Wiesmann, T. and Schubert, A-K and Volk, T. and Kubulus, C. and Zausig, Y. and Graf, B. M. and Steinfeldt, T. (2020) Prevention & therapy of local anaesthetic systemic toxicity (LAST) Updated action recommendations of the scientific working group of regional anaesthesia of the German Society of Anaesthesiology and Intensive Care Medicine. ANASTHESIOLOGIE & INTENSIVMEDIZIN, 61. pp. 225-238. ISSN 0170-5334, 1439-0256
Full text not available from this repository. (Request a copy)Abstract
Local anaesthetic systemic toxicity (LAST) is a rare, mostly iatrogenic complication. Because of its potential life threat a systematic procedure is recommended. Prevention measures designed to avoid LAST events are of great importance. Regular aspiration under a fractionated injection of local anaesthetics, a dose reduction of lipophilic local anaesthetics as well as a more frequent application of ultrasounding to decrease accidental vascular puncture (by visualisation of anatomical structures), and training of the users of local anaesthetic constitute the essential preventive actions. Once a LAST event occurs any further administration of the local anaesthetic must be stopped immediately. Securing adequate oxygenation (also airway management, if necessary) is of decisive significance as hypoxia and acidosis potentiate the toxicity of local anaesthetics. Anticonvulsive therapy should be applied in case convulsive seizures appear. If LAST is associated with cardiac arrest immediate cardiopulmonary resuscitation must proceed in accordance with the valid guideline, whereby resuscitation efforts must be continued over a longer period of time due to the pharmacodynamics of some local anaesthetics. An early and rapid intravenous administration of lipid solution as an unspecific antidote is of importance in severe cases of LAST (cardiovascular arrest, severe circulatory depression). A redistribution of local anaesthetics from the heart and the central nervous system as well as cardiotonic and post-conditioning cardioprotective effects are being discussed as the underlying mechanisms of a therapy with lipid emulsions. Recommended is the immediate application of a lipid bolus of 100 ml of a 20% lipid solution (equivalent to a dose 1.5 ml/kg b.w. in a patient weighing 70 kg) over one minute, in case of persistence of symptoms a repetition of the bolus after 5 minutes and a subsequent continuous infusion of 0.25 ml/kg b.w./min lipid solution for 15-20 minutes. In the event of prolonged resuscitation measures an extracorporeal veno-arterial circulation (extracorporeal cardiopulmonary resuscitation - eCPR) should be taken into consideration at an early stage.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | INTRAVENOUS LIPID EMULSION; CENTRAL-NERVOUS-SYSTEM; INDUCED CARDIAC-ARREST; SUCCESSFUL RESUSCITATION; CARDIOVASCULAR COLLAPSE; AMERICAN SOCIETY; PATIENT SAFETY; PLEXUS BLOCK; RAT MODEL; BUPIVACAINE; Intoxication; Local Anaesthetics; Resuscitation; Convulsive Seizure |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Anästhesiologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 22 Mar 2021 11:50 |
| Last Modified: | 22 Mar 2021 11:50 |
| URI: | https://pred.uni-regensburg.de/id/eprint/44473 |
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