Toxicidad por anestésicos locales

Emulsión lipídica para toxicidad sistémica de 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.
Abstract
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.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182561/pdf/ARP20120indf


Emulsión lípida intravenosa para el tratamiento de la toxicidad de 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.


Abstract
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.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2952483/pdf/tcrm-6-449.pdf

Efectos hemodinámicos de la insulina después de sobredosis de levobupivacaína o bupivacaína racémica en perros
The hemodynamic effects of insulin following overdosage with levobupivacaine or racemic bupivacaine in dogs.
Jung CW, Kim JT, Lee KH.
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 28 Yeongeon-dong, Jongno-gu, Seoul, Korea.
J Korean Med Sci. 2007 Apr;22(2):342-6.
Abstract
Although levobupivacaine (LBUP) is less cardiotoxic than racemic bupivacaine (RBUP), the resuscitation from the LBUP-induced cardiovascular collapse (CVC) has not been easy as expected. Following the recent reports that proposed the resuscitative action of insulin for the RBUP-induced CVC, a controlled trial was performed to assess the feasibility of insulin for the LBUP-induced CVC. Fourteen dogs were randomly allocated into two groups: the RBUP and LBUP groups. Each group received continuous intravenous infusions of RBUP or LBUP until the mean arterial pressure (MAP) reached 40 mmHg. Then, an intravenous bolus of insulin (2 U/kg) was administered. Both groups were successfully resuscitated. At CVC, a decrease of cardiac output and an increase of systemic vascular resistance were observed but to a lesser degree in the LBUP group (p<0.05). After insulin injection, the MAP further declined to under 40 mmHg for several minutes, which was more protracted in the LBUP group (p<0.05). The CVCs induced by LBUP or RBUP in anesthetized dogs could be successfully resuscitated by insulin. Compared with RBUP, however, the less degree of vasoconstriction by LBUP and the innate vasodilatory property of insulin yielded a delayed increment of MAP during the immediate resuscitation period in the LBUP-induced CVC.
http://www.jkms.org/Synapse/Data/PDFData/0063JKMS/jkms-22-342.pdf





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Anestesiología y Medicina del Dolor
www.anestesia-dolor.org