The Effect of Lipid Emulsion Infusion on Postmortem Ropivacaine Concentrations in Swine

Buckenmaier, Chester C.; Capacchione, John F.; Mielke, Arthur R.; Bina, Saiid; Shields, Cynthia H.; Kwon, Kyung H.; McKnight, Geselle M.; Fish, D; Bedőcs, Péter

doi:10.1213/ane.0b013e31822c10b8

Cited by 15 publications

(14 citation statements)

References 12 publications

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“…Fifty cases of toxicity occurred after a single injection of LA, whereas in 8 cases, signs and symptoms arose during continuous infusion of LA. 35,38,40,41,54,55,58 In 7 cases, toxicity followed topical administration of LA without needle injection. 26,45,47,48,50,57,59 Finally, in 2 cases, LAST followed direct unintentional LA intravascular injection through a venous cannula.…”

Section: Setting Of Lastmentioning

confidence: 99%

“…Overall, adrenaline was added to the anesthetic mixture in 8 cases. 8,16,23,27,32,35,37,49 With regard to local field anesthesia, lidocaine was used in nearly 80% of the cases, occasionally combined with other LAs. Articaine, 49 propitocaine, 20 and bupivacaine 38 were used alone in 1 case each.…”

Section: Local Anestheticsmentioning

confidence: 99%

“…Eleven (16%) cases reported the use of UGRA. 19,25,29,32,33,35,51,53,55 Fifteen (22%) practitioners adopted ENS, 12,16,22,24,29,31,41,44 whereas intermittent aspiration before injection was reported in 22 cases of LA administration for peripheral nerve block. 8,11,15,16,18,19,22,24,25,27,[31][32][33]36,38,41,43,46,58 Finally, only 1 author reported on the concomitant use of ultrasound, ENS, and intermittent aspiration 29 in a patient who developed toxicity 10 minutes after LA injection.…”

Section: Nerve Localization and Safety Measuresmentioning

confidence: 99%

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A Review of Local Anesthetic Systemic Toxicity Cases Since Publication of the American Society of Regional Anesthesia Recommendations

Vasques

Behr

Weinberg

et al. 2015

Regional Anesthesia and Pain Medicine

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Local anesthetic systemic toxicity (LAST) occurrence may cross several medical specialties. In 2010, the American Society of Regional Anesthesia and Pain Medicine (ASRA) published the first algorithm on LAST management, introducing the use of lipid emulsion (ILE) treatment. In the present study, we retrieved the cases of LAST published between ASRA guidelines dissemination and March 2014. We analyzed the reported clinical manifestations of LAST, characteristics of affected patients, onset time of toxicity, and clinical setting. We also focused on the treatment measures that were applied in the different cases, especially on the use of ILE and adherence to ASRA recommendations. Despite the limits of a review of case reports, the present study calls attention to the insidious nature of LAST, especially its atypical manifestations, and shows that ILE may currently be underadministered in daily clinical practice, especially in nonanesthesiology practice.

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Section: Setting Of Lastmentioning

confidence: 99%

Section: Local Anestheticsmentioning

confidence: 99%

Section: Nerve Localization and Safety Measuresmentioning

confidence: 99%

See 1 more Smart Citation

A Review of Local Anesthetic Systemic Toxicity Cases Since Publication of the American Society of Regional Anesthesia Recommendations

Vasques

Behr

Weinberg

et al. 2015

Regional Anesthesia and Pain Medicine

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“…Accordingly, there is a great number of reports in the literature on C activation and its consequences in various animals, Brought to you by | University of Michigan Authenticated Download Date | 6/16/15 10:59 PM including rats (9,(29)(30)(31)(32)(33), mice (33), dogs (34)(35)(36)(37), rabbits (38,39) nonhuman primates (40)(41)(42)(43)(44)(45)(46)(47)(48)(49) and pigs (50)(51)(52)(53)(54)(55). Among these experimental systems, it is the pigs' response to C activator liposomes that best mimics the human infusion reactions to liposomes in terms of kinetics and spectrum of symptoms and the conditions of reaction induction (Table 1).…”

Section: Non-standard Immunotoxicity Tests Of Carpa In Different Animalsmentioning

confidence: 99%

“…Pigs are widely used as large animal models in biomedical research (57)(58)(59)(60)(61), particularly in studies on cardiovascular diseases (62)(63)(64)(65)(66)(67), trauma (68)(69)(70)(71), sepsis (72)(73)(74)(75)(76), drug intoxications (54,55), and, since 1999 (53), CARPA. As described in many previous experimental studies (50)(51)(52)(53)77) and a recent review (7), the porcine CARPA model represents a highly sensitive and reproducible model for the most serious, life threatening HSRs in man caused by RNM.…”

Section: The Use Of Pigs As Disease Modelsmentioning

confidence: 99%

Lessons learned from the porcine CARPA model: constant and variable responses to different nanomedicines and administration protocols

Urbanics

Bedőcs

Szebeni

2015

European Journal of Nanomedicine

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Pigs provide a sensitive and quantitative animal model of complement (C) activation-related pseudoallergy (CARPA) caused by liposomes and a wide range of nanoparticulate drugs or drug nanocarriers (nanomedicines). The tetrad of symptoms (hemodynamic, hematological, laboratory and skin changes) that arise within minutes after i.v. injection of reactogenic nanomedicines (RNMs) are highly reproducible among different pigs but the presence, direction and relative severity of symptoms are very different with different RNMs and their administration schedule. Bolus administration of RNMs usually trigger pulmonary hypertension with or without various degrees of systemic hyper-or hypotension, tachy-or bradycardia, arrhythmia, blood cell and inflammatory mediator changes and skin rash. These reactions can be rapid or protracted, and fully tachyphylactic, semi-tachyphylactic or non-tachyphylactic. Slow infusion usually diminishes the reactions and/or entail delayed, protracted and less severe hemodynamic and other changes. The goal of this review is to present some technical details of the porcine CARPA model, point out its constant and variable parameters, show examples of different reactions, highlight the unique features and capabilities of the model and evaluate its utility in preclinical safety assessment. The information obtained in this model enables the understanding of the complex pathomechanism of CARPA involving simultaneous anaphylatoxin and inflammatory mediator actions at multiple sites in different organs.

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Lipid emulsion improves survival in animal models of local anesthetic toxicity: a meta-analysis

Fettiplace

McCabe

2017

Clinical Toxicology

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Meta-analysis of animal data supports the use of lipid emulsion (in combination with other resuscitative measures) for the treatment of local anesthetic toxicity, specifically from bupivacaine. Our conclusion differed from the original review. Analysis of outliers reinforced the need for good life support measures (securement of airway and chest compressions) along with prompt treatment with lipid.

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The Effect of Lipid Emulsion Infusion on Postmortem Ropivacaine Concentrations in Swine

Abstract: Our data show that postmortem blood samples in swine that experience local anesthetic cardiovascular collapse and are treated with lipid emulsions will result in measurements that cannot be directly extrapolated to premortem drug concentrations.

Cited by 15 publications

References 12 publications

A Review of Local Anesthetic Systemic Toxicity Cases Since Publication of the American Society of Regional Anesthesia Recommendations

A Review of Local Anesthetic Systemic Toxicity Cases Since Publication of the American Society of Regional Anesthesia Recommendations

Lessons learned from the porcine CARPA model: constant and variable responses to different nanomedicines and administration protocols

Lipid emulsion improves survival in animal models of local anesthetic toxicity: a meta-analysis

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