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    Local anesthetic toxicity

    ashdom
    ashdom

    عدد الرسائل : 171
    العمر : 40
    العمل/الترفيه : Anesthesiologist
    تاريخ التسجيل : 2010-07-08

    Local anesthetic toxicity Empty Local anesthetic toxicity

    Post by ashdom on Wed Apr 17, 2013 6:34 pm


    Local anesthetic toxicity
    Local anesthetic toxicity is related to high plasma levels of local anesthetic found in:
    1 -drug overdose.
    2-direct intravascular injection.
    3 -rapid absorption/injection into a highly vascular area, e.g.
    intercostals.
    4 -continuous infusion of local anesthetic.
    4 -cumulative effect of multiple injections.

    Maximum recommended doses of common agents

    Bupivacaine
    2mg/kg
    with vasoconstrictor 2mg/kg

    Levobupivacaine

    2mg/kg

    Ropivacaine

    3mg/kg

    Lidcaine

    3mg/kg
    with vasoconstrictor 6mg/kg

    Prilocaine
    6mg/kg
    with vasoconstrictor 8mg/kg

    Cocaine
    3mg/kg
    Symptoms and signs of toxicity:

    Mild toxicity
    Tingling around the mouth
    Metallic taste
    Tinnitus
    Visual disturbance
    Slurred speech

    Moderate toxicity
    Altered conscious state
    Convulsions
    Coma

    Potentially fatal toxicity
    Respiratory arrest
    Cardiac arrhythmias
    Cardiovascular collapse
    Treatment:


    Stop injection or infusion as appropriate.
    Treatment of adverse local anesthetic toxicity depends on their severity.

    Minor reactions can be allowed to resolve spontaneously.

    Local anesthetic-induced seizures should be managed by protecting the airway and providing oxygen.

    Seizures may be terminated with intravenous thiopental, midazolam, or prpofol.

    If local anesthetic intoxication produce cardiac arrest, the guide lines for advanced cardiac life support (ACLS) are reasonable.
    Amidarone and vasopressin are suggested for lidocaine and epinephrine, respectively.

    With unresponsive bupivacaine cardiac toxicity, intravenous lipid or cardiopulmonary bypass may be considered.

      Current date/time is Fri Nov 15, 2019 10:38 am