Convulsions after normal dose of lidocaine: a probable drug interaction

Landy, C.; Schaeffer, Eva; Raynaud, Laurent; Favier, J.-C.

doi:10.1093/bja/aes085

Cited by 9 publications

(7 citation statements)

References 5 publications

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“…5 Lidocaine is an amide LA which is a class 1B anti-arrhythmic drug affecting nerve axon sodium channels, thus preventing depolarization. 6 In our case, both flecainide and lidocaine were within their therapeutic range. An interaction with this anti-arrhythmic agent could potentially explain the LA toxicity observed and care may be needed with this combination of drugs.…”

Section: Convulsions After Normal Dose Of Lidocaine: a Probable Drug supporting

confidence: 45%

Reply from the authors

Orange¹,

Passini²,

Amorim³

et al. 2012

British Journal of Anaesthesia

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our NHS trust over the last few years, and in particular how to prevent it.We conducted an audit in 2005 of 129 patients (56 epidurals) and confirmed the findings in many of the studies referenced that epidurals are associated with an increase in maternal temperature. As a result, more patients with a temperature over 388C were investigated for potential infective causes (especially chorioamnionitis). There was an increase in the number of mothers having antibiotics and babies being admitted to Special Care Baby Unit (SCBU) among those whose temperature increased above 388C.We hypothesized that paracetamol given at the time of epidural insertion, and then 6 hourly, could reduce the incidence of a maternal temperature increase. In 2009, we conducted a further audit involving 155 patients (63 epidurals) ( Table 1).Our 2005 data show that there is a statistically significant association between the use of epidurals in labour and both a modest increase in temperature of 0.58C (P.0.001) and the clinically important increase in temperature to 388C (P.0.005). In 2009, with the prophylactic use of paracetamol, this association is no longer present (P.0.07 and .0.18, respectively). A comparison of the epidural data between 2005 and 2009 shows a significant decrease in the likelihood of developing a significant increase in temperature with the use of prophylactic paracetamol (P.005). The odds ratio indicates that you are 3.2 times more likely to develop a temperature with an epidural in labour if you do not give paracetamol prophylactically. In both audits, although there were more cultures taken in the epidural group, there was no increase in the number of positive cultures. There certainly seems to be some benefit to the use of paracetamol prophylactically for patients with epidurals. We are in the process of a two-centre study, comparing patients with and without paracetamol on a larger scale to assess whether there is a true benefit. 1 de Orange FA, Passini R, Amorim M, Almeida T, Barros A. Combined spinal and epidural anaesthesia and maternal intrapartum temperature during vaginal delivery: a randomized clinical trial.Editor-We thank Drs Akerman and Hall for their interesting comments on our study 1 and for sharing the results of their audit. The first report of an increase in maternal temperature after anaesthesia was published in 1989 as the result of a study that compared epidural anaesthesia with meperidine. 2 That study revealed a significant increase in mean temperature in the epidural group 6 h after delivery. Similar results were later reported by other investigators. The cause of this increase in maternal temperature after epidural anaesthesia remains to be clarified. Most investigators believe that it may be the result of maternal thermoregulatory changes during childbirth. However, others consider this increase to be a consequence of subclinical placental infections, since maternal fever is more common in women undergoing prolonged labour or prolonged rupture of membranes. With respect to combined spinal-ep...

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Section: Convulsions After Normal Dose Of Lidocaine: a Probable Drug supporting

confidence: 45%

Reply from the authors

Orange¹,

Passini²,

Amorim³

et al. 2012

British Journal of Anaesthesia

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“…[8][9][10][12][13][14][15][16][17][18][19][20][21][22]24,25,[27][28][29][31][32][33][34][36][37][38][40][41][42][43][51][52][53][54][55][56][57][58]60,61 Twelve percent of the cases developed in an office, 30,39,45,46,[48][49][50] whereas another 4% occurred in other locations, including the patient's home. Finally, 15% of the authors did not specify the hospital setting where the LA was administered.…”

Section: Setting Of Lastmentioning

confidence: 99%

“…Overall, adrenaline was added to the anesthetic mixture in 8 cases. 8,16,23,27,32,35,37,49 With regard to local field anesthesia, lidocaine was used in nearly 80% of the cases, occasionally combined with other LAs. Articaine, 49 propitocaine, 20 and bupivacaine 38 were used alone in 1 case each.…”

Section: Local Anestheticsmentioning

confidence: 99%

“…Eleven (16%) cases reported the use of UGRA. 19,25,29,32,33,35,51,53,55 Fifteen (22%) practitioners adopted ENS, 12,16,22,24,29,31,41,44 whereas intermittent aspiration before injection was reported in 22 cases of LA administration for peripheral nerve block. 8,11,15,16,18,19,22,24,25,27,[31][32][33]36,38,41,43,46,58 Finally, only 1 author reported on the concomitant use of ultrasound, ENS, and intermittent aspiration 29 in a patient who developed toxicity 10 minutes after LA injection.…”

Section: Nerve Localization and Safety Measuresmentioning

confidence: 99%

“…8,10,[12][13][14][15][16][17]19,24,25,29,[32][33][34][35]37,40,45,46,51,59,61 In 13 cases, ILE was used after the conventional treatment was started, whereas in the remaining 10 cases, ILE represented the first therapeutic measure, being the sole treatment in 7 patients. With regard to ILE use, 6 patients were given ILE according to ASRA guidelines, whereas a liberal use of lipid was adopted in 9 cases.…”

Section: Treatment Of Lastmentioning

confidence: 99%

See 2 more Smart Citations

A Review of Local Anesthetic Systemic Toxicity Cases Since Publication of the American Society of Regional Anesthesia Recommendations

Vasques

Behr

Weinberg

et al. 2015

Regional Anesthesia and Pain Medicine

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Local anesthetic systemic toxicity (LAST) occurrence may cross several medical specialties. In 2010, the American Society of Regional Anesthesia and Pain Medicine (ASRA) published the first algorithm on LAST management, introducing the use of lipid emulsion (ILE) treatment. In the present study, we retrieved the cases of LAST published between ASRA guidelines dissemination and March 2014. We analyzed the reported clinical manifestations of LAST, characteristics of affected patients, onset time of toxicity, and clinical setting. We also focused on the treatment measures that were applied in the different cases, especially on the use of ILE and adherence to ASRA recommendations. Despite the limits of a review of case reports, the present study calls attention to the insidious nature of LAST, especially its atypical manifestations, and shows that ILE may currently be underadministered in daily clinical practice, especially in nonanesthesiology practice.

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Introduction

Marcucci¹

2015

A Case Approach to Perioperative Drug-Drug Interactions

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Convulsions after normal dose of lidocaine: a probable drug interaction

Cited by 9 publications

References 5 publications

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Reply from the authors

A Review of Local Anesthetic Systemic Toxicity Cases Since Publication of the American Society of Regional Anesthesia Recommendations

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