Prolonged Pulseless Electrical Activity Cardiac Arrest After Intranasal Injection of Lidocaine With Epinephrine: A Case Report

Weber, Frank; Guha, Rahul; Weinberg, Guy; Gitman, Marina

doi:10.1213/xaa.0000000000000962

Cited by 10 publications

(4 citation statements)

References 4 publications

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“…In Rosenblatt et al (32) used 20% lipid emulsion infusion and successfully resuscitated a patient whose heart was arrested for a long time as a result of bupivacaine toxicity. Thus, the effectiveness of lipid emulsions has been verified in clinical cases; many reports have documented successful recovery from LAST with lipid emulsions (33)(34)(35). Lipid emulsion therapy has also achieved good results as a treatment for LAST in newborns and children, not just in adults (36,37).…”

Section: Lipid Emulsion Therapy In Last Lipid Emulsionsmentioning

confidence: 97%

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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Section: Lipid Emulsion Therapy In Last Lipid Emulsionsmentioning

confidence: 97%

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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“…93 Local anesthetic systemic toxicity (LAST) can cause devastating arrhythmia and POCA. [94][95][96][97][98][99][100][101][102][103][104][105][106] Bupivacaine can induce severe myocardial depression 107 and cardiac toxicity, mimicking an acute non-ST segment elevation myocardial infarction. 108 One case described a 76-year-old woman undergoing outpatient TEE and atrial fibrillation cardioversion.…”

Section: Drugsmentioning

confidence: 99%

Causes of Perioperative Cardiac Arrest: Mnemonic, Classification, Monitoring, and Actions

Meng,

Rasmussen,

Abcejo

et al. 2023

Anesthesia &Amp; Analgesia

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Perioperative cardiac arrest (POCA) is a catastrophic complication that requires immediate recognition and correction of the underlying cause to improve patient outcomes. While the hypoxia, hypovolemia, hydrogen ions (acidosis), hypo-/hyperkalemia, and hypothermia (Hs) and toxins, tamponade (cardiac), tension pneumothorax, thrombosis (pulmonary), and thrombosis (coronary) (Ts) mnemonic is a valuable tool for rapid differential diagnosis, it does not cover all possible causes leading to POCA. To address this limitation, we propose using the preload-contractility-afterload-rate and rhythm (PCARR) construct to categorize POCA, which is comprehensive, systemic, and physiologically logical. We provide evidence for each component in the PCARR construct and emphasize that it complements the Hs and Ts mnemonic rather than replacing it. Furthermore, we discuss the significance of utilizing monitored variables such as electrocardiography, pulse oxygen saturation, end-tidal carbon dioxide, and blood pressure to identify clues to the underlying cause of POCA. To aid in investigating POCA causes, we suggest the Anesthetic care, Surgery, Echocardiography, Relevant Check and History (A-SERCH) list of actions. We recommend combining the Hs and Ts mnemonic, the PCARR construct, monitoring, and the A-SERCH list of actions in a rational manner to investigate POCA causes. These proposals require real-world testing to assess their feasibility.

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“…Between December 2017 and May 2020, there were a further 36 cases of LAST reported in 34 peer‐reviewed published articles [6–39]. These data indicated 30% of patients were older than 65 y, and 6% were younger than 5 y. Sixty‐one percent of cases occurred in the hospital; 17% in outpatient surgery centres; and 14% in outpatient clinics (e.g.…”

Section: Clinical Presentationmentioning

confidence: 99%

Updates in our understanding of local anaesthetic systemic toxicity: a narrative review

et al. 2021

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Summary Despite advances in clinical practice, local anaesthetic systemic toxicity continues to occur with the therapeutic use of local anaesthesia. Patterns of presentation have evolved over recent years due in part to the increasing use of ultrasound which has been demonstrated to reduce risk. Onset of toxicity is increasingly delayed, a greater proportion of clinical reports are secondary to fascial plane blocks, and cases are increasing where non‐anaesthetist providers are involved. The evolving clinical context presents a challenge for diagnosis and requires education of all physicians, nurses and allied health professionals about these changing patterns and risks. This review discusses: mechanisms; prevention; diagnosis; and treatment of local anaesthetic systemic toxicity. The local anaesthetic and dose used, site of injection and block conduct and technique are all important determinants of local anaesthetic systemic toxicity, as are various patient factors. Risk mitigation is discussed including the care of at‐risk groups, such as: those at the extremes of age; patients with cardiac, hepatic and specific metabolic diseases; and those who are pregnant. Advances in the changing clinical landscape with novel applications and settings for the use of local anaesthesia are also described. Finally, we signpost future directions to potentially improve the management of local anaesthetic systemic toxicity. The utility of local anaesthetics remains unquestionable in clinical practice, and thus maximising the safe and appropriate use of these drugs should translate to improvements in patient care.

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Prolonged Pulseless Electrical Activity Cardiac Arrest After Intranasal Injection of Lidocaine With Epinephrine: A Case Report

Cited by 10 publications

References 4 publications

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

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

Causes of Perioperative Cardiac Arrest: Mnemonic, Classification, Monitoring, and Actions

Updates in our understanding of local anaesthetic systemic toxicity: a narrative review

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