Successful lipid rescue of local anesthetic systemic toxicity following peribulbar block

Pujari, Vinayak Seenappa; Bhandary, Ananth; Bevinaguddaiah, Yatish; Shivanna, Shivakumar

doi:10.4103/0975-2870.169942

Cited by 7 publications

(9 citation statements)

References 1 publication

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“…5,9,11,17,23,[32][33][34] The remaining cases resulted from neuraxial (13%: 4 of the 6 were epidural, 2 were described specifically as caudal injections), 16,20,26,29,30,38 paravertebral blocks (8.5%), 15,21,22,30 lower (8.5%) 6,7,13 and upper (8.5%) 6,31,36,39 extremity blocks, head and neck blocks (8.5%) (maxillary nerve, peribulbar), 14,19 topical, 28,35,37 transabdominis plane blocks, 8 and intravenous administration. 18 Seven cases (15%) involved continuous infusions of local anesthetic.…”

Section: Block Typesmentioning

confidence: 99%

“…Lidocaine was used in 26% of cases and ropivacaine in 21%. Levobupivacaine (3 cases), 8,16,26 2-chloroprocaine (1 case), 22 articaine, 33 and mixtures of local anesthetics (bupivacaine/mepivacaine, 7 bupivacaine/ lidocaine, 14 levobupivacaine/lidocaine 39 ) made up the remainder of cases. The local anesthetics associated with LAST are summarized in Figure 2.…”

Section: Local Anesthetic Typementioning

confidence: 99%

“…Isolated CNS presenting features occurred in 45% (21/47), followed by combined CNS/CV toxicity 32% (15/47) and CValone 23% (11/47). Among the subgroup (15 of 47 cases) that had combined toxicity, CNS signs occurred first in 12 (75%) of the patients, 5,7,11,12,14,17,21,24,36,37,39 and CV signs occurred first in 3 (25%). 9,25,28 In 1 of these 3 cases, the patient was under general anesthesia when CV signs were noticed; therefore, the presence or absence of CNS toxicity is uncertain.…”

Section: Vascular Markersmentioning

confidence: 99%

“…Twenty-two patients (47%) were treated with ILE. 5,[7][8][9][10][11][12]14,15,17,21,23,24,26,29,30,32,34,37,39 In 1 case report, 39 ClinOleic 20% emulsion (Baxter, Deerfield, Illinois) was used instead of ILE. Nine patients received both a benzodiazepine and ILE.…”

Section: Treatment Of Lastmentioning

confidence: 99%

“…Nine patients received both a benzodiazepine and ILE. [7][8][9]12,14,21,32,34,39 Lack of details on the timing of ILE administration in relation to the onset of LAST precluded detailed analysis. Timing of ILE was under 10 minutes (n = 8), or ILE was given at 20, 30, 40, and more than 60 min after onset of LAST.…”

Section: Treatment Of Lastmentioning

confidence: 99%

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Local Anesthetic Systemic Toxicity

Gitman

Barrington

2018

Regional Anesthesia and Pain Medicine

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This review summarizes presenting features, management, and outcomes of local anesthetic systemic toxicity (LAST) from published cases and those submitted to online registries capturing use of intravenous lipid emulsion (ILE) therapy. The results of single-center and multicenter registries and epidemiologic studies complement this information. Between March 2014 and November 2016, 47 separate cases of LAST were described in 35 peer-reviewed articles. Local anesthetic systemic toxicity events occurred as a result of penile blocks (23%), local infiltration (17%), and upper/lower extremity, torso, and neuraxial blockade. Twenty-two patients (47%) were treated with ILE, and 2 patients (4.3%) died. During the same time period, 11 cases submitted to lipidrescue.org were treated with ILE and survived. The incidence of LAST reported in registries is 0.03% or 0.27 (95% confidence interval, 0.21-0.35) per 1000 peripheral nerve blocks (denominator of 251,325). Seizure (53% and 61% from case reports and registries, respectively) was the most common presenting feature.

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Section: Block Typesmentioning

confidence: 99%

Section: Local Anesthetic Typementioning

confidence: 99%

Section: Vascular Markersmentioning

confidence: 99%

Section: Treatment Of Lastmentioning

confidence: 99%

Section: Treatment Of Lastmentioning

confidence: 99%

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Local Anesthetic Systemic Toxicity

Gitman

Barrington

2018

Regional Anesthesia and Pain Medicine

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A Case of Brainstem Anesthesia after Retrobulbar Block for Globe Rupture Repair

Nanda

Ross

Kerr

2021

Case Reports in Anesthesiology

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Purpose. To present a rare case of brainstem anesthesia from retrobulbar block and discuss evidence-based methods for reducing the incidence of this complication. Case. A 72-year-old female, was given a retrobulbar block of 5 mL of bupivacaine 0.5% for postoperative pain management, after a globe rupture repair under general anesthesia. Prior to injection, the patient was breathing spontaneously via the anesthesia machine circuit and had not received any additional narcotics/muscle relaxants for 2.5 hr (with full recovery of neuromuscular blocking agent after anesthetic reversal). Over 7 min, however, there was a steady increase in ETCO2 and the patient became apneic, consistent with brainstem anesthesia. She remained intubated and was transported to the postanesthesia care unit for prolonged monitoring, with eventual extubation. Discussion. Brainstem anesthesia is an important complication to recognize as it can lead to apnea and death. The judicious use of anesthetic volume, shorter needle tips, and mixed formulations can help reduce the chance of brainstem anesthesia. Observation of the contralateral eye 5–10 minutes after injection for pupillary dilation, and prior to surgical draping, can help identify early CNS involvement.

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Lipid emulsion therapy of local anesthetic systemic toxicity due to dental anesthesia

Rhee

Park

Ryoo

et al. 2019

J Dent Anesth Pain Med

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Local anesthetic systemic toxicity (LAST) refers to the complication affecting the central nervous system (CNS) and cardiovascular system (CVS) due to the overdose of local anesthesia. Its reported prevalence is 0.27/1000, and the representative symptoms range from dizziness to unconsciousness in the CNS and from arrhythmias to cardiac arrest in the CVS. Predisposing factors of LAST include extremes of age, pregnancy, renal disease, cardiac disease, hepatic dysfunction, and drug-associated factors. To prevent the LAST, it is necessary to recognize the risk factors for each patient, choose a safe drug and dose of local anesthesia, use vasoconstrictor , confirm aspiration and use incremental injection techniques. According to the treatment guidelines for LAST, immediate application of lipid emulsion plays an important role. Although lipid emulsion is commonly used for parenteral nutrition, it has recently been widely used as a non-specific antidote for various types of drug toxicity, such as LAST treatment. According to the recently published guidelines, 20% lipid emulsion is to be intravenously injected at 1.5 mL/kg. After bolus injection, 15 mL/kg/h of lipid emulsion is to be continuously injected for LAST. However, caution must be observed for >1000 mL of injection, which is the maximum dose. We reviewed the incidence, mechanism, prevention, and treatment guidelines, and a serious complication of LAST occurring due to dental anesthesia. Furthermore, we introduced lipid emulsion that has recently been in the spotlight as the therapeutic strategy for LAST.

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Successful lipid rescue of local anesthetic systemic toxicity following peribulbar block

Cited by 7 publications

References 1 publication

Local Anesthetic Systemic Toxicity

Local Anesthetic Systemic Toxicity

A Case of Brainstem Anesthesia after Retrobulbar Block for Globe Rupture Repair

Lipid emulsion therapy of local anesthetic systemic toxicity due to dental anesthesia

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