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"Local Anaesthetic Toxicity" OR "Local Anesthetic Toxicity" AND ("Intralipid" OR "Lipid")

O S Geodakian
The article deals with an analysis of the publications devoted of local anaesthetics' systemic toxicity (LAST) due to regional anaesthesia and symptoms of this potentially lethal complication. The review discusses features of systemic absorption and forms of local anaesthetics' neurotoxicity and cardiotoxicity in children, including newborns, differences of clinical signs of the LAST in adults and children and dosage of racemic bupivacaine. Moreover, the article deals with a modified treatment protocol for LAST and a method of lipid resuscitation with 20% lipid emulsion in the form of Intralipid...
September 2014: Anesteziologiia i Reanimatologiia
Juho A Heinonen, Erik Litonius, Tapani Salmi, Juhani Haasio, Pekka Tarkkila, Janne T Backman, Per H Rosenberg
Intravenous lipid emulsion has been suggested as treatment for local anaesthetic toxicity, but the exact mechanism of action is still uncertain. Controlled studies on the effect of lipid emulsion on toxic doses of local anaesthetics have not been performed in man. In randomized, subject-blinded and two-phase cross-over fashion, eight healthy volunteers were given a 1.5 ml/kg bolus of 20% Intralipid(®) (200 mg/ml) or Ringer's acetate solution intravenously, followed by a rapid injection of lidocaine 1.0 mg/kg...
April 2015: Basic & Clinical Pharmacology & Toxicology
Philipp Lirk, Susanne Picardi, Markus W Hollmann
This review seeks to address 10 essential questions regarding the clinical use of local anaesthetics. Each local anaesthetic has distinctive physicochemical properties but with the same mode of action; they block voltage-gated sodium channels in the axon. Sodium channel block is brought about by a conformational change and the creation of a positive charge in the channel pore. Different local anaesthetics can reach the local anaesthetic binding site in the axon from the cytoplasmic compartment (classic hydrophilic pathway), or directly via its lipid membrane (hydrophobic pathway), or can enter via large-pore channels (alternative hydrophilic pathway)...
November 2014: European Journal of Anaesthesiology
M de Queiroz Siqueira, D Chassard, H Musard, A Heilporn, J-C Cejka, O Leveneur, B Allaouchiche, O Rhondali
BACKGROUND: The optimal dosing regimens of lipid emulsion, epinephrine, or both are not yet determined in neonates in cases of local anaesthetic systemic toxicity (LAST). METHODS: Newborn piglets received levobupivacaine until cardiovascular collapse occurred. Standard cardiopulmonary resuscitation was started and electrocardiogram (ECG) was monitored for ventricular tachycardia, fibrillation, or QRS prolongation. Piglets were then randomly allocated to four groups: control (saline), Intralipid(®) alone, epinephrine alone, or a combination of Intralipd plus epinephrine...
April 2014: British Journal of Anaesthesia
J A Evans, S C Wallis, J M Dulhunty, G Pang
Lipid emulsions have been used to treat cardiovascular collapse due to local anaesthetic toxicity. However, there are few data available on the comparative efficiency of the partitioning properties of available lipid emulsions in clinical use. This in vitro study compared the buffering properties of the lipid emulsions Clinoleic™ 20% (Baxter, Old Toongabbie, NSW) and Intralipid® 20% (Fresenius Kabi, Pymble, NSW) using both bupivacaine (Marcain® 0.5%, AstraZeneca, North Ryde, NSW) and ropivacaine (Naropin® 1%, AstraZeneca, North Ryde, NSW)...
September 2013: Anaesthesia and Intensive Care
B Admani, F Essajee
Anaesthetic agents used locally can be toxic especially if given as an inappropriate dose or route. Lipid infusion has been demonstrated in several animal models to successfully resuscitate bupivacaine induced toxicity. We present a case of successful use of 26% lipid infusion to resuscitate a paediatric patient with a presumed subcutaneous injection of bupivacaine and lignocaine which led to neurological and cardiologic consequences.
August 2010: East African Medical Journal
Jean-Xavier Mazoit
Local anaesthetics may induce cardiac arrest, usually because of rapid absorption from the site of injection or because of an intended intravascular injection. Early central nervous system symptoms usually precede seizures. Cardiac arrhythmias follow the CNS signs. These arrhythmias often resolve with the i.v. bolus injection of 100 to 150mL of a lipid emulsion (20% Intralipid(®)). Although long acting local anaesthetics (bupivacaine, ropivacaine, levobupivacaine) are predominantly involved in this cardiac toxicity, lidocaine may also induce cardiac arrhythmias and clinician must be aware of this risk...
March 2013: La Presse Médicale
B R Cooper, T Moll, J R Griffiths
BACKGROUND: Local anaesthetic agents are commonly encountered in the Emergency Department (ED). Local anaesthetic toxicity leading to cardiorespiratory arrest is a rare, but potentially fatal, complication of an overdose of these agents. A recent innovation in the treatment of severe local anaesthetic toxicity has been the introduction of intravenous lipid emulsion therapy (Intralipid 20%). The aim of this study was to gauge the current level of knowledge surrounding the administration and complications associated with commonly used local anaesthetic agents...
August 2010: Emergency Medicine Journal: EMJ
Philip Hamann, Paul I Dargan, Nisha Parbat, Hanna Ovaska, David M Wood
There is increasing evidence for the use of Intralipid in the management of acute local anaesthetic toxicity. This is supported by the recent Association of Anaesthetists of Great Britain and Ireland (AAGBI) guidelines for the management of local anaesthetic toxicity. Acute hospitals in England and Wales were surveyed to determine the proportion that currently stocked Intralipid, the locations of stocks within the hospital, guidelines related to its use and previous use in the last 12 months. The majority of hospitals surveyed stocked Intralipid in multiple locations, although not in all areas using high volumes of local anaesthetics...
August 2010: Emergency Medicine Journal: EMJ
Wojciech Polenceusz, Jacek Kupisiak, Robert Goch, Dariusz Paczkowski
Regional anaesthesia can be associated with severe complications, which may be due to overdose or accidental intravascular injection of local anaesthetics. The clinical picture varies and depends on the pharmacodynamics of specific drugs, the total dose used, and the route of injection. Among the most common side effects are: excitation, seizures, loss of consciousness, cardiac dysrhythmias, severe shock and cardiac arrest. Cardiovascular resuscitation in such cases may be prolonged and very difficult, mostly because local anaesthetics are lipid soluble and require a long time for redistribution...
October 2008: Anestezjologia Intensywna Terapia
G Foxall, R McCahon, J Lamb, J G Hardman, N M Bedforth
Lipid emulsion has been used in the successful treatment of local anaesthetic-induced cardiovascular collapse in animals and in two cases of cardiac arrest in humans. Previous reports of levobupivacaine toxicity in humans have been characterised by neurological signs and symptoms, without serious cardiovascular events. We present a case in which presumed intravenous injection of levobupivacaine led to neurological and cardiovascular consequences. This was treated successfully by resuscitation that included intravenous Intralipid infusion...
May 2007: Anaesthesia
R J Litz, M Popp, S N Stehr, T Koch
Ropivacaine 1% 40 ml was mistakenly injected as part of an axillary plexus block in an 84-year-old woman. After 15 min the patient complained of dizziness and drowsiness and developed a generalised tonic-clonic seizure followed by an asystolic cardiac arrest. After 10 min of unsuccessful cardiopulmonary resuscitation, a bolus of 100 ml of Intralipid 20% (2 was administered followed by a continuous infusion of 10 ml.min(-1). After a total dose of 200 ml of Intralipid 20% had been given spontaneous electrical activity and cardiac output was restored...
August 2006: Anaesthesia
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