determining the effect of Intralipid® administration on the time to neurologic symptoms. METHODS: Ropivacaine or levobupivacaine was infused intravenously in 16 volunteers (8 mg/min up to 120 mg) with 120 ml Intralipid® 20% (Fresenius, Paris France) or placebo infused at T + 2 min)...
September 2016: Anesthesiology
Sam H Muller, James H Diaz, Alan David Kaye
Intralipid emulsion therapy is well-established for the treatment of local-anesthetic systemic toxicities. In recent years, its role has expanded as an important therapeutic agent in the reversal of other types of drug overdoses, including certain types of antipsychotics, antidepressants, antiarrhythmics, and calcium channel blockers. A literature review identified thirty-one case reports including forty-nine separate drug overdose cases involving ten separate drug classes which were successfully reversed with Intralipid...
May 2016: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
Siavash Beiranvand, Ali Eatemadi, Arash Karimi
Lipid nanoparticles (liposomes) were first described in 1965, and several work have led to development of important technical advances like triggered release liposomes and drug-loaded liposomes. These advances have led to numerous clinical trials in such diverse areas such as the delivery of anti-cancer, antifungal, and antibiotic drugs; the delivery of gene medicines; and most importantly the delivery of anesthesia drugs. Quite a number of liposomes are on the market, and many more are still in developmental stage...
December 2016: Nanoscale Research Letters
Michael J Barrington, Yoshiaki Uda
No abstract text is available yet for this article.
July 2016: Regional Anesthesia and Pain Medicine
Yutaka Oda
No abstract text is available yet for this article.
August 2016: Journal of Anesthesia
Richard N Yu, Constance S Houck, Alfonso Casta, Richard H Blum
Dorsal penile nerve block is a widely used method of analgesia for infants undergoing penile surgery. Because of its potency, extended duration of action, and lack of vasoconstriction, bupivacaine remains the most commonly used local anesthetic. Rapid systemic absorption of bupivacaine, however, has been associated with profound central nervous system and cardiovascular side effects, including cardiac arrest. As determined by retrospective medical record analysis, the incidence of complications associated with dorsal penile blockade in our institution was 0...
August 1, 2016: A & A Case Reports
Luisa Muraro, Laura Longo, Federico Geraldini, Andrea Bortot, Andrea Paoli, Annalisa Boscolo
Caffeine is arguably the most widely used stimulant drug in the world. Here we describe a suicide attempt involving caffeine overdose whereby the patient's severe intoxication was successfully treated with the prompt infusion of Intralipid. A 19-year-old man was found in an agitated state at home by the volunteer emergency team about 1 h after the intentional ingestion of 40 g of caffeine (tablets). His consciousness decreased rapidly, followed quickly by seizures, and electrocardiographic monitoring showed ventricular fibrillation...
October 2016: Journal of Anesthesia
J A Heinonen, A A Schramko, M B Skrifvars, E Litonius, J T Backman, E Mervaala, P H Rosenberg
Local anesthetic toxicity is thought to be mediated partly by inhibition of cardiac mitochondrial function. Intravenous (i.v.) lipid emulsion may overcome this energy depletion, but doses larger than currently recommended may be needed for rescue effect. In this randomized study with anesthetized pigs, we compared the effect of a large dose, 4 mL/kg, of i.v. 20% Intralipid(®) (n = 7) with Ringer's acetate (n = 6) on cardiovascular recovery after a cardiotoxic dose of bupivacaine. We also examined mitochondrial respiratory function in myocardial cell homogenates analyzed promptly after needle biopsies from the animals...
May 24, 2016: Human & Experimental Toxicology
Justin B Long, Anita S Joselyn, Tarun Bhalla, Joseph D Tobias, Gildasio S De Oliveira, Santhanam Suresh
BACKGROUND: Currently, there is limited evidence to support the safety of neuraxial catheters in neonates. Safety concerns have been cited as a major barrier to performing large randomized trials in this population. The main objective of this study is to examine the safety of neuraxial catheters in neonates across multiple institutions. Specifically, we sought to determine the incidence of overall and individual complications encountered when neuraxial catheters were used for postoperative analgesia in neonates...
June 2016: Anesthesia and Analgesia
S Yu Sichkar, I I Afukov, O V Koshko, N V Yeliseeva
Introduction of local anesthetic proved application of epidural (EP) as an effective and safe way of an analgesia in intra- and the post-operational period and now it is widely applied at children of all age groups (1). However there is a number of contraindications for application of this type of an analgesia. At children till 6 months lower dosages of a ropivacain of 2 mg/kg are applied, considering their age features. At the phenomena of system toxicity infusion of 20% lipofundin is applied. The child has an age 1...
January 2016: Anesteziologiia i Reanimatologiia
Daryl S Henshaw, Matthew L Baker, Robert S Weller, Jon Wellington Reynolds, Jonathan Douglas Jaffe
STUDY OBJECTIVE: The primary goal of this study was to determine whether transversus abdominis plane (TAP) blocks were effective as the primary anesthetic technique for insertion and/or removal of peritoneal dialysis catheters. DESIGN: This study is a descriptive case series investigation. SETTING: Operating rooms at a tertiary care academic medical center. PATIENTS: Twenty-four patients, American Society of Anesthesiologists (ASA) physical status 3 and 4, were included in this study...
June 2016: Journal of Clinical Anesthesia
Guy Weinberg
No abstract text is available yet for this article.
May 2016: Anesthesia and Analgesia
Maria A Hernandez, Karen Boretsky
Regional anesthesia use in pediatric patients has a good safety profile. 2-Chloroprocaine is used frequently in infants due to rapid onset, lack of accumulation, and rapid plasma degradation. We present a case of local anesthetic systemic toxicity following the administration of 3% 2-chloroprocaine through a paravertebral catheter in an infant. The episode lasted 40 s followed by complete recovery. The infrequent reporting of local anesthetic systemic toxicity and limited duration of symptoms supports the continued use of 2-chloroprocaine in infants...
June 2016: Paediatric Anaesthesia
Geoff Frawley, Ben Hallett, Tony Velkov, Andrew Bjorksten
BACKGROUND: Infant spinal anesthesia with levobupivacaine has been promoted as a technique to reduce both the risk of postoperative apnea and exposure to volatile anesthesia. There is, however, no pharmacokinetic data to support the currently recommended doses. AIMS: Our aim was to determine whether infant levobupivacaine spinal anesthesia is associated with plasma concentrations consistent with a low risk of local anesthetic systemic toxicity. METHODS: This was an open-label pharmacokinetic safety and tolerability study of levobupivacaine spinal anesthesia in infants <55 weeks Post Menstrual Age undergoing lower abdominal surgery...
June 2016: Paediatric Anaesthesia
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