Long-Acting Local Anesthetic Drugs and Convulsions with Hypoxia and Acidosis

Moore, Daniel C.; Thompson, Gale E.; Crawford, Robert D.

doi:10.1097/00132586-198212000-00053

Cited by 14 publications

(19 citation statements)

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“…This patient was not hypoxic; however, he was mildly hypercarbic at the time of the arrhythmias. The mild respiratory acidosis may have contributed to the toxicity of the bupivacaine (Moore, Thompson & Crawford 1982). The arrhythmias may, on the other hand, have had nothing to do with bupivacaine.…”

Section: Discussionmentioning

confidence: 99%

Excessively high plasma bupivacaine concentrations after tonsillar bed and adenoidal injection of 0.25% bupivacaine

Brown

Wilhoit

Samuel

1993

Pediatric Anesthesia

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The injection of local anaesthetics into the tonsillar bed has gained acceptance in the United States as a method for providing postoperative pain relief. A clinical trial. was devised in which the tonsillar bed was injected at the upper and lower poles subsequent to the removal of each tonsil. In addition, a small amount of local anaesthetic was sprayed topically by the nares onto the adenoidal beds subsequent to adenoidectomy to alleviate pain from this area. Bupivacaine was used as the local anaesthetic because of its long duration of action. Despite extreme care in the performance of this study, one patient developed ventricular tachycardia subsequent to the injection of bupivacaine. Plasma bupivacaine levels were obtained after tonsillar bed infiltration and nasal instillation post tonsillectomy and adenoidectomy in each of the patients, and though most levels were below toxic ranges, one patient had high serum levels. This high serum level coincided with the development of ventricular tachycardia. On the basis of this finding, we have abandoned this technique for postoperative pain management after tonsillectomy.

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Section: Discussionmentioning

confidence: 99%

Excessively high plasma bupivacaine concentrations after tonsillar bed and adenoidal injection of 0.25% bupivacaine

Brown

Wilhoit

Samuel

1993

Pediatric Anesthesia

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“…Es wird empfohlen die Indikation zur Intubation und Beatmung mit 100% Sauerstoff bereits bei den ersten Anzeichen einer Atemdepression großzügig zu stellen [28,29,44].Die Therapie der Krampfanfälle wird mit Barbituraten (z. B. Thiopental) oder Benzodiazepinen (z.B.Diazepam) durchgeführt [28,29,43,44].…”

Section: Vorgehen Bei Systemischen Intoxikationenunclassified

Ausgew�hlte Notf�lle in der operativen Dermatologie

Schulte

Horn

2004

Der Hautarzt

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The large number of surgical procedures in many subspecialty areas of dermatology, such as dermatologic oncology, phlebology and aesthetic dermatology, raises the question of possible complications and emergency situations. Along with common complications such as post-operative bleeding, infections or flap necrosis, there are emergency situations which require immediate intervention to avoid significant harm to the patient. One must distinguish between dermatologic situations which require emergency surgery and emergencies that arise during or after dermatological surgery.

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“…Es wird empfohlen, die Indikation zur endotachealen Intubation und Beatmung mit 100% Sauerstoff bereits bei den ersten Anzeichen einer beginnenden Atemdepression großzügig zu stellen und eine leichte Hyperventilation zur Verminderung der zerebralen Perfusion anzustreben [149,150,151,152].…”

Section: Therapieoptionen Bei Systemischer Intoxikationunclassified

Toxikologie der Lokalan�sthetika

Zink

Graf

2003

Der Anaesthesist

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Regardless of their specific physico-chemical properties and chemical structures, all local anaesthetic agents block neuronal voltage-gated sodium channels, and thus suppress conduction in peripheral nerves. Since these ion channels ubiquitously appear in excitable membranes, systemic accumulation of local anaesthetic agents may affect the functional integrity of these structures. Clinically, local anaesthetic-induced systemic toxicity results in central nervous and cardiovascular malfunction. With regard to CNS toxicity, symptoms which are largely drug-independent appear in a characteristic biphasic sequence. Nevertheless, the plasma levels necessary to provoke these symptoms are to a large extent agent-specific. Initially, these toxic mechanisms are due to a selective blockade of cortical inhibitory neurons, which enables the formation of seizure potentials within subcortical structures. With high cerebral drug levels, however, excitatory neurons are also increasingly blocked, resulting in coma, apnoeic episodes and circulatory failure. Direct cardiac effects of local anaesthetics can be divided into (i) stereospecific inhibition of intracardial conduction and (ii) unspecific inhibition of myocardial energy supply and ion channels. The corresponding spectrum of symptoms is not uniform and may range from extreme bradycardia, (malignant) ventricular arrhythmia to refractory cardiac arrest. Local tissue toxicity has to be strictly delimited from systemic toxicity and allergies, respectively, which are mainly caused by aminoester agents. Local anaesthetics may cause neuronal and striated muscle injury at the site of injection. With regard to (central) neurotoxicity, "transient neurologic symptoms" and "cauda equina syndrome" have been increasingly recognised. However, the clinical relevance of local anaesthetic-induced myotoxicity is still controversly discussed. In order to avoid systemic accumulation of local anaesthetic agents, several safety procedures have to be considered during the application of these drugs. The treatment of systemic toxicity is strictly dependent on the expression of symptoms. However, hypoxia and acidotic episodes must be avoided and must be treated aggressively.

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Long-Acting Local Anesthetic Drugs and Convulsions with Hypoxia and Acidosis

Cited by 14 publications

References 0 publications

Excessively high plasma bupivacaine concentrations after tonsillar bed and adenoidal injection of 0.25% bupivacaine

Excessively high plasma bupivacaine concentrations after tonsillar bed and adenoidal injection of 0.25% bupivacaine

Ausgew�hlte Notf�lle in der operativen Dermatologie

Toxikologie der Lokalan�sthetika

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