Perinatal asphyxia and inadvertent neonatal intoxication from local anaesthetics given to the mother during labour

Pignotti, Maria Serenella; Indolfi, Giuseppe; Ciuti, Riccardo; Donzelli, Gabriele

doi:10.1136/bmj.330.7481.34

Cited by 12 publications

(5 citation statements)

References 5 publications

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“…Plasma lidocaine levels were 14 μg/mL (equivalent to 14 mg/L). Since this initial report, there have been case reports of intoxication from local anaesthetics for episiotomy, including lidocaine and mepivacaine, with a number of these suggestive of transplacental intoxication following local perineal infiltration rather than direct foetal injection 4–6…”

Section: Discussionmentioning

confidence: 99%

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Early-onset neonatal seizures: lidocaine toxicity as a rare differential diagnosis to hypoxic ischaemic encephalopathy

2023

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A term newborn girl presented with apnoea and seizures at approximately 20 min of life following an uneventful vaginal delivery. She required admission to the Neonatal Intensive Care Unit following intubation and was commenced on conventional ventilation. Her mother had received a local lidocaine injection for an episiotomy prior to delivery. Initial investigations confirmed electrographic seizures for which she received an anticonvulsant with successful termination of seizure activity. Investigations for hypoxic injury, intracranial trauma, structural brain abnormalities, metabolic disorders and infection were unremarkable. Her blood lidocaine level was subsequently found to be elevated, confirming lidocaine toxicity as the cause of presentation. She demonstrated clinical improvement with no evidence of complications at time of discharge or on early follow-up.

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Section: Discussionmentioning

confidence: 99%

“…Very rarely, some neonates will experience toxic levels of local anaesthetic which lead to symptoms such as those experienced in our patient. Toxic levels have been shown to occur in the absence of direct foetal injection 4–6…”

Section: Discussionmentioning

confidence: 99%

Early-onset neonatal seizures: lidocaine toxicity as a rare differential diagnosis to hypoxic ischaemic encephalopathy

2023

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“…Furthermore, brain imaging and blood results were not suggestive for asphyxia during pregnancy or labor. The onset of all the signs observed in our case might therefore be caused by intoxication from local anesthesia [2].…”

Section: Discussionmentioning

confidence: 99%

Severe Cardiorespiratory and Neurologic Symptoms in a Neonate due to Mepivacaine Intoxication

Mooren

Quint

Knobbe

et al. 2019

Case Reports in Pediatrics

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Local anesthesia with mepivacaine is used for vaginal deliveries and for minor surgeries of the vagina and perineum as repair of an episiotomy or perineal laceration. Neonatal intoxication caused by local anesthesia with mepivacaine for maternal episiotomy has been rarely reported. We present a case of a term female infant with unexplained cardiorespiratory distress and several neurologic findings, including seizures, one hour after birth. Electrocardiogram showed a second-degree atrioventricular block and a left-bundle branch block. Blood measures in the patient revealed a high mepivacaine level following local anesthesia for maternal episiotomy. Because of the increasing practice of local anesthesia, high awareness for neonatal intoxication and further research in safe elimination therapy in neonates is needed.

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“…• quatre sont secondaires à une infiltration accidentelle de lidocaïne dans le scalp du bébé après bloc pudendal [1,2,10,11] ; • une observation fait suite à un bloc pudendal sans effraction du scalp avec confirmation par un taux élevé de lidocaïne dans le sang du cordon [12] ; • un cas d'intoxication néonatale à la lidocaïne et à la prilocaïne, après application locale d'une crème de lidocaïne et prilocaïne à 2,5 % avant réalisation d'une épisiotomie [13]. Il s'agit d' un tableau clinique typique d'intoxication néonatale à la lidocaïne avec un dosage sanguin de lidocaïne et de prilocaïne retrouvant des concentrations élevées.…”

Section: Discussionunclassified

“…Les sept autres intoxications concernaient des injections périnéales de mépivacaïne dont six dans le scalp [14,15] et une injection sous cutanée périnéale sans lésion du scalp avec confirmation par dosage sanguin [13].…”

Section: Discussionunclassified

Intoxication néonatale à la lidocaïne après analgésie par bloc des nerfs honteux : à propos de trois observations

Pagès

Gastine²,

Quedru-Aboane

et al. 2008

Journal de Gynécologie Obstétrique et Biologie de la Reproducti

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Perinatal asphyxia and inadvertent neonatal intoxication from local anaesthetics given to the mother during labour

Cited by 12 publications

References 5 publications

Early-onset neonatal seizures: lidocaine toxicity as a rare differential diagnosis to hypoxic ischaemic encephalopathy

Early-onset neonatal seizures: lidocaine toxicity as a rare differential diagnosis to hypoxic ischaemic encephalopathy

Severe Cardiorespiratory and Neurologic Symptoms in a Neonate due to Mepivacaine Intoxication

Intoxication néonatale à la lidocaïne après analgésie par bloc des nerfs honteux : à propos de trois observations

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