lunes, 6 de febrero de 2012

Lipidos y toxicidad por anestesicos locales

Emulsión de lípidos para la toxicidad por anestésicos locales
Lipid emulsion for local anesthetic systemic toxicity.
Ciechanowicz S, Patil V.
Department of Anaesthesia, BHR University Hospitals NHS Trust, Romford, London RM7 0AG, UK.
Anesthesiol Res Pract. 2012;2012:131784. Epub 2011 Sep 29
The accidental overdose of local anesthetics may prove fatal. The commonly used amide local anesthetics have varying adverse effects on the myocardium, and beyond a certain dose all are capable of causing death. Local anesthetics are the most frequently used drugs amongst anesthetists and although uncommon, local anaesthetic systemic toxicity accounts for a high proportion of mortality, with local anaesthetic-induced cardiac arrest particularly resistant to standard resuscitation methods. Over the last decade, there has been convincing evidence of intravenous lipid emulsions as a rescue in local anesthetic-cardiotoxicity, and anesthetic organisations, over the globe have developed guidelines on the use of this drug. Despite this, awareness amongst practitioners appears to be lacking. All who use local anesthetics in their practice should have an appreciation of patients at high risk of toxicity, early symptoms and signs of toxicity, preventative measures when using local anesthetics, and the initial management of systemic toxicity with intravenous lipid emulsion. In this paper we intend to discuss the pharmacology and pathophysiology of local anesthetics and toxicity, and the rationale for lipid emulsion therapy. 
Uso seguro de anestésicos locales: prevención y manejo de la toxicidad sistémica
Safe use of local anaesthetics: prevention and management of systemic toxicity
Lui KC, Chow YF.
Department of Anaesthesiology and OT Services, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
Hong Kong Med J. 2010 Dec;16(6):470-5.
Local anaesthetic administration is a common clinical practice not only in the operating theatres, but also in other clinical settings. Relevant monitoring and resuscitation facilities in certain clinical settings outside the operation rooms may not be optimal. Despite the low incidence of severe complications associated with administration of local anaesthetics, their safe use is very important since systemic toxicity can be fatal. This article reviews the pharmacology of local anaesthetics, clinical features of systemic toxicity resulting from their local use, and necessary preventive measures and management. The role of lipid emulsion therapy is also discussed.
Emulsión de lípidos intravenosos para el tratamiento de la toxicidad por anestésicos locales
Intravenous lipid emulsion for treatment of local anesthetic toxicity.
Kosh MC, Miller AD, Michels JE.
Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina Campus, Columbia, South Carolina, USA.
Ther Clin Risk Manag. 2010 Oct 5;6:449-51.
CLINICAL QUESTION: Is intravenous lipid emulsion a safe and effective therapy for the reversal and treatment of local anesthetic toxicity? RESULTS: Systematic reviews, human case reports, and experimental animal studies have demonstrated the efficacy of intravenous lipid emulsion therapy in successfully reversing cardiac arrhythmias, cardiac arrest, and cardiac collapse seen with severe systemic local anesthetic toxicity. There are fewer data to support treatment of neurologic toxicities associated with local anesthetics. IMPLEMENTATION: Intravenous lipid emulsion 20% should be available whenever patients receive large doses of local anesthetics in operating rooms and emergency departments. Various dosing protocols have been published in the medical literature. Although the dosing protocols are based on low-level evidence, a lack of major adverse events makes lipid emulsion an appropriate therapy for treating cardiotoxic symptoms induced by local anesthetics
Papel de la emulsión de lípidos durante el apoyo cardiaco avanzado para toxicidad por anestésicos locales
The role of lipid emulsion during advanced cardiac life support for local anesthetic toxicity
P. Toledo
Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
International Journal of Obstetric Anesthesia (2011) 20, 60-63
Lipid emulsion has recently emerged as a potential antidote for local anesthetic systemic toxicity. This review examines the literature and guidelines for administration of lipid emulsion in the setting of advanced cardiac life support. 
Anestesiología y Medicina del Dolor
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