Development of Resistance to the Effect of Local Anesthetic Agents Administered Via Various Routes Due to Single or Multiple, Previous Scorpion Bites: A Proposed Hypothesis and Reporting a Yet Unrecognized Phenomenon

Panditrao, Mridul M

doi:10.15406/jaccoa.2015.03.00110

Cited by 3 publications

(3 citation statements)

References 19 publications

(30 reference statements)

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“…Experiments have shown that these scorpion toxins are modifiers of the gating mechanism of the Na+-channel function, affecting either the inactivation (a-toxins) or the activation (b-toxins) kinetics of the channels. Mostly our study results can also be attributed to the antagonism at the binding site [9][10][11][12][13][14] . However, many authors attribute antagonism as one of the important factor for the failure but, more research at the molecular level has to be conducted to find out the exact cause of failure of anesthesia [15][16] .…”

Section: Discussionmentioning

confidence: 97%

Local Anesthesia Failure Cases with Scorpion Bite History in Third Molar Surgery- A Challenge

2017

ARC Journal of Anesthesiology

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Patients planned for third molar surgery who were administered conventional intraoral mandibular nerve block were considered. Local anesthesia failure in third molar surgery can be attributed to many causes but, failure due to history of scorpion bite was not reported in the literature in oral and maxillofacial surgeries. On the operative day after obtaining informed consent, local infiltration of the skin on the ventral aspect of the forearm, using, 6 ml, 2% lignocaine with adrenaline, was carried out. Confirming the suspicion, there was no sensory block after the injection, confirmed by pin prick method. Cases reported in the literature were due to failure of spinal anesthesia but not in third molar surgery the female patients also gave a history of spinal anesthesia failure during their deliveries and were operated under general anesthesia.

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Section: Discussionmentioning

confidence: 97%

Local Anesthesia Failure Cases with Scorpion Bite History in Third Molar Surgery- A Challenge

2017

ARC Journal of Anesthesiology

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“…10 The other postulated theory is development of antibodies to highly antigenic scorpion venom which competitively inhibit binding of local anesthetic at sixth segment of domain four of the Alpha () subunit (DIV -S6). 11 Kosam D and colleagues in their study found that patients with history of scorpion bite < 6 months back had complete failure of spinal anesthesia requiring administration of general anesthesia. While adequate subarachnoid block was noted in those patients who had history of scorpion sting > 12 months back.…”

Section: Discussionmentioning

confidence: 98%

Scorpion Envenomation: The Cause of Inadequate Subarachnoid Block - A Case Series

Pakhare,

Nanda,

Priyanka

et al. 2023

JAP

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Background: Failure of neuraxial or regional anaesthesia can result from factors such as drug errors, technical inefficiencies, and poor patient positioning. While these causes are well-known, resistance to local anaesthetic action due to mutations in sodium channels or scorpion sting is a lesser-known contributor to block failure. In India, a tropical country with a significant number of patients presenting for surgical procedures, a history of scorpion bites is not uncommon. Case: We observed seven cases of failed regional anesthesia who had history of scorpion sting. All the patients received intrathecal bupivacaine by experienced anesthesiologists, of seven patients five patients did not develop sensory or motor block. One patient had delayed successful subarachnoid block after second attempt and one patient had successful block at first attempt. Conclusion: Our observations revealed instances of failed spinal blocks, despite adequate drug dosages and experienced anesthesiologists performing the procedures, in patients with a history of scorpion envenomation. Accordingly, our study concludes that obtaining a thorough scorpion sting history during pre-anesthesia check-ups, particularly in endemic areas, can effectively prevent unnecessary repeated pinpricks, escalating dosages, patient and surgeon discomfort, and skepticism towards the skills of anesthesiologists.

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“…To test any possible correlation between scorpion bite and the changed response to spinal anesthesia, a case-control study was conducted by Issin et al [15] involving patients with a history of scorpion bite/s and without such a history. The anesthetic management was identical inclusive of the subarachnoid block with 3.5 mL 0.5% bupivacaine heavy.…”

Section: Tripathi Et Almentioning

confidence: 99%

Effect of Previous Scorpion Bite on the Efficacy of Intrathecally Administered Levobupivacaine in Subarachnoid Block

Tripathi

BADLANI

JAIN

et al. 2023

Asian J Pharm Clin Res

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Objectives: Local anesthetics administered by spinal anesthesia acts through sodium channels. Mutations of sodium channels may be responsible for resistance to local anesthetic agents. The scorpion venom contains neurotoxins that block the sodium channels. In view of the high prevalence of scorpion stings in our region and observation of failure of spinal anesthesia in patients with a history of scorpion stings in routine practice, the present study is planned. Methods: Forty patients of the American Society of Anesthesiologists Grade I or II who were undergoing infraumbilical surgery were divided into two groups as S (patients with h/o scorpion bite) and C (patients with no such history). The subarachnoid block was given with 3.2 ml of injection Levobupivacaine 0.5% heavy using 26 gauzes Quincke spinal needle. A blind observer recorded a sensory block using a needle prick and a motor block using the Bromage scale. Onset of sensory and motorized block, time to peak of sensory, and motor block and its relation to number of scorpion bites were observed in both the groups. Results: The onset of sensory (2.61±1.68 mins) and motor blockade (2.91±1.80 mins) was significantly delayed in Group S (p=0.010 and 0.004, respectively). Time to peak of sensory and motor blockade was also prolonged in Group S (6.45±2.83 mins and 7.8±3.95 mins) compared to Group C (3.60±0.84 mins and 4.56±1.30 mins) which was statistically significant (p<0.05). Patients who had previous scorpion bites (Group S) had a significant failure rate of spinal anesthesia compared to the control group. Conclusion: In this study, it was observed that the patients with scorpion bites had a significant failure rate of spinal anesthesia, suggesting probable resistance to the local anesthetic agents.

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Development of Resistance to the Effect of Local Anesthetic Agents Administered Via Various Routes Due to Single or Multiple, Previous Scorpion Bites: A Proposed Hypothesis and Reporting a Yet Unrecognized Phenomenon

Cited by 3 publications

References 19 publications

Local Anesthesia Failure Cases with Scorpion Bite History in Third Molar Surgery- A Challenge

Local Anesthesia Failure Cases with Scorpion Bite History in Third Molar Surgery- A Challenge

Scorpion Envenomation: The Cause of Inadequate Subarachnoid Block - A Case Series

Effect of Previous Scorpion Bite on the Efficacy of Intrathecally Administered Levobupivacaine in Subarachnoid Block

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