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Anesthetic Toxicity
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Guy L Weinberg – One of the best experts on this subject based on the ideXlab platform.
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Prolonged Pulseless Electrical Activity Cardiac Arrest After Intranasal Injection of Lidocaine With Epinephrine: A Case Report.
A&A practice, 2019Co-Authors: Frank Weber, Guy L Weinberg, Rahul Guha, Frank Steinbach, Marina GitmanAbstract:Local Anesthetic Toxicity is a rare but serious complication of local Anesthetic administration. Although lidocaine has a safety profile superior to other amide local Anesthetics, we report a case of cardiac arrest after intranasal injection of lidocaine. The case involves a 22-year-old healthy woma
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confusion about infusion rational volume limits for intravenous lipid emulsion during treatment of oral overdoses
Annals of Emergency Medicine, 2015Co-Authors: Michael R. Fettiplace, Belinda S Akpa, Israel Rubinstein, Guy L WeinbergAbstract:After the initial report of treatment of bupropion and lamotrigine overdose by intravenous lipid emulsion, additional case reports have asserted the usefulness of lipid emulsion for enteral poisonings. In accordance with these and other reports, the American College of Medical ToxiToxicology offered interim guidelines on lipid resuscitation therapy; they recommended a bolus of 1.5 mL/kg, followed by an infusion of 0.25 mL/kg/min of intravenous lipid emulsion if Toxicity persists. This recommendation was based on guidelines for treatment of local Anesthetic Toxicity, in which absorption is quick and Toxicity short lived. In contrast to local Anesthetic Toxicity, prolonged absorption during enteral overdose can result in extended Toxicity, with a need for continuing medical support, including a protracted infusion of lipid emulsion. Guidelines for lipid resuscitation therapy in local Anesthetic Toxicity set an upper limit of 10 to 12 mL/kg during the first half hour, but because of the aforementioned nature of oral overdoses, the American College of Medical ToxiToxicology did not provide a limit on total lipid infusion volume or duration of infusion. In the absence of limits, an increasing number of cases have reported the use of large volumes of lipid to treat oral overdose. However, until definitive studies can be conducted, there is a need for rational volume limits to prevent undisciplined use of intravenous lipid emulsion. With the increased adoption of lipid resuscitation therapy, several case reports have identified the potential usefulness of prolonged lipid infusions for enteral Toxicity. In the largest aggregation of cases, Cave et al reported that intravenous lipid emulsion improved Glasgow ComaComale ratings and increased systolic blood pressure during treatment of nonlocal Anesthetic overdose in 38 patients. The average dose of lipid used in these cases was 531 mL (SD 22 mL), which is within ranges recommended by professional societies. With these doses, there were no significant adverse effects except interference with laboratory tests because of lipemia
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American Society of Regional Anesthesia and Pain Medicine checklist for managing local Anesthetic systemic Toxicity: 2012 version.
Regional anesthesia and pain medicine, 2012Co-Authors: Joseph M. Neal, Michael F. Mulroy, Guy L WeinbergAbstract:The American Society of Regional Anesthesia and Pain Medicine (ASRA) periodically revises and updates its checklist for the management of local Anesthetic systemic Toxicity. The 2017 update replaces the 2012 version and reflects new information contained in the third ASRA Practice Advisory on Local Anesthetic Systemic Toxicity. Electronic copies of the ASRA checklist can be downloaded from the ASRA Web site (www.asra.com) for inclusion in local Anesthetic Toxicity rescue kits or perioperative checklist repositories.
James R. Hebl – One of the best experts on this subject based on the ideXlab platform.
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Mayo Clinic Atlas of Regional Anesthesia and Ultrasound-Guided Nerve Blockade – Complications of Peripheral Nerve Blockade
Mayo Clinic Atlas of Regional Anesthesia and Ultrasound-Guided Nerve Blockade, 2010Co-Authors: James R. Hebl, Robert L. LennonAbstract:Most complication associated with peripheral nerve blockade fall into one of three categories: neurologic, hemorrhagic, or infectious. Most neurologic complications are attributable to mechanical trauma or local Anesthetic Toxicity. Patient, procedure, and Anesthetic risk factors are reviewed. Hemorrhagic complications include bruising and hematoma formation. Single-injection and continuous catheter techniques are discussed. The possible role of catheters in infectious complications of nerve blockade is examined.
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Clinical utility of low-volume ultrasound-guided interscalene blockade: contraindications reconsidered.
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2009Co-Authors: Hugh M. Smith, Christopher M. Duncan, James R. HeblAbstract:Objective. The purpose of this series is to describe cases in which ultrasound guidance was used to allow patients to receive the benefits of regional anesthesia while safely circumventing traditional contraindications to interscalene blockade (ISB). Methods. Targeted low-volume ISB was performed in 3 patients in whom this procedure would typically be contraindicated because of phrenic nerve blockade or risk of local Anesthetic Toxicity. A patient with severe respiratory dysfunction, a patient undergoing bilateral shoulder surgery, and a patient requiring awake fiberoptic intubation underwent low-volume ultrasound-guided ISB. The ultrasound technique involved the use a low local Anesthetic volume, anatomic identification of the brachial plexplexus trunk, needle placement opposite the phrenic nerve position, and control over local Anesthetic spread. Results. In both patients in whom diaphragmatic paralysis was a concern, postoperative respiratory parameters indicated successful regional analgesia without evidence of phrenic nerve blockade. In the patient requiring an additional regional Anesthetic procedure, ISB was performed with a local Anesthetic volume low enough to avoid exceeding toxic safety thresholds. Conclusions. Although further studies are warranted, we report on 3 cases in which ultrasound guidance was used to allow patients to receive the benefits of regional anesthesia while safely avoiding standard contraindications to ISB. Ultrasound technology may allow providers to perform low-volume brachial plexplexus blockade while avoiding issues related to phrenic nerve blockade and systemic local Anesthetic Toxicity.
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Regional blockade in patients with a history of a seizure disorder.
Anesthesia and analgesia, 2009Co-Authors: Sandra L. Kopp, James R. Hebl, Terese T. Horlocker, Kimberly P. Wynd, Jack L. WilsonAbstract:BACKGROUND:Systemic local Anesthetic Toxicity is a potential complication in patients undergoing regional anesthesia, particularly during procedures requiring large doses of local Anesthetic, such as epidurals, caudals, and peripheral nerve blocks. It is unknown whether patients with a history of a
Italo Castelli – One of the best experts on this subject based on the ideXlab platform.
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Unusual Psychological Manifestation of Systemic Local Anesthetic Toxicity
Anesthesiology, 1998Co-Authors: Stephan Marsch, H. G. Schaefer, Italo CastelliAbstract:Unusual Psychological Manifestation of Systemic Local Anesthetic Toxicity Stephan Marsch;Hans-Gerhard Schaefer;Italo Castelli; Anesthesiology
Martyn Harvey – One of the best experts on this subject based on the ideXlab platform.
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Lipid emulsion in local Anesthetic Toxicity.
Current opinion in anaesthesiology, 2017Co-Authors: Martyn Harvey, Grant CaveAbstract:Purpose of reviewEnthusiasm for regional anesthesia has been driven by multimodal benefits to patient outcomes. Despite widespread awareness and improved techniques (including the increasing use of ultrasound guidance for block placement), intravascular sequestration and the attendant risk of local
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intravenous lipid emulsion as antidote beyond local Anesthetic Toxicity a systematic review
Academic Emergency Medicine, 2009Co-Authors: Grant Cave, Martyn HarveyAbstract:Objectives: The objective was to asses the efficacy of lipid emulsion as antidotal therapy outside the accepted setting of local Anesthetic Toxicity. Methods: Literature was accessed through PubMed, OVID (1966–February 2009), and EMBASE (1947–February 2009) using the search terms “intravenous” AND [“fat emulsion” OR “lipid emulsion” OR “Intralipid”] AND [“Toxicity” OR “resuscitation” OR “rescue” OR “arrest” OR “antidote”]. Additional author and conference publication searches were undertaken. Publications describing the use of lipid emulsion as antidotal treatment in animals or humans were included. Results: Fourteen animal studies, one human study, and four case reports were identified. In animal models, intravenous lipid emulsion (ILE) has resulted in amelioration of Toxicity associated with cyclic antidepressants, verapamil, propranolol, and thiopentone. Administration in human cases has resulted in successful resuscitation from combined bupropion/lamotrigine-induced cardiac arrest, reversal of sertraline/quetiapine-induced coma, and amelioration of verapamil- and beta blocker–induced shock. Conclusions: Management of overdose with highly lipophilic cardiotoxic medications should proceed in accord with established antidotal guidelines and early poisons center consultation. Data from animal experiments and human cases are limited, but suggestive that ILE may be helpful in potentially lethal cardioToxicity or developed cardiac arrest attributable to such agents. Use of lipid emulsion as antidote remains a nascent field warranting further preclinical study and systematic reporting of human cases of use.
Grant Cave – One of the best experts on this subject based on the ideXlab platform.
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Lipid emulsion in local Anesthetic Toxicity.
Current opinion in anaesthesiology, 2017Co-Authors: Martyn Harvey, Grant CaveAbstract:Purpose of reviewEnthusiasm for regional anesthesia has been driven by multimodal benefits to patient outcomes. Despite widespread awareness and improved techniques (including the increasing use of ultrasound guidance for block placement), intravascular sequestration and the attendant risk of local
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intravenous lipid emulsion as antidote beyond local Anesthetic Toxicity a systematic review
Academic Emergency Medicine, 2009Co-Authors: Grant Cave, Martyn HarveyAbstract:Objectives: The objective was to asses the efficacy of lipid emulsion as antidotal therapy outside the accepted setting of local Anesthetic Toxicity. Methods: Literature was accessed through PubMed, OVID (1966–February 2009), and EMBASE (1947–February 2009) using the search terms “intravenous” AND [“fat emulsion” OR “lipid emulsion” OR “Intralipid”] AND [“Toxicity” OR “resuscitation” OR “rescue” OR “arrest” OR “antidote”]. Additional author and conference publication searches were undertaken. Publications describing the use of lipid emulsion as antidotal treatment in animals or humans were included. Results: Fourteen animal studies, one human study, and four case reports were identified. In animal models, intravenous lipid emulsion (ILE) has resulted in amelioration of Toxicity associated with cyclic antidepressants, verapamil, propranolol, and thiopentone. Administration in human cases has resulted in successful resuscitation from combined bupropion/lamotrigine-induced cardiac arrest, reversal of sertraline/quetiapine-induced coma, and amelioration of verapamil- and beta blocker–induced shock. Conclusions: Management of overdose with highly lipophilic cardiotoxic medications should proceed in accord with established antidotal guidelines and early poisons center consultation. Data from animal experiments and human cases are limited, but suggestive that ILE may be helpful in potentially lethal cardioToxicity or developed cardiac arrest attributable to such agents. Use of lipid emulsion as antidote remains a nascent field warranting further preclinical study and systematic reporting of human cases of use.