Local anesthetic systemic toxicity: current perspectives

被引:293
作者
El-Boghdadly, Kariem [1 ,2 ]
Pawa, Amit [1 ]
Chin, Ki Jinn [3 ]
机构
[1] Guys & St Thomas NHS Fdn Trust, Dept Anaesthesia, London SE1 9RT, England
[2] Kings Coll London, Sch Med, London, England
[3] Univ Toronto, Toronto Western Hosp, Dept Anaesthesia, Toronto, ON, Canada
关键词
local anesthetic; toxicity; therapy; regional anesthesia;
D O I
10.2147/LRA.S154512
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Local anesthetic systemic toxicity (LAST) is a life-threatening adverse event that may occur after the administration of local anesthetic drugs through a variety of routes. Increasing use of local anesthetic techniques in various healthcare settings makes contemporary understanding of LAST highly relevant. Recent data have demonstrated that the underlying mechanisms of LAST are multifactorial, with diverse cellular effects in the central nervous system and cardiovascular system. Although neurological presentation is most common, LAST often presents atypically, and one-fifth of the reported cases present with isolated cardiovascular disturbance. There are several risk factors that are associated with the drug used and the administration technique. LAST can be mitigated by targeting the modifiable risk factors, including the use of ultrasound for regional anesthetic techniques and restricting drug dosage. There have been significant developments in our understanding of LAST treatment. Key advances include early administration of lipid emulsion therapy, prompt seizure management, and careful selection of cardiovascular supportive pharmacotherapy. Cognizance of the mechanisms, risk factors, prevention, and therapy of LAST is vital to any practitioner using local anesthetic drugs in their clinical practice.
引用
收藏
页码:35 / 44
页数:10
相关论文
共 93 条
[1]   Local infiltration analgesia in knee and hip arthroplasty efficacy and safety [J].
Affas, Fatin .
SCANDINAVIAN JOURNAL OF PAIN, 2016, 13 :59-66
[2]   Ropivacaine Pharmacokinetics After Local Infiltration Analgesia in Hip Arthroplasty [J].
Affas, Fatin ;
Eksborg, Staffan ;
Wretenberg, Per ;
Olofsson, Christina ;
Stiller, Carl-Olav .
ANESTHESIA AND ANALGESIA, 2014, 119 (04) :996-999
[3]  
Aggarwal N., 2018, EXPERT OPIN DRUG SAF, V17, P1
[4]  
Association of Anaesthetists of Great Britain and Ireland, AAGBI SAF GUID MAN S
[5]  
Bacon B, 2018, J CARDIOTHORAC VASC
[6]   A comparison of the cardiovascular effects of levobupivacaine and rac-bupivacaine following intravenous administration to healthy volunteers [J].
Bardsley, H ;
Gristwood, R ;
Baker, H ;
Watson, N ;
Nimmo, W .
BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, 1998, 46 (03) :245-249
[7]   Ultrasound Guidance Reduces the Risk of Local Anesthetic Systemic Toxicity Following Peripheral Nerve Blockade [J].
Barrington, Michael J. ;
Kluger, Roman .
REGIONAL ANESTHESIA AND PAIN MEDICINE, 2013, 38 (04) :289-297
[8]  
Becker Daniel E, 2012, Anesth Prog, V59, P90, DOI 10.2344/0003-3006-59.2.90
[9]   Central nervous system toxicity following the administration of levobupivacaine for lumbar plexus block: A report of two cases [J].
Breslin, DS ;
Martin, G ;
MacLeod, DB ;
D'Ercole, F ;
Grant, SA .
REGIONAL ANESTHESIA AND PAIN MEDICINE, 2003, 28 (02) :144-147
[10]   Ropivacaine plasma levels following high-dose local infiltration analgesia for total knee arthroplasty [J].
Brydone, A. S. ;
Souvatzoglou, R. ;
Abbas, M. ;
Watson, D. G. ;
McDonald, D. A. ;
Gill, A. M. .
ANAESTHESIA, 2015, 70 (07) :784-790