LOCAL ANESTHETIC OVERDOSE: DIAGNOSIS AND TREATMENT
Advances in Medicine and Biology: Volume 160, NOVA Publications , ss.129-151, 2020
- Yayın Türü: Kitapta Bölüm / Araştırma Kitabı
- Basım Tarihi: 2020
- Yayınevi: NOVA Publications
- Sayfa Sayıları: ss.129-151
- Anahtar Kelimeler: Diagnosis, Emergency medicine, Local anesthetic systemic toxicity, Overdose, Poisoning, Treatment
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Local anesthetic agents reduce the rate of depolarization by decreasing the permeability of the ion channels to sodium. These compounds (-caines) are also utilized as topical anesthetics which may cause decreased gag reflex, central nervous system depression or excitation, or cardiovascular effects, depending upon its application site. Local anesthetic overdose leads to local anesthetic systemic toxicity (LAST) and manifestations which can turn into a lethal complication of regional or local anesthesia. Besides mild side effects such as isolated systolic hypertension, LAST can cause refractory cardiac dysfunction and collapse. A major strategy to beware of LAST is to use these agents combined with vasopressor agents, although this approach can trigger tachyarrhythmias in selected patients. The maximum calculated drug dose is to be decreased in the elderly, compromised, debilitated patients. Total blood volume and liver and kidney functions can affect metabolism, halflives and toxicity potential of local anesthetics. One can easily find convincing data on the use of intravenous lipid emulsion (ILE) to cure LAST and relevant systemic toxicity, and/or serious cardiotoxicity. ILE is useful against toxicity inflicted by almost all local anesthetics including bupivacaine, mepivacaine, ropivacaine, levobupivacaine, prilocaine, and lidocaine. Despite significant impediments, refinement to recommendations for lipid emulsion will be best driven by structured analysis of quality registry data or controlled human evaluation. This review is intended to address a common and updated understanding of the prevention, diagnosis, and treatment of LAST for healthcare workers, especially those in emergency care who perform local anesthesia in their routine practice.