Systemic toxisity of local anesthethics during regional anesthesia in orthopedics and traumatology

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Abstract

There are cases of accidental intravascular injection of local anesthetic when performing regional anesthesia. The frequency of this complication was 0.28 per 1,000. We describe the clinical manifestations and the basic principles of the treatment of local anesthetics systemic toxicity. Discussed in detail the mechanism of action of fat emulsion and the protocol of lipid resuscitation Accidental intravascular injection of local anesthetics. The mechanism of action of fat emulsion and the protocol of lipidrescue accidental intravascular injection of local anesthetics was discussed.

About the authors

V. A. Koryachkin

Vreden Russian Research Institute of Traumatology and Orthopedics

Author for correspondence.
Email: vakoryachkin@rniito.ru
Russian Federation

V. G. Chupris

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: noemail@neicon.ru
Russian Federation

A. Z. Cherny

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: noemail@neicon.ru
Russian Federation

V. S. Kasarin

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: noemail@neicon.ru
Russian Federation

M. A. Lis’Kov

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: noemail@neicon.ru
Russian Federation

G. M. Malevich

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: noemail@neicon.ru
Russian Federation

M. P. Maltsev

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: noemail@neicon.ru
Russian Federation

References

  1. Корячкин В.А. Нейроаксиальные блокады. СПб.: ЭЛБИ-СПб; 2013. 544 с.
  2. Корячкин В.А., Страшнов В.И. Анестезия и интенсивная терапия. СПб.; 2004. 465 с.
  3. Корячкин В.А., Эмануэль В.Л., Страшнов В.И. Диагностика в анестезиологии и интенсивной терапии. СПб.: Спецлит; 2011. 414 с.
  4. Потапов А.Л., Бабанин А.А., Пылаева Н.Ю., Пивоваренко С.А., Каврайская О.В. Клиническая токсикология - новая область применения жировой эмульсии. Клiнiчна хірургія. 2010; (11-12):101-103.
  5. Фесенко В.С. «Серебряная пуля» получает признание: новые рекомендации относительно интоксикации местными анестетиками. Медицина неотложных состояний. 2011; (7-8):33-45.
  6. Фесенко В.С. Интоксикация местными анестетиками: старая опасность, современные мифы, новые препараты и «серебряная пуля». Медицина неотложных состояний. 2008; (4):131-138.
  7. Auroy Y., Narchi P., Messiah A., Litt L., Rouvier B., Samii K. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology. 1997; 87(3):479-486.
  8. Auroy Y., Benhamou D., Bargues L., Ecoffey C., Falissard B., Mercier F.J., Bouaziz H., Samii K. Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service. Anesthesiology. 2002; 97(5):1274-1280.
  9. Bern S., Akpa B.S., Kuo I., Weinberg G. Lipid resuscitation: a life-saving antidote for local anesthetic toxicity. Curr Pharm Biotechnol. 2011; 12(2):313-319.
  10. Brown D.L., Ransom D.M., Hall J.A., Leicht C.H., Schroeder D.R., Offord K.P Regional anesthesia and local anesthetic-induced systemic toxicity: seizure frequency and accompanying cardiovascular changes. Anesth Analg. 1995; 81(2):321-328.
  11. Ciechanowicz S.J., Patil V.K. Association of Anaesthetists of Great Britain and Ireland. Intravenous lipid emulsion -rescued at LAST. Br Dent J. 2012; 212(5):237-241.
  12. Di Gregorio G., Neal J.M., Rosenquist R.W., Weinberg G.L. Clinical presentation of local anesthetic systemic toxicity: a review of published cases, 1979 to 2009. Reg Anesth Pain Med. 2010; 35(2):181-187.
  13. Finucane B.T., ed. Complications of regional anesthesia. New York: Springer; 2007.
  14. Jamaty C., Bailey B., Larocque A., Notebaert E., Sanogo K., Chauny J.M. Lipid emulsions in the treatment of acute poisoning: A systematic review of human and animal studies. Clin Toxicol. 2010; 48:1-27.
  15. Kenepp N.B., Gutsche B.B. Inadvertent intravascular injections during lumbar epidural anesthesia. Anesthesiology. 1981; 54(2):172-173.
  16. Litz R.J., Popp M., Stehr S.N., Koch T. Successful resuscitation of a patient with ropivacaine-induced asystole after axillary plexus block using lipid infusion. Anaesthesia. 2006; 61(8):800-801.
  17. Marwick P.C., Levin A.I., Coetzee A.R. Recurrence of cardiotoxicity after lipid rescue from bupivacaine-induced cardiac arrest. Anesth Analg. 2009; 108:1344-1346.
  18. McCutchen T., Gerancher J.C. Early intralipid therapy may have prevented bupivacaine-associated cardiac arrest. Reg Anesth Pain Med. 2008; 33(2):178-180.
  19. Mellin-Olsen J., Staender S., Whitaker D.K., Smith A.F. The Helsinki declaration on patient safety in anaesthesiology. Eur J Anaesthesiol. 2010;27(7): 592-597.
  20. Mottram A.R., Valdivia C.R., Makielski J.C. Fatty acids antagonizebupivacaine-induced I(Na) blockade. Clinical Toxicol. 2011; 49:729-733.
  21. Neal J.M., Bernards C.M., Butterworth J.F. 4th, Di Gregorio G., Drasner K., Hejtmanek M.R., Mulroy M.F., Rosenquist R.W., Weinberg G.L. ASRA practice advisory on local anesthetic systemic toxicity. Reg Anesth Pain Med. 2010; 35(2):152-161.
  22. Partownavid P., Umar S., Li J., Rahman S., Eghbali M. Fatty-acid oxidation and calcium homeostasis are involved in the rescue of bupivacaine-induced cardiotoxicity by lipid emulsion in rats. Crit Care Med. 2012; 40(8):2431-2437.
  23. Rahman S., Li J., Bopassa J.C., Umar S., Iorga A., Partownavid P., Eghbali M. Phosphorylation of GSK-3ß mediates intralipid-induced cardioprotection against ischemia/reperfusion injury. Anesthesiology. 2011; 115(2):242-253.
  24. Rashid R.H., Shah A.A., Shakoor A., Noordin S. Hip fracture surgery: does type of anesthesia matter? Biomed Res Int. 2013; 2013:252-256.
  25. Rosenblatt M.A., Abel M., Fischer G.W., Itzkovich C.J., Eisenkraft J. Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. Anesthesiology. 2006; 105(1):217-218.
  26. Shah S., Gopalakrishnan S., Apuya J., Martin T. Use of Intralipid in an infant with impending cardiovascular collapse due to local anesthetic toxicity. J Anesth. 2009; 23:439-241.
  27. Weinberg G.L., VadeBoncouer T., Ramaraju G.A., Garcia-Amaro M.F., Cwik M.J. Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Anesthesiology. 1998; 88(4):1071-1075.
  28. Weinberg G.L., Ripper R., Murphy P., Edelman L.B., Hoffman W., Strichartz G., Feinstein D.L. Lipid infusion accelerates removal of bupivacaine and recovery from bupivacaine toxicity in the isolated rat heart. Reg Anesth Pain Med. 2006; 31:296-303.
  29. Weinberg G.L. Lipid emulsion infusion: resuscitation for local anesthetic and other drug overdose. Anesthesiology. 2012; 117(1):180-187.
  30. West P.L., McKeown N.J., Hendrickson R.G. Iatrogenic lipid emulsion overdose in a case of amlodipine poisoning. Clin Toxicol. 2010; 48:393-396.

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