Blood-soft tissue barrier breach and soft tissue recoil pressure on local anesthetic: two physiological mechanisms for local anesthetic systemic toxicity

Kumar, Amarjeet; Kumar, Ajeet

doi:10.1016/j.bjane.2021.04.016

Cited by 1 publication

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“…The inadvertent intravascular injection of LA during regional anesthesia causes Local Anesthetic Systemic Toxicity (LAST). This syndrome includes seizures, malignant arrhythmias to cardiac arrest, hardly responsive to resuscitation [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Cardio Protective Effects of Lipid Emulsion against Ropivacaine-Induced Local Anesthetic Systemic Toxicity—An Experimental Study

Lazăr

Gurzu

Kövecsi

et al. 2022

JCM

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Inadvertent intravascular injection of local anesthetics (LA) during regional anesthesia causes Local Anesthetic Systemic Toxicity (LAST). Theories of lipid rescue in the case of LAST proved that the administration of lipids in LAST has beneficial effects. One possible mechanism of action is based on the lipophilic properties of LA which allow plasma-free LA to be bound by the molecules of Lipid Emulsion (LE). The association LA–LE is shuttled towards organs such as liver and the kidneys, and the half-life of LA is shortened. The main objective of this experimental study was to assess the possible cardio-prophylactic effect of LE administration before the induction of LAST by intravenous administration of Ropivacaine. This was an experimental, interventional, prospective, and non-randomized study. The subjects were divided into groups and received, under general anesthesia, LE 20% first 0.3–0.4 mL, followed by 0.1 mL Ropivacaine 2 mg/mL, or Ropivacaine alone. At the end of the experiment, the subjects were sacrificed, and tissue samples of kidney, heart and liver were harvested for histopathological examination. LE, when administered as prophylaxis in Ropivacaine-induced LAST, had protective cardiac effects in rats. The LE known side effects were not produced if the substance was administered in the low doses used for LAST prophylaxis.

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Section: Introductionmentioning

confidence: 99%