Incidence of severe local anaesthetic toxicity and adoption of lipid rescue in Finnish anaesthesia departments in 2011–2013

Heinonen, Juho A.; Litonius, Erik; Pitkänen, M.; Rosenberg, P. H.

doi:10.1111/aas.12545

Cited by 22 publications

(11 citation statements)

References 25 publications

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“…The PPD's 1.8/1000 cumulative rate and the NIS 1.04/1000 incidence, while similar, are considerably higher than the 0.04/ 1000 to 0.8/1000 LAST incidences reported contemporaneously from various registries, 32 national surveys, 33 and single institutions. 29,34 Variations in the incidence may reflect differing definitions of LAST.…”

Section: Administrative Databasesmentioning

confidence: 64%

“…These works range from extensions of previously published quality assurance data sets, 36,37 national databases 33,38 and international registries, 35,39 to specific registries that focus on pediatric practice, [40][41][42] single-center data, 29,32 and data specific to interscalene brachial plexus block. 34 The most important new finding from the Australian and New Zealand Registry of Regional Anaesthesia (now the International Registry of Regional Anaesthesia) is that ultrasound guidance reduces the risk of LAST throughout its continuum by 60% to 65% (propensity analysis OR, 0.35-0.36) as compared with peripheral nerve stimulation alone.…”

Section: Registriesmentioning

confidence: 99%

See 1 more Smart Citation

The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity

Neal

Barrington

Fettiplace

et al. 2018

Regional Anesthesia and Pain Medicine

337

185

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The American Society of Regional Anesthesia and Pain Medicine's Third Practice Advisory on local anesthetic systemic toxicity is an interim update from its 2010 advisory. The advisory focuses on new information regarding the mechanisms of lipid resuscitation, updated frequency estimates, the preventative role of ultrasound guidance, changes to case presentation patterns, and limited information related to local infiltration anesthesia and liposomal bupivacaine. In addition to emerging information, the advisory updates recommendations pertaining to prevention, recognition, and treatment of local anesthetic systemic toxicity. WHAT'S NEW IN THIS UPDATE?: This interim update summarizes recent scientific findings that have enhanced our understanding of the mechanisms that lead to lipid emulsion reversal of LAST, including rapid partitioning, direct inotropy, and post-conditioning. Since the previous practice advisory, epidemiological data have emerged that suggest a lower frequency of LAST as reported by single institutions and some registries, nevertheless a considerable number of events still occur within the general community. Contemporary case reports suggest a trend toward delayed presentation, which may mirror the increased use of ultrasound guidance (fewer intravascular injections), local infiltration techniques (slower systemic uptake), and continuous local anesthetic infusions. Small patient size and sarcopenia are additional factors that increase potential risk for LAST. An increasing number of reported events occur outside of the traditional hospital setting and involve non-anesthesiologists.

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Section: Administrative Databasesmentioning

confidence: 64%

Section: Registriesmentioning

confidence: 99%

The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity

Neal

Barrington

Fettiplace

et al. 2018

Regional Anesthesia and Pain Medicine

337

185

View full text Add to dashboard Cite

show abstract

“…44 A nationwide study in Finland used an electronic survey to record outcomes over a 3-year period, 2011 to 2013, where it was estimated that 211,700 regional anesthesia episodes (excluding spinal anesthesia) were performed. 47 Fifteen episodes of LASTwere reported after upper extremity blockade (n = 12), intercostal blockade (n = 2), and caudal anesthesia (n = 1). After caudal anesthesia, the pediatric patient had a tachyarrhythmia and cardiovascular collapse of short duration and had a good outcome.…”

Section: Clinical Registries/observational and Administrative Datamentioning

confidence: 99%

Local Anesthetic Systemic Toxicity

Gitman

Barrington

2018

Regional Anesthesia and Pain Medicine

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This review summarizes presenting features, management, and outcomes of local anesthetic systemic toxicity (LAST) from published cases and those submitted to online registries capturing use of intravenous lipid emulsion (ILE) therapy. The results of single-center and multicenter registries and epidemiologic studies complement this information. Between March 2014 and November 2016, 47 separate cases of LAST were described in 35 peer-reviewed articles. Local anesthetic systemic toxicity events occurred as a result of penile blocks (23%), local infiltration (17%), and upper/lower extremity, torso, and neuraxial blockade. Twenty-two patients (47%) were treated with ILE, and 2 patients (4.3%) died. During the same time period, 11 cases submitted to lipidrescue.org were treated with ILE and survived. The incidence of LAST reported in registries is 0.03% or 0.27 (95% confidence interval, 0.21-0.35) per 1000 peripheral nerve blocks (denominator of 251,325). Seizure (53% and 61% from case reports and registries, respectively) was the most common presenting feature.

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“…Soybean oil–based intravenous lipid emulsion (SO‐ILE) plays important roles in parenteral nutrition therapy not only as a source of nonprotein calories but also as a preventive treatment for essential fatty acid deficiency and fatty liver 1 , 2 . Moreover, SO‐ILE has emerged as a novel treatment for local anesthesia systemic toxicity—namely, lipid rescue therapy 3 – 5 . However, despite its clinical benefits, SO‐ILE has undesirable effects on the immune, inflammatory, and coagulation systems 6 – 8 and can cause fat overload syndrome 9 – 11 and other serious complications.…”

Section: Introductionmentioning

confidence: 99%

Population Semiphysiologic Kinetic Modeling and Simulation of Plasma Triglyceride Levels After Soybean Oil–Based Intravenous Lipid Emulsion Administration in Rats

Okada

Hirano

Tanioka

et al. 2016

J Parenter Enteral Nutr

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The proposed kinetic model accurately described TG concentrations after SO-ILE administration at various infusion rates, including a lipid rescue regimen. The maximum acceptable infusion rate of SO-ILE in routine use should correspond to the maximum velocity of the apolipoprotein acquisition: 0.619 g/kg/h in rats. The prediction of TG kinetics at extremely high concentrations will provide useful information for lipid rescue therapy.

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Incidence of severe local anaesthetic toxicity and adoption of lipid rescue in Finnish anaesthesia departments in 2011–2013

Abstract: The incidence of LAST in Finland is very low. Several departments have adopted lipid emulsion treatment for LAST despite lack of national recommendations and knowledge of the possible mechanism of action.

Cited by 22 publications

References 25 publications

The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity

The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity

Local Anesthetic Systemic Toxicity

Population Semiphysiologic Kinetic Modeling and Simulation of Plasma Triglyceride Levels After Soybean Oil–Based Intravenous Lipid Emulsion Administration in Rats

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