LOCAL ANAESTHETIC SYSTEMIC TOXICITY: CURRENT CONCEPTS AND

Local anesthetics are one of the most commonly used drugs in the field of medicine. Local anesthetics are widely used to induce anesthesia and analgesia for surgical procedures and pain management. Local an aesthetic systemic toxicity (LAST) is a rare but potentially fatal complication of regional anesthesia and has been recognized and reported since the late1800s. This narrative review summarizes the pharmacology of local anesthetics, clinical manifestations of systemic toxicity associated with these agents, necessary preventive measures and recent treatment strategies.

[1]  L. Mather,et al.  Cardiotoxicity with Modern Local Anaesthetics , 2012, Drugs.

[2]  B. Finucane,et al.  Local anesthetic systemic toxicity , 2010, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[3]  J. Neal,et al.  ASRA Practice Advisory on Local Anesthetic Systemic Toxicity , 2009, Regional Anesthesia & Pain Medicine.

[4]  G. Weinberg,et al.  Lipid resuscitation for local anesthetic toxicity: is it really lifesaving? , 2009, Current opinion in anaesthesiology.

[5]  T. Martin,et al.  Use of Intralipid in an infant with impending cardiovascular collapse due to local anesthetic toxicity , 2009, Journal of Anesthesia.

[6]  J. Butterworth.  Models and Mechanisms of Local Anesthetic Cardiac Toxicity: A Review , 2009, Regional Anesthesia & Pain Medicine.

[7]  B. Graf,et al.  The toxicity of local anesthetics: the place of ropivacaine and levobupivacaine , 2008, Current opinion in anaesthesiology.

[8]  G. Fanelli,et al.  Pharmacology, toxicology, and clinical use of new long acting local anesthetics, ropivacaine and levobupivacaine. , 2008, Acta bio-medica : Atenei Parmensis.

[9]  J. Gerancher,et al.  Early Intralipid Therapy May Have Prevented Bupivacaine‐Associated Cardiac Arrest , 2008, Regional anesthesia and pain medicine.

[10]  N. Bedforth,et al.  Levobupivacaine‐induced seizures and cardiovascular collapse treated with Intralipid® , 2007, Anaesthesia.

[11]  David.L Brown,et al.  Local Anesthetic Toxicity , 2007 .

[12]  S. Stehr,et al.  Successful resuscitation of a patient with ropivacaine‐induced asystole after axillary plexus block using lipid infusion * , 2006, Anaesthesia.

[13]  J. Eisenkraft,et al.  Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. , 2006, Anesthesiology.

[14]  A. Casati,et al.  Bupivacaine, levobupivacaine and ropivacaine: are they clinically different? , 2005, Best practice & research. Clinical anaesthesiology.

[15]  D. Feinstein,et al.  Lipid Infusion Accelerates Removal of Bupivacaine and Recovery From Bupivacaine Toxicity in the Isolated Rat Heart , 2005, Regional Anesthesia & Pain Medicine.

[16]  P. Rosenberg,et al.  Maximum Recommended Doses of Local Anesthetics: A Multifactorial Concept , 2004, Regional Anesthesia & Pain Medicine.

[17]  P. Neuvonen,et al.  Pharmacokinetics of Ropivacaine in Uremic and Nonuremic Patients After Axillary Brachial Plexus Block , 2003, Anesthesia and analgesia.

[18]  M. Mulroy.  Systemic Toxicity and Cardiotoxicity From Local Anesthetics: Incidence and Preventive Measures , 2002, Regional Anesthesia & Pain Medicine.

[19]  P. Chui,et al.  Local anaesthesia outside the operating room. , 2002, Hong Kong medical journal = Xianggang yi xue za zhi.

[20]  R. Gristwood.  Cardiac and CNS Toxicity of Levobupivacaine , 2002 .

[21]  A. Borgeat,et al.  From cocaine to ropivacaine: the history of local anesthetic drugs. , 2001, Current topics in medicinal chemistry.

[22]  T. Nelson,et al.  Is Comparative Cardiotoxicity of S(−) and R(+) Bupivacaine Related to Enantiomer-Selective Inhibition of L-Type Ca2+ Channels? , 2001, Anesthesia and analgesia.

[23]  G. Weinberg,et al.  Pretreatment or Resuscitation with a Lipid Infusion Shifts the Dose‐Response to Bupivacaine‐induced Asystole in Rats , 1998, Anesthesiology.

[24]  B. Graf,et al.  Stereospecific Effect of Bupivacaine Isomers on Atrioventricular Conduction in the Isolated Perfused Guinea Pig Heart , 1997, Anesthesiology.

[25]  K. Samii,et al.  Myocardial uptake of bupivacaine: II. Pharmacokinetics and pharmacodynamics of bupivacaine enantiomers in the isolated perfused rabbit heart. , 1993, Anesthesia and analgesia.

[26]  A. Artru,et al.  Effect of Intracerebroventricular Picrotoxin and Muscimol on Intravenous Bupivacaine Toxicity: Evidence Supporting Central Nervous System Involvement in Bupivacaine Cardiovascular Toxicity , 1993, Anesthesiology.

[27]  B. Covino,et al.  Effect of progesterone on the cardiac electrophysiologic alterations produced by ropivacaine and bupivacaine. , 1992, Anesthesiology.

[28]  F. Walker,et al.  Pregnancy Increases Median Nerve Susceptibility to Lidocaine , 1990 .

[29]  R. Lindberg,et al.  EXTRADURAL ADMINISTRATION OF BUPIVACAINE: PHARMACOKINETICS AND METABOLISM IN PREGNANT AND NON-PREGNANT WOMEN , 1990 .

[30]  D. Denson,et al.  Alpha1‐acid glycoprotein and albumin in human serum bupivacaine binding , 1984 .

[31]  A. Barson,et al.  Fat embolism in infancy after intravenous fat infusions. , 1978, Archives of disease in childhood.

[32]  M. H. Alper.  Toxicity of local anesthetics. , 1976, The New England journal of medicine.

[33]  S. Englesson.  The Influence of Acid‐Base Changes on Central Nervous System Toxicity of Local Anaesthetic Agents I: An Experimental Study in Cats , 1974, Acta anaesthesiologica Scandinavica.

[34]  D. Moore,et al.  Oxygen: the antidote for systemic toxic reactions from local anesthetic drugs. , 1960, JAMA.

[35]  P. E. Ireland,et al.  The clinical and experimental comparison of cocaine and pontocaine as topical anesthetics in otolaryngological practice , 1951, The Laryngoscope.