Local Anesthetic Toxicity in the Geriatric Population

Waldinger, Rachel; Weinberg, Guy; Gitman, Marina

doi:10.1007/s40266-019-00718-0

Cited by 37 publications

(24 citation statements)

References 45 publications

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“…It remains a painful technique and may increase stress in some patients [ 21 ]. The elderly appear to be at a disproportionately increased risk for toxicity owing to the presence of relevant comorbidities and decreased muscle mass [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Outcome of early stage Merkel carcinoma treated by exclusive radiation: a study of 53 patients

Dubois¹,

Rached

Escande

et al. 2021

Radiat Oncol

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Purpose Early stage Merkel cell carcinoma (MCC) is a rare and aggressive primary skin cancer. The standard of care for MCC is broad excision and adjuvant external beam radiation therapy (EBRT). However, for some patients, anesthesia is contraindicated, while others run the risk of serious aesthetic sequelae. In such cases, exclusive radiotherapy is an interesting alternative to surgery. Though limited data is available, this study evaluates exclusive radiotherapy for MCC, using data from the largest retrospective study to date. Methods All patients who were followed in our center between 1989 and 2019 for histologically proven early stage MCC were included in the study. They were treated either by surgery with a 2-cm clear margin followed by adjuvant radiotherapy (RT) or by exclusive RT. Survival rates with adjuvant and exclusive EBRT were analyzed using Cox model and Fine and Gray model depending on the type of survival. p value < 0.05 was considered significant. Results Eighty-four patients treated for MCC were included. Fifty-three of them (63.1%) were treated by exclusive RT, and 31 (36.9%) had surgical excision followed by adjuvant RT. Local relapse rate was 13.7% (95% CI 8.0–43.7) in the RT monotherapy group (group A) and 25.8% (95% CI 10.3–56.2) in the surgery + RT group (group B) (p = 0.42). No statistical difference was found for nodal relapse (p = 0.81), metastatic relapse (p = 0.10), disease free survival (p = 0.83) or overall survival (p = 0.98). Conclusion Our study suggests that exclusive radiotherapy for early Merkel cell carcinoma leads to a similar oncological outcome as combined treatment, with fewer aesthetic sequelae. The approach is interesting for elderly patients with comorbidities or patients for whom surgery would cause significant functional or aesthetic sequelae.

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Section: Discussionmentioning

confidence: 99%

Outcome of early stage Merkel carcinoma treated by exclusive radiation: a study of 53 patients

Dubois¹,

Rached

Escande

et al. 2021

Radiat Oncol

View full text Add to dashboard Cite

show abstract

“…It remains a painful technique and may increase stress in some patients [23]. The elderly appear to be at a disproportionately increased risk for toxicity owing to the presence of relevant comorbidities and decreased muscle mass [24].…”

Section: Discussionmentioning

confidence: 99%

Outcome of Early Stage Merkel Carcinoma Treated by Exclusive Radiation: A Study of 53 Patients.

Dubois

Rached

Escande

et al. 2020

Preprint

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PurposeEarly stage Merkel cell carcinoma (MCC) is a rare and aggressive primary skin cancer. The standard of care for MCC is broad excision and adjuvant external beam radiation therapy (EBRT). However, for some patients, anesthesia is contraindicated, while others run the risk of serious aesthetic sequelae. In such cases, exclusive radiotherapy is an interesting alternative to surgery. Though limited data is available, this study evaluates exclusive radiotherapy for MCC, using data from the largest retrospective study to date. MethodsAll patients who were followed in our center between 1989 and 2019 for histologically proven early stage MCC were included in the study. They were treated either by surgery with a 2-cm clear margin followed by adjuvant radiotherapy (RT) or by exclusive RT. Survival rates with adjuvant and exclusive EBRT were analyzed using Cox model and Fine & Gray model depending on the type of survival. P-value < 0.05 was considered significant ResultsEighty-four patients treated for MCC were included. Fifty-three of them (63.1%) were treated by exclusive RT, and 31 (36.9%) had surgical excision followed by adjuvant RT. Local relapse rate was 13.7% (95%CI 8.0-43.7) in the RT monotherapy group (group A) and 25.8% (95%CI 10.3-56.2) in the surgery + RT group (group B) (p = 0.42). No statistical difference was found for nodal relapse (p = 0.81), metastatic relapse (p = 0.10), disease free survival (p = 0.83) or overall survival (p = 0.98). ConclusionOur study suggests that exclusive radiotherapy for early Merkel cell carcinoma leads to a similar oncological outcome as combined treatment, with fewer aesthetic sequelae. The approach is interesting for elderly patients with comorbidities or patients for whom surgery would cause significant functional or aesthetic sequelae.

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“…Barrington et al ( 5 ) and Abrahams et al ( 6 ) found through statistical analysis that the use of ultrasound guidance was related to a decrease in the incidence of local anesthetic toxicity (from mildly toxic subjective symptoms to epileptic seizures and cardiac arrest). The type and the dosage of the local anesthetic, the proficiency of the nerve block technique, the patient's own physical fitness, the time when a LAST event is discovered, the appropriateness of treatment measures, and other considerations are all related to the success of the local anesthesia and, more importantly, to the question of whether the safety of the patients is guaranteed ( 7 , 8 ).…”

Section: Local Anesthetic Systemic Toxicity (Last)mentioning

confidence: 99%

Mechanisms and Efficacy of Intravenous Lipid Emulsion Treatment for Systemic Toxicity From Local Anesthetics

Liu

Zhang

et al. 2021

Front. Med.

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Local anesthetics are widely used clinically for perioperative analgesia to achieve comfort in medical treatment. However, when the concentration of local anesthetics in the blood exceeds the tolerance of the body, local anesthetic systemic toxicity (LAST) will occur. With the development and popularization of positioning technology under direct ultrasound, the risks and cases of LAST associated with direct entry of the anesthetic into the blood vessel have been reduced. Clinical occurrence of LAST usually presents as a series of severe toxic reactions such as myocardial depression, which is life-threatening. In addition to basic life support (airway management, advanced cardiac life support, etc.), intravenous lipid emulsion (ILE) has been introduced as a treatment option in recent years and has gradually become the first-line treatment for LAST. This review introduces the mechanisms of LAST and identifies the clinical symptoms displayed by the central nervous system and cardiovascular system. The paper features the multimodal mechanism of LAST reversal by ILE, describes research progress in the field, and identifies other anesthetics involved in the resuscitation process of LAST. Finally, the review presents key issues in lipid therapy. Although ILE has achieved notable success in the treatment of LAST, adverse reactions and contraindications also exist; therefore, ILE requires a high degree of attention during use. More in-depth research on the treatment mechanism of ILE, the resuscitation dosage and method of ILE, and the combined use with other resuscitation measures is needed to improve the efficacy and safety of clinical resuscitation after LAST in the future.

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Local Anesthetic Toxicity in the Geriatric Population

Cited by 37 publications

References 45 publications

Outcome of early stage Merkel carcinoma treated by exclusive radiation: a study of 53 patients

Outcome of early stage Merkel carcinoma treated by exclusive radiation: a study of 53 patients

Outcome of Early Stage Merkel Carcinoma Treated by Exclusive Radiation: A Study of 53 Patients.

Mechanisms and Efficacy of Intravenous Lipid Emulsion Treatment for Systemic Toxicity From Local Anesthetics

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