Arrêt cardiaque après gargarisme et ingestion orale de lidocaïne 5 %

Doumiri, Mohcine; Moussaoui, A.; Maazouzi, Wajdi

doi:10.1007/bf03034065

Cited by 8 publications

(5 citation statements)

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“…Generalized CNS depression ensues with potential lethargy, coma, cardiovascular collapse, and respiratory depression [2] , [6] , [7] . Epidemiological studies and case reports have linked clinical lidocaine usage with cardiac arrest and neurological deficits including, transient radiating post-operative pain, cauda equina syndrome, and seizure onset [8] , [9] , [10] , [11] , [12] .…”

Section: Introductionmentioning

confidence: 99%

Oxidative stress, metabolomics profiling, and mechanism of local anesthetic induced cell death in yeast

et al. 2017

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The World Health Organization designates lidocaine as an essential medicine in healthcare, greatly increasing the probability of human exposure. Its use has been associated with ROS generation and neurotoxicity. Physiological and metabolomic alterations, and genetics leading to the clinically observed adverse effects have not been temporally characterized. To study alterations that may lead to these undesirable effects, Saccharomyces cerevisiae grown on aerobic carbon sources to stationary phase was assessed over 6 h. Exposure of an LC50 dose of lidocaine, increased mitochondrial depolarization and ROS/RNS generation assessed using JC-1, ROS/RNS specific probes, and FACS. Intracellular calcium also increased, assessed by ICP-MS. Measurement of the relative ATP and ADP concentrations indicates an initial 3-fold depletion of ATP suggesting an alteration in the ATP:ADP ratio. At the 6 h time point the lidocaine exposed population contained ATP concentrations roughly 85% that of the negative control suggesting the surviving population adapted its metabolic pathways to, at least partially restore cellular bioenergetics. Metabolite analysis indicates an increase of intermediates in the pentose phosphate pathway, the preparatory phase of glycolysis, and NADPH. Oxidative stress produced by lidocaine exposure targets aconitase decreasing its activity with an observed decrease in isocitrate and an increase citrate. Similarly, increases in α-ketoglutarate, malate, and oxaloacetate imply activation of anaplerotic reactions. Antioxidant molecule glutathione and its precursor amino acids, cysteine and glutamate were greatly increased at later time points. Phosphatidylserine externalization suggestive of early phase apoptosis was also observed. Genetic studies using metacaspase null strains showed resistance to lidocaine induced cell death. These data suggest lidocaine induces perpetual mitochondrial depolarization, ROS/RNS generation along with increased glutathione to combat the oxidative cellular environment, glycolytic to PPP cycling of carbon generating NADPH, obstruction of carbon flow through the TCA cycle, decreased ATP generation, and metacaspase dependent apoptotic cell death.

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Section: Introductionmentioning

confidence: 99%

Oxidative stress, metabolomics profiling, and mechanism of local anesthetic induced cell death in yeast

et al. 2017

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“…Application of LAP has been used in flexible bronchoscopy for decades and is considered to be standard practice in order to improve patient tolerance and comfort. However, its side effects, albeit rare, may sometimes be serious and are not usually considered [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Although the application of LA has been recommended in various guidelines, data supporting its advantage are limited in the context of deep sedation [ 4 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…While side effects of LA are rare [ 7 ], there have been reports of serious and life threatening side effects including cardiac [ 8 , 9 ], pulmonary [ 10 ] and central nervous [ 11 , 12 , 13 , 14 ] impairment, methemoglobinemia [ 15 , 16 ] and allergic reactions [ 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Data on the risk and benefit of LA in addition to general sedation for FB is limited and inconclusive, ranging from reduced cough rate with lidocaine [ 24 ] and improved patient tolerance and satisfaction of the procedure [ 25 , 26 ], to a lack of any difference between LA and placebo for bronchoscopy in patients under deep sedation [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Influence of Pharyngeal Anaesthesia on Post-Bronchoscopic Coughing: A Prospective, Single Blinded, Multicentre Trial

Häntschel

Zahn-Paulsen

Ehab

et al. 2021

JCM

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Background: Local anaesthesia of the pharynx (LAP) was introduced in the era of rigid bronchoscopy (which was initially a conscious procedure under local anaesthetic), and continued into the era of flexible bronchoscopy (FB) in order to facilitate introduction of the FB. LAP reduces cough and gagging reflex, but its post-procedural effect is unclear. This prospective multicentre trial evaluated the effect of LAP on coughing intensity/time and patient comfort after FB, and the feasibility of FB under propofol sedation alone, without LAP. Material and methods: FB was performed in 74 consecutive patients under sedation with propofol, either alone (35 patients, 47.3%) or with additional LAP (39 patients, 52.7%). A primary endpoint of post-procedural coughing duration in the first 10 min after awakening was evaluated. A secondary endpoint was the cough frequency, quality and development of coughing in the same period during the 10 min post-procedure. Finally, the ease of undertaking the FB and the patient’s tolerance and safety were evaluated from the point of view of the investigator, the assistant technician and the patient. Results: We observed a trend to a shorter cumulative coughing time of 48.6 s in the group without LAP compared to 82.8 s in the group receiving LAP within the first 10 min after the procedure, although this difference was not significant (p = 0.24). There was no significant difference in the cough frequency, quality, peri-procedural complication rate, nor patient tolerance or safety. FB, including any additional procedure, could be performed equally well with or without LAP in both groups. Conclusions: Our study suggests that undertaking FB under deep sedation without LAP does to affect post-procedural cough duration and frequency. However, further prospective randomised controlled trials are needed to further support this finding.

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“…While very rare, LAST can occur after topical administration of local anesthetic, especially when the drug is applied to mucosal membranes in repeated or high doses. There have been reported cases documenting seizures and cardiac arrest with high doses of oral viscous lidocaine (Doumiri, Moussaoui, & Maazouzi, 2008).…”

Section: Epidemiologymentioning

confidence: 99%

Emergency Medicine Case Study on Local Anesthetic Systemic Toxicity

Hays

2024

Advanced Emergency Nursing Journal

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The purpose of this case study on local anesthetic systemic toxicity (LAST), a potentially life-threatening complication of local anesthetic, is to ensure that emergency nurse practitioners (ENPs) are knowledgeable on this disease process. Local anesthetics are used frequently, often daily, by ENPs, as well as multiple other health care providers for various procedures. They should be knowledgeable of the steps to resuscitate a patient who may have severe LAST. This case study reviews the emergency management of LAST, including pharmacologic treatment, deviations from routine advanced resuscitative guidelines, and disposition of the patient upon successful resuscitation. Additionally, risk assessment and clinical manifestations will be discussed. After reviewing this case study, ENPs should be able to recognize the presentation of LAST and provide emergent management to reduce complications, comorbidities, and death.

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Arrêt cardiaque après gargarisme et ingestion orale de lidocaïne 5 %

Cited by 8 publications

References 5 publications

Oxidative stress, metabolomics profiling, and mechanism of local anesthetic induced cell death in yeast

Oxidative stress, metabolomics profiling, and mechanism of local anesthetic induced cell death in yeast

Influence of Pharyngeal Anaesthesia on Post-Bronchoscopic Coughing: A Prospective, Single Blinded, Multicentre Trial

Emergency Medicine Case Study on Local Anesthetic Systemic Toxicity

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