Cardiac Arrest and Seizures Caused by Local Anesthetic Systemic Toxicity After Peripheral Nerve Blocks

Liu, Spencer S.; Ortolan, Sarah; Sandoval, Miguel Vizarreta; Curren, Jodie; Fields, Kara G.; Memtsoudis, Stavros G.; YaDeau, Jacques T.

doi:10.1097/aap.0000000000000329

Cited by 45 publications

(28 citation statements)

References 18 publications

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“…Similarly, the Hospital for Special Surgery in New York, which represents a specialized high-volume regional anesthesia practice, reported 0.04 seizures per 1000 blocks, which is lower than other reports and may not apply to the community at large. 29 Pediatric anesthetics captured in registries 40,42 and singlecenter 41 observational studies confirm a very low overall rate of LAST in children. Data from the 2012 Pediatric Regional Anesthesia Network documented no LAST episodes in 14,917 procedures, 42 although its most recent analysis of over 100,000 regional anesthetics will report 7 severe LAST episodes (cardiac arrest or seizure)-0.076/1000, 95% CI, 0.029 to 0.14/1000 (J.M.…”

Section: Registriesmentioning

confidence: 90%

“…This information is derived from analysis of administrative databases, registries, and case reports/case series. Of particular importance is publication of several studies that suggest the incidence of LAST associated with epidural 28 and peripheral nerve blocks (PNBs) is decreasing, 29 which has led some experts 29,30 to debate whether or not LAST remains a clinically relevant complication.…”

Section: Incidence and Epidemiologymentioning

confidence: 99%

“…29,34 Variations in the incidence may reflect differing definitions of LAST. For example, studies that include generalized CNS excitation 35 or minor cardiac complications 12 in addition to seizure and cardiac arrest report a higher incidence of LAST (0.87/1000 to 1.04/1000) than studies 29 that only include seizure or cardiac arrest (0.04/1000).…”

Section: Administrative Databasesmentioning

confidence: 99%

“…These works range from extensions of previously published quality assurance data sets, 36,37 national databases 33,38 and international registries, 35,39 to specific registries that focus on pediatric practice, [40][41][42] single-center data, 29,32 and data specific to interscalene brachial plexus block. 34 The most important new finding from the Australian and New Zealand Registry of Regional Anaesthesia (now the International Registry of Regional Anaesthesia) is that ultrasound guidance reduces the risk of LAST throughout its continuum by 60% to 65% (propensity analysis OR, 0.35-0.36) as compared with peripheral nerve stimulation alone.…”

Section: Registriesmentioning

confidence: 99%

See 3 more Smart Citations

The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity

Neal

Barrington

Fettiplace

et al. 2018

Regional Anesthesia and Pain Medicine

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262

185

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The American Society of Regional Anesthesia and Pain Medicine's Third Practice Advisory on local anesthetic systemic toxicity is an interim update from its 2010 advisory. The advisory focuses on new information regarding the mechanisms of lipid resuscitation, updated frequency estimates, the preventative role of ultrasound guidance, changes to case presentation patterns, and limited information related to local infiltration anesthesia and liposomal bupivacaine. In addition to emerging information, the advisory updates recommendations pertaining to prevention, recognition, and treatment of local anesthetic systemic toxicity. WHAT'S NEW IN THIS UPDATE?: This interim update summarizes recent scientific findings that have enhanced our understanding of the mechanisms that lead to lipid emulsion reversal of LAST, including rapid partitioning, direct inotropy, and post-conditioning. Since the previous practice advisory, epidemiological data have emerged that suggest a lower frequency of LAST as reported by single institutions and some registries, nevertheless a considerable number of events still occur within the general community. Contemporary case reports suggest a trend toward delayed presentation, which may mirror the increased use of ultrasound guidance (fewer intravascular injections), local infiltration techniques (slower systemic uptake), and continuous local anesthetic infusions. Small patient size and sarcopenia are additional factors that increase potential risk for LAST. An increasing number of reported events occur outside of the traditional hospital setting and involve non-anesthesiologists.

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Section: Registriesmentioning

confidence: 90%

Section: Incidence and Epidemiologymentioning

confidence: 99%

Section: Administrative Databasesmentioning

confidence: 99%

Section: Registriesmentioning

confidence: 99%

See 2 more Smart Citations

The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity

Neal

Barrington

Fettiplace

et al. 2018

Regional Anesthesia and Pain Medicine

Self Cite

262

185

View full text Add to dashboard Cite

show abstract

“…LAST remains a relatively rare event despite the widespread use of local anaesthetic agents 4. Continuous regional nerve blocks are employed as opioid sparing techniques for intraoperative and postoperative use.…”

Section: Discussionmentioning

confidence: 99%

Lipid rescue for treatment of delayed systemic ropivacaine toxicity from a continuous thoracic paravertebral block

Tsang

Okullo²,

Field

et al. 2016

BMJ Case Reports

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A 66-year-old man underwent a left minithoracotomy for pleural biopsies and thoracentesis. A left T3 paravertebral catheter was placed prior to induction of general anaesthesia, and a total of 20 mL of bupivacaine 0.25% administered. Postoperatively, ropivacaine 0.2% infusion was commenced at 10 mL/hour. Thirty-seven hours after the initial block, the patient developed convulsions without loss of consciousness. The ropivacaine infusion rate was unchanged and no further boluses had been given. He reported of perioral tingling, a burning sensation in his legs and penis and agitation. Ropivacaine infusion was ceased and a bolus of lipid emulsion (Intralipid 20%) administered, followed by an infusion. His symptoms (aside from mild agitation) resolved within an hour of cessation of the local anaesthetic and commencement of lipid rescue. The total serum concentration of ropivacaine during the event was 2.1 mg/L compared with a published toxic level of 2.2 mg/L in healthy human volunteers.

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Complications of Loco‐Regional Anesthesia

García¹

2021

Complications in Equine Surgery

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Cardiac Arrest and Seizures Caused by Local Anesthetic Systemic Toxicity After Peripheral Nerve Blocks

Cited by 45 publications

References 18 publications

The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity

The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity

Lipid rescue for treatment of delayed systemic ropivacaine toxicity from a continuous thoracic paravertebral block

Complications of Loco‐Regional Anesthesia

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