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Meng L, Rasmussen M, Abcejo AS, Meng DM, Tong C, Liu H. Causes of Perioperative Cardiac Arrest: Mnemonic, Classification, Monitoring, and Actions. Anesth Analg 2024; 138:1215-1232. [PMID: 37788395 DOI: 10.1213/ane.0000000000006664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Perioperative cardiac arrest (POCA) is a catastrophic complication that requires immediate recognition and correction of the underlying cause to improve patient outcomes. While the hypoxia, hypovolemia, hydrogen ions (acidosis), hypo-/hyperkalemia, and hypothermia (Hs) and toxins, tamponade (cardiac), tension pneumothorax, thrombosis (pulmonary), and thrombosis (coronary) (Ts) mnemonic is a valuable tool for rapid differential diagnosis, it does not cover all possible causes leading to POCA. To address this limitation, we propose using the preload-contractility-afterload-rate and rhythm (PCARR) construct to categorize POCA, which is comprehensive, systemic, and physiologically logical. We provide evidence for each component in the PCARR construct and emphasize that it complements the Hs and Ts mnemonic rather than replacing it. Furthermore, we discuss the significance of utilizing monitored variables such as electrocardiography, pulse oxygen saturation, end-tidal carbon dioxide, and blood pressure to identify clues to the underlying cause of POCA. To aid in investigating POCA causes, we suggest the Anesthetic care, Surgery, Echocardiography, Relevant Check and History (A-SERCH) list of actions. We recommend combining the Hs and Ts mnemonic, the PCARR construct, monitoring, and the A-SERCH list of actions in a rational manner to investigate POCA causes. These proposals require real-world testing to assess their feasibility.
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Affiliation(s)
- Lingzhong Meng
- From the Department of Anesthesia, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mads Rasmussen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Arnoley S Abcejo
- Department of Anesthesiology, Section of Neuroanesthesia, Aarhus University Hospital, Aarhus, Denmark
| | - Deyi M Meng
- Choate Rosemary Hall School, Wallingford, Connecticut
| | - Chuanyao Tong
- Department of Anesthesiology, Wake Forest University, Winston-Salem, North Carolina
| | - Hong Liu
- Department of Anesthesiology and Pain Medicine, University of California Davis, Sacramento, California
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Chen MS, Chong ZY, Huang C, Huang HC, Su PH, Chen JC. Lidocaine attenuates TMZ resistance and inhibits cell migration by modulating the MET pathway in glioblastoma cells. Oncol Rep 2024; 51:72. [PMID: 38606513 PMCID: PMC11024889 DOI: 10.3892/or.2024.8731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/05/2024] [Indexed: 04/13/2024] Open
Abstract
Glioblastoma multiforme (GBM) is the most aggressive type of malignant brain tumor. Currently, the predominant clinical treatment is the combination of surgical resection with concurrent radiotherapy and chemotherapy, using temozolomide (TMZ) as the primary chemotherapy drug. Lidocaine, a widely used amide‑based local anesthetic, has been found to have a significant anticancer effect. It has been reported that aberrant hepatocyte growth factor (HGF)/mesenchymal‑epithelial transition factor (MET) signaling plays a role in the progression of brain tumors. However, it remains unclear whether lidocaine can regulate the MET pathway in GBM. In the present study, the clinical importance of the HGF/MET pathway was analyzed using bioinformatics. By establishing TMZ‑resistant cell lines, the impact of combined treatment with lidocaine and TMZ was investigated. Additionally, the effects of lidocaine on cellular function were also examined and confirmed using knockdown techniques. The current findings revealed that the HGF/MET pathway played a key role in brain cancer, and its activation in GBM was associated with increased malignancy and poorer patient outcomes. Elevated HGF levels and activation of its receptor were found to be associated with TMZ resistance in GBM cells. Lidocaine effectively suppressed the HGF/MET pathway, thereby restoring TMZ sensitivity in TMZ‑resistant cells. Furthermore, lidocaine also inhibited cell migration. Overall, these results indicated that inhibiting the HGF/MET pathway using lidocaine can enhance the sensitivity of GBM cells to TMZ and reduce cell migration, providing a potential basis for developing novel therapeutic strategies for GBM.
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Affiliation(s)
- Ming-Shan Chen
- Department of Anesthesiology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 60002, Taiwan, R.O.C
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung 41354, Taiwan, R.O.C
| | - Zhi-Yong Chong
- Department of Biochemical Science and Technology, National Chiayi University, Chiayi 600355, Taiwan, R.O.C
| | - Cheng Huang
- Department of Biotechnology and Laboratory Science in Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan, R.O.C
| | - Hsiu-Chen Huang
- Department of Applied Science, National Tsing Hua University South Campus, Hsinchu 30014, Taiwan, R.O.C
- Center for Teacher Education, National Tsing Hua University, Hsinchu 300044, Taiwan, R.O.C
| | - Pin-Hsuan Su
- Department of Biochemical Science and Technology, National Chiayi University, Chiayi 600355, Taiwan, R.O.C
| | - Jui-Chieh Chen
- Department of Biochemical Science and Technology, National Chiayi University, Chiayi 600355, Taiwan, R.O.C
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Macfarlane AJR, Gitman M, Bornstein KJ, El-Boghdadly K, Weinberg G. Updates in our understanding of local anaesthetic systemic toxicity: a narrative review. Anaesthesia 2021; 76 Suppl 1:27-39. [PMID: 33426662 DOI: 10.1111/anae.15282] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 12/21/2022]
Abstract
Despite advances in clinical practice, local anaesthetic systemic toxicity continues to occur with the therapeutic use of local anaesthesia. Patterns of presentation have evolved over recent years due in part to the increasing use of ultrasound which has been demonstrated to reduce risk. Onset of toxicity is increasingly delayed, a greater proportion of clinical reports are secondary to fascial plane blocks, and cases are increasing where non-anaesthetist providers are involved. The evolving clinical context presents a challenge for diagnosis and requires education of all physicians, nurses and allied health professionals about these changing patterns and risks. This review discusses: mechanisms; prevention; diagnosis; and treatment of local anaesthetic systemic toxicity. The local anaesthetic and dose used, site of injection and block conduct and technique are all important determinants of local anaesthetic systemic toxicity, as are various patient factors. Risk mitigation is discussed including the care of at-risk groups, such as: those at the extremes of age; patients with cardiac, hepatic and specific metabolic diseases; and those who are pregnant. Advances in the changing clinical landscape with novel applications and settings for the use of local anaesthesia are also described. Finally, we signpost future directions to potentially improve the management of local anaesthetic systemic toxicity. The utility of local anaesthetics remains unquestionable in clinical practice, and thus maximising the safe and appropriate use of these drugs should translate to improvements in patient care.
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Affiliation(s)
- A J R Macfarlane
- Department of Anaesthesia, Critical Care and Pain Medicine, Glasgow Royal Infirmary, Glasgow, UK.,2University of Glasgow, Glasgow, UK
| | - M Gitman
- Department of Anaesthesia, University of Illinois College of Medicine, Chicago, IL, USA
| | - K J Bornstein
- Department of Medical Education, University of Miami School of Medicine, Miami, FL, USA
| | - K El-Boghdadly
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - G Weinberg
- Department of Anaesthesia, University of Illinois College of Medicine, Chicago, IL, USA.,Jesse Brown VA Medical Centre, Chicago, IL, USA
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DEMİRÖZ ASLAN D, FERLENGEZ AG. Cerrahi branş hekimlerinin lokal anestezik kullanımı ve toksisitesine yaklaşımının değerlendirilmesi: Anket çalışması. EGE TIP DERGISI 2020. [DOI: 10.19161/etd.834127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Lipid Emulsion Improves Functional Recovery in an Animal Model of Stroke. Int J Mol Sci 2020; 21:ijms21197373. [PMID: 33036206 PMCID: PMC7582956 DOI: 10.3390/ijms21197373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/29/2020] [Accepted: 10/03/2020] [Indexed: 12/16/2022] Open
Abstract
Stroke is a life-threatening condition that leads to the death of many people around the world. Reperfusion injury after ischemic stroke is a recurrent problem associated with various surgical procedures that involve the removal of blockages in the brain arteries. Lipid emulsion was recently shown to attenuate ischemic reperfusion injury in the heart and to protect the brain from excitotoxicity. However, investigations on the protective mechanisms of lipid emulsion against ischemia in the brain are still lacking. This study aimed to determine the neuroprotective effects of lipid emulsion in an in vivo rat model of ischemic reperfusion injury through middle cerebral artery occlusion (MCAO). Under sodium pentobarbital anesthesia, rats were subjected to MCAO surgery and were administered with lipid emulsion through intra-arterial injection during reperfusion. The experimental animals were assessed for neurological deficit wherein the brains were extracted at 24 h after reperfusion for triphenyltetrazolium chloride staining, immunoblotting and qPCR. Neuroprotection was found to be dosage-dependent and the rats treated with 20% lipid emulsion had significantly decreased infarction volumes and lower Bederson scores. Phosphorylation of Akt and glycogen synthase kinase 3-β (GSK3-β) were increased in the 20% lipid-emulsion treated group. The Wnt-associated signals showed a marked increase with a concomitant decrease in signals of inflammatory markers in the group treated with 20% lipid emulsion. The protective effects of lipid emulsion and survival-related expression of genes such as Akt, GSK-3β, Wnt1 and β-catenin were reversed by the intra-peritoneal administration of XAV939 through the inhibition of the Wnt/β-catenin signaling pathway. These results suggest that lipid emulsion has neuroprotective effects against ischemic reperfusion injury in the brain through the modulation of the Wnt signaling pathway and may provide potential insights for the development of therapeutic targets.
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ILHAN B, DEMİR M. Local Anesthetic Systemic Toxicity Knowledge Of Emergency Medicine Residents: A Cross-Sectional Study. KONURALP TIP DERGISI 2020. [DOI: 10.18521/ktd.746744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tanioka M, Park WK, Shim I, Kim K, Choi S, Kim UJ, Lee KH, Hong SK, Lee BH. Neuroprotection from Excitotoxic Injury by Local Administration of Lipid Emulsion into the Brain of Rats. Int J Mol Sci 2020; 21:ijms21082706. [PMID: 32295117 PMCID: PMC7215821 DOI: 10.3390/ijms21082706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 01/10/2023] Open
Abstract
Lipid emulsion was recently shown to attenuate cell death caused by excitotoxic conditions in the heart. There are key similarities between neurons and cardiomyocytes, such as excitability and conductibility, which yield vulnerability to excitotoxic conditions. However, systematic investigations on the protective effects of lipid emulsion in the central nervous system are still lacking. This study aimed to determine the neuroprotective effects of lipid emulsion in an in vivo rat model of kainic acid-induced excitotoxicity through intrahippocampal microinjections. Kainic acid and/or lipid emulsion-injected rats were subjected to the passive avoidance test and elevated plus maze for behavioral assessment. Rats were sacrificed at 24 h and 72 h after kainic acid injections for molecular study, including immunoblotting and qPCR. Brains were also cryosectioned for morphological analysis through cresyl violet staining and Fluorojade-C staining. Anxiety and memory functions were significantly preserved in 1% lipid emulsion-treated rats. Lipid emulsion was dose-dependent on the protein expression of β-catenin and the phosphorylation of GSK3-β and Akt. Wnt1 mRNA expression was elevated in lipid emulsion-treated rats compared to the vehicle. Neurodegeneration was significantly reduced mainly in the CA1 region with increased cell survival. Our results suggest that lipid emulsion has neuroprotective effects against excitotoxic conditions in the brain and may provide new insight into its potential therapeutic utility.
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Affiliation(s)
- Motomasa Tanioka
- Department of Physiology, Yonsei University College of Medicine, Seoul 03722, Korea; (M.T.); (K.K.); (S.C.); (U.J.K.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Wyun Kon Park
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Insop Shim
- Department of Physiology, School of Medicine, Kyung Hee University, Seoul 02447, Korea;
| | - Kyeongmin Kim
- Department of Physiology, Yonsei University College of Medicine, Seoul 03722, Korea; (M.T.); (K.K.); (S.C.); (U.J.K.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Songyeon Choi
- Department of Physiology, Yonsei University College of Medicine, Seoul 03722, Korea; (M.T.); (K.K.); (S.C.); (U.J.K.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Un Jeng Kim
- Department of Physiology, Yonsei University College of Medicine, Seoul 03722, Korea; (M.T.); (K.K.); (S.C.); (U.J.K.)
| | - Kyung Hee Lee
- Department of Dental Hygiene, Division of Health Science, Dongseo University, Busan 47011, Korea;
| | - Seong-Karp Hong
- Division of Biomedical Engineering, Mokwon University, Daejeon 35349, Korea;
| | - Bae Hwan Lee
- Department of Physiology, Yonsei University College of Medicine, Seoul 03722, Korea; (M.T.); (K.K.); (S.C.); (U.J.K.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
- Correspondence: ; Tel.: + 82-2-2228-1711
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Bedi A, Trinh TQ, Olszewski AM, Maerz T, Ramme AJ. Nonbiologic Injections in Sports Medicine. JBJS Rev 2020; 8:e0052. [PMID: 32224626 DOI: 10.2106/jbjs.rvw.19.00052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Nonbiologic medications (local anesthetics, corticosteroids, and nonsteroidal anti-inflammatory drugs) are commonly administered to athletes for analgesia after injury. However, the risks of nonbiologic injections often are overlooked simply because of their long-term market availability.
A thorough understanding of the mechanism of action, the reported benefits, and the potential risks of nonbiologic medications is crucial prior to their use, especially in the treatment of young athletes. Sports medicine physicians and surgeons must be aware of the systemic and local effects of these medications to ensure an appropriate drug choice that minimizes side effects and avoids recently reported toxicity to myocytes, tenocytes, and chondrocytes.
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Affiliation(s)
- Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Thai Q Trinh
- Department of Orthopaedic Surgery, Genesis Healthcare, Zanesville, Ohio
| | - Adam M Olszewski
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Tristan Maerz
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Austin J Ramme
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan.,Steindler Orthopedic Clinic, Iowa City, Iowa
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Guilbaud L, Maurice P, Dhombres F, Maisonneuve É, Rigouzzo A, Darras AM, Jouannic JM. [Feticide procedures in second and third trimesters terminations of pregnancy]. ACTA ACUST UNITED AC 2020; 48:687-692. [PMID: 32092488 DOI: 10.1016/j.gofs.2020.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Indexed: 11/19/2022]
Abstract
Performing a feticide as part of termination of late pregnancy is recommended in many countries. Feticide avoids a live birth of a severely affected premature newborn and prevents fetal pain. There are limited data on feticide procedures since only a few countries in the world authorize late termination of pregnancy. The objective of this review was to assess the most appropriate feticide procedure based on published data during the last thirty years. Administration of an initial fetal analgesia followed by a lethal lidocaine injection through the umbilical cord, under ultrasound guidance, appears to be the most effective, safe and ethical way to perform feticide. According to the current knowledge regarding the risk of fetal pain and survival of extremely preterm infants, a feticide should be discussed as early as 20-22 weeks of gestation.
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Affiliation(s)
- L Guilbaud
- Service de Médecine Fœtale, centre pluridisciplinaire de diagnostic prénatal de l'Est parisien, DMU ORIGYNE, hôpital Armand-Trousseau, AP-HP, 26, avenue du Docteur-Netter, 75012 Paris, France.
| | - P Maurice
- Service de Médecine Fœtale, centre pluridisciplinaire de diagnostic prénatal de l'Est parisien, DMU ORIGYNE, hôpital Armand-Trousseau, AP-HP, 26, avenue du Docteur-Netter, 75012 Paris, France
| | - F Dhombres
- Service de Médecine Fœtale, centre pluridisciplinaire de diagnostic prénatal de l'Est parisien, DMU ORIGYNE, hôpital Armand-Trousseau, AP-HP, 26, avenue du Docteur-Netter, 75012 Paris, France; Médecine Sorbonne Université, 15-21, rue de l'École-de-Médecine, 75006 Paris, France
| | - É Maisonneuve
- Service de Médecine Fœtale, centre pluridisciplinaire de diagnostic prénatal de l'Est parisien, DMU ORIGYNE, hôpital Armand-Trousseau, AP-HP, 26, avenue du Docteur-Netter, 75012 Paris, France
| | - A Rigouzzo
- Service d'Anesthésie, hôpital Armand-Trousseau, AP-HP, 26, avenue du Docteur-Netter, 75012 Paris, France
| | - A-M Darras
- Service de Médecine Fœtale, centre pluridisciplinaire de diagnostic prénatal de l'Est parisien, DMU ORIGYNE, hôpital Armand-Trousseau, AP-HP, 26, avenue du Docteur-Netter, 75012 Paris, France
| | - J-M Jouannic
- Service de Médecine Fœtale, centre pluridisciplinaire de diagnostic prénatal de l'Est parisien, DMU ORIGYNE, hôpital Armand-Trousseau, AP-HP, 26, avenue du Docteur-Netter, 75012 Paris, France; Médecine Sorbonne Université, 15-21, rue de l'École-de-Médecine, 75006 Paris, France
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Chukhlovina ML, Chukhlovin AA. [Specifics of diagnosis and treatment of diabetic polyneuropathy in elderly patients]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:42-46. [PMID: 31407680 DOI: 10.17116/jnevro201911906142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To study the specifics of diagnosis and treatment of diabetic polyneuropathy in elderly patients. MATERIAL AND METHODS Forty-two patients (22 men and 20 women, aged from 65 to 75 years) with diabetes mellitus type 2 and diabetic polyneuropathy were studied using the following psychometric scales: the Michigan Neuropathy Screening Instrument (MNSI), Neurological symptoms scale (NSS), Neuropathy Disability Score (NDS), the Numerical Rating Scale (NRS), Kaplan-Feinstein index (KFI), the Covi Anxiety Scale (COVI), the Recovery Locus of Control Scale (RLOC). Patients were divided into group 1 (n=24) treated with neuromultivit injections, along with standard treatment, and group 2 (n=18), which received standard treatment only. Patients were examined at baseline and one month after treatment. RESULTS In elderly patients, diabetic distal symmetric sensorimotor polyneuropathy of moderate severity was comorbid mostly with cardio-vascular disease. Pain syndrome was associated with anxiety and significant direct correlation between anxiety and pain intensity was found. The level of motivation towards recovery was significantly lower and correlated with COVI scores. CONCLUSION Injections of neuromultivit decrease the intensity of pain, improve the emotional state and increase the level of motivation towards recovery.
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Affiliation(s)
- M L Chukhlovina
- Polenov Research Institute of Neurosurgery, St.-Petersburg, the Branch of Almazov National Medical Research Center, Ministry of Healthcare of Russia, St.-Petersburg, Russia
| | - A A Chukhlovin
- Polenov Research Institute of Neurosurgery, St.-Petersburg, the Branch of Almazov National Medical Research Center, Ministry of Healthcare of Russia, St.-Petersburg, Russia
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Sanoja IA, Toth KS. Profound Bradycardia and Cardiac Arrest After Sugammadex Administration in a Previously Healthy Patient: A Case Report. A A Pract 2019; 12:22-24. [PMID: 30004912 DOI: 10.1213/xaa.0000000000000834] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We report the case of a 60-year-old man who underwent open radical prostatectomy for prostate adenocarcinoma. He had no known cardiac disease or symptoms other than controlled hypertension and remote history of cocaine use. The patient was given sugammadex for reversal of neuromuscular blockade and, within 1 minute, developed severe, drug-resistant bradycardia followed by pulseless electrical activity arrest. Advanced cardiac life support was initiated and continued for 15 minutes before the return of spontaneous circulation. Subsequent cardiac workup showed no abnormalities. We believe the cause of arrest was sugammadex, considering the time of administration, the absence of cardiac disease, and stable operative course.
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Affiliation(s)
- Ivanna A Sanoja
- From the Department of Anesthesiology and Pain Management, John H. Stroger Jr. Hospital of Cook County, Chicago Illinois
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Šimurina T, Mraović B, Župčić M, Graf Župčić S, Vulin M. LOCAL ANESTHETICS AND STEROIDS: CONTRAINDICATIONS AND COMPLICATIONS - CLINICAL UPDATE. Acta Clin Croat 2019; 58:53-61. [PMID: 31741560 PMCID: PMC6813483 DOI: 10.20471/acc.2019.58.s1.08] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The objective of this clinical update, based on recently published literature, was to discuss incidence and characteristics of the most relevant clinical adverse effects associated with local anesthetic and steroid use in regional anesthesia and treatment of acute or chronic pain. A comprehensive review of the English-language medical literature search utilizing PubMed, Ovid Medline® and Google Scholar from 2015 to 2018 was performed. This narrative review provides anesthesia practitioners with updated evidences on complications and contraindications of local anesthetic and steroid use with emphasis on current points of view regarding prevention, early diagnosis and treatment of adverse events.
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Paneta M, Waring WS. Literature review of the evidence regarding intravenous lipid administration in drug-induced cardiotoxicity. Expert Rev Clin Pharmacol 2019; 12:591-602. [PMID: 31106655 DOI: 10.1080/17512433.2019.1621163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Intravenous lipid emulsion (ILE) administration is capable of reversing the acute cardiac and neurological toxicity caused by local anesthetic agents. In recent years, ILE has also been explored as a potential antidote for cardiotoxicity caused by non-anesthetic agents too. Areas covered: The potential mechanisms, safety, and efficacy of this approach are considered. Data were sought from published reports listed in PubMed and EMBASE, and abstracts of meetings of the North American Congress of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists. There were reports involving 298 patients where ILE has been administered for severe drug toxicity. Clinical improvement was observed in 57 of 59 patients with local anesthetic toxicity (96.6%); there were 239 patients where toxicity was due to non-anesthetic agents, and ILE apparently improved clinical outcome in 215 (72.1%). Expert opinion: Response rates were similar between ILE treated toxicity caused by lipid soluble and non-lipid soluble drugs. Potential adverse effects of ILE include interference with laboratory assays, acute pancreatitis, and adult respiratory distress syndrome, although the rate of occurrence is difficult to ascertain.
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Affiliation(s)
- Maria Paneta
- a Acute Medical Unit , York Teaching Hospital NHS Foundation Trust , York , UK
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Avcı S, Başaran A, Genç S, Özkan S, Arslan ED. Endosulfan induced cardiac arrest treated with intravenous lipid emulsion. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 89:573-575. [PMID: 30657127 PMCID: PMC6502109 DOI: 10.23750/abm.v89i4.6582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/31/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Endosulfan is an organochlorine pesticide with high lipophilic features that makes it a well-absorbed agent and penetrates easily to the site of action. Endosulfan toxicities may result in disastrous complications and have high rates of mortality. Several case reports and some researchs discuss the evidence supporting intravenous lipid emulsion (ILE) therapy as a rescue therapy in lipophilic agents' toxicity. CASE REPORT A 33-years-old healthy woman with a history of endosulfan ingestion of uncertain quantity in a suicide attempt six hours ago was admitted to our emergency department. Cardiac arrest ensued after one hour of admission. Cardiopulmonary resuscitation was initiated in accordance with advanced cardiac life support (ACLS) algorithm for asystole. During resuscitation, 2 mL/kg bolus of 20% intravenous lipid emulsion (ILE) was administered for three times at five-minute intervals in addition to ACLS guidance. Spontaneous circulation returned after twenty minutes of resuscitation. No additional antidotal or vasopressor therapies were required during the hospital course of the patient. To our knowledge, this is the first reported case with responded use of ILE treatment for endosulfan toxicity. CONCLUSION This case report indicates that ILE treatment should be considered for life-threatening endosulfan intoxications.
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Zou YX, Feng X, Chu ZY, Liu WH, Zhang XD, Ba JB. Preclinical safety assessment of antipyrine combined with lidocaine hydrochloride as ear drops. Regul Toxicol Pharmacol 2019; 103:34-40. [PMID: 30634025 DOI: 10.1016/j.yrtph.2019.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/04/2019] [Accepted: 01/07/2019] [Indexed: 01/14/2023]
Abstract
This study was designed to assess the preclinical toxicity of antipyrine combined with lidocaine hydrochloride ear drops (ALED) and support the clinical trials of ALED in clinical settings in China. All the experiments including acute toxicity in rodents, skin sensitization toxicity in guinea pigs, skin irritation toxicity in rabbits and chronic toxicity in rats were performed according to China Food and Drug Administration guidelines. The maximum tolerated dose (MTD) of ALED administration for mice and rats was over (400 g antipyrine plus 100 g lidocaine hydrochloride)/kg and (240 g andtipyrine plus 60 g lidocaine hydrochloride)/kg, respectively. No obvious skin sensitization toxicity and skin irritation toxicity were observed. The main changes concentrated in chronic toxicity study in rats. For the chronic toxicity, rats were administrated once a day for 28 consecutive days, and a 14-day recovery period was followed. The side effects of ALED included decreased dietary intake in male rats, increased proportion of reticulocytes, decreased or even inversed granulocyte:erythrocyte ratio, fluctuated alanine aminotransferase and aspartate aminotransferase, and slightly increased relative weight of liver. Conclusively, blood system (especially erythrocyte system) and digestive system, including liver and gastrointestinal tract, might be the toxic targets of ALED.
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Affiliation(s)
- Ying-Xin Zou
- Naval Medical Research Institute, Second Military Medical University, 880 Xiangyin Road, Shanghai, 200433, China
| | - Xu Feng
- Naval Medical Research Institute, Second Military Medical University, 880 Xiangyin Road, Shanghai, 200433, China
| | - Zhi-Yong Chu
- Naval Medical Research Institute, Second Military Medical University, 880 Xiangyin Road, Shanghai, 200433, China
| | - Wei-Hong Liu
- Naval Medical Research Institute, Second Military Medical University, 880 Xiangyin Road, Shanghai, 200433, China
| | - Xiao-Dong Zhang
- College of Naval Medicine, Second Military Medical University, 800 Xiangyin Road, Shanghai, 200433, China
| | - Jian-Bo Ba
- Naval Medical Research Institute, Second Military Medical University, 880 Xiangyin Road, Shanghai, 200433, China.
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Bacon B, Silverton N, Katz M, Heath E, Bull DA, Harig J, Tonna JE. Local Anesthetic Systemic Toxicity Induced Cardiac Arrest After Topicalization for Transesophageal Echocardiography and Subsequent Treatment With Extracorporeal Cardiopulmonary Resuscitation. J Cardiothorac Vasc Anesth 2019; 33:162-165. [PMID: 29525187 PMCID: PMC6068002 DOI: 10.1053/j.jvca.2018.01.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Brandon Bacon
- University of Utah School of Medicine, Salt Lake City, UT
| | - Natalie Silverton
- Department of Anesthesiology, University of Utah, Salt Lake City, UT
| | - Micah Katz
- Department of Surgery, University of Utah, Salt Lake City, UT
| | - Elise Heath
- Department of Anesthesiology, University of Utah, Salt Lake City, UT
| | - David A Bull
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT
| | - Jason Harig
- Department of Anesthesiology, University of Utah, Salt Lake City, UT
| | - Joseph E Tonna
- Department of Surgery, University of Utah, Salt Lake City, UT; Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT; Division of Emergency Medicine, University of Utah, Salt Lake City, UT.
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18
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Wadlund DL. Local Anesthetic Systemic Toxicity. AORN J 2018; 106:367-377. [PMID: 29107256 DOI: 10.1016/j.aorn.2017.08.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/13/2017] [Accepted: 08/31/2017] [Indexed: 11/18/2022]
Abstract
Local anesthetics are commonly used in the perioperative environment to facilitate surgical procedures or to provide postoperative pain management for patients. The use of local anesthetics, however, introduces the risk of complications resulting from local anesthetic systemic toxicity and the risks of increased morbidity and mortality for the surgical patient. Systemic toxicity from the injection or overdose of local anesthetics is a rare but potentially fatal complication that occurs in less than 1 in 1,000 patients. This article provides the perioperative nurse with information about local anesthetics, the signs and symptoms of local anesthetic systemic toxicity, and the information needed to manage a patient experiencing this complication.
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Garcia-Rodriguez L, Spiegel JH. Are surgeons overdosing patients with lidocaine? Am J Otolaryngol 2018; 39:370-371. [PMID: 29567199 DOI: 10.1016/j.amjoto.2018.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
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21
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Abstract
For the past 50 years, local anesthetics such as lidocaine have been commonly used in various clinical settings. Its use is not just limited to anesthesia and surgery but is also frequently utilized in internal medicine and in primary care setting for bedside procedures. Despite its widespread use, most physicians are not familiar with the life-threatening manifestations of lidocaine toxicity and its treatment. Our case demonstrates a successful resuscitation after cardiac arrest in a healthy 33-year-old female with systemic lidocaine toxicity after she received lidocaine as a local anesthetic. Our goal is to educate general internists and primary care physicians of the possible hazards of lidocaine use. We also aim to create mindfulness of the symptoms of lidocaine toxicity and the use of intravenous lipid emulsion as an antidote.
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Affiliation(s)
- Badar Hasan
- Department of Internal Medicine, University of Missouri Kansas City (UMKC)
| | - Talal Asif
- Department of Internal Medicine, University of Missouri Kansas City (UMKC)
| | - Maryam Hasan
- Internal Medicine, NYU Langone Medical Center, New York
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22
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O’Connor J, Wilson SS. Intravenous Lipid Emulsion for Management of Systemic Toxic Effects of Drugs. AACN Adv Crit Care 2016; 27:394-404. [DOI: 10.4037/aacnacc2016570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The incidence of toxic effects of drugs leading to emergency department visits has increased in the United States in the past several years. Most of these patients can be adequately managed by supportive care alone. However, pharmacological antidotes may be necessary, particularly in patients with hemodynamic instability. In severe cases refractory to conventional antidote therapy, rescue therapy with intravenous lipid emulsion (ILE) may be necessary. Traditionally, ILE has been used as an antidote of choice in treating toxic effects of local anesthetics. But data continue to emerge on the successful use of ILE to treat overdoses of drugs other than local anesthetics, particularly lipophilic medications. The recommended ILE dose is a 1.5 mL/kg bolus followed by infusion of 15 mL/kg per hour, with repeat dosing permissible for continued hemodynamic instability. Use of ILE should be considered early as a rescue therapy in the settings of lipophilic medication overdoses when cardiovascular compromise or cardiac arrest is present.
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Affiliation(s)
- Jaclyn O’Connor
- Jaclyn O’Connor is Clinical Pharmacy Specialist, Emergency Medicine, Department of Pharmacy Services, Martin Memorial Hospital, Stuart, Florida. Suprat Saely Wilson is Pharmacy Coordinator, Emergency Medicine Services, Detroit Receiving Hospital, Department of Pharmacy, 1B-UHC, 4201 St Antoine Blvd, Detroit, MI 48201
| | - Suprat Saely Wilson
- Jaclyn O’Connor is Clinical Pharmacy Specialist, Emergency Medicine, Department of Pharmacy Services, Martin Memorial Hospital, Stuart, Florida. Suprat Saely Wilson is Pharmacy Coordinator, Emergency Medicine Services, Detroit Receiving Hospital, Department of Pharmacy, 1B-UHC, 4201 St Antoine Blvd, Detroit, MI 48201
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23
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Karasu D, Yılmaz C, Özgünay ŞE, Dayıoğlu M, Baytar Ç, Korfalı G. Knowledge of the Research Assistants Regarding Local Anaesthetics and Toxicity. Turk J Anaesthesiol Reanim 2016; 44:201-205. [PMID: 27909594 PMCID: PMC5019871 DOI: 10.5152/tjar.2016.53138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/19/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Cardiovascular system depression, respiratory arrest, coma, convulsions, loss of consciousness, muscle twitching, blurred vision, vertigo, dizziness and numbness of the tongue can be seen in local anaesthetic toxicity. Treatment includes 20% lipid solutions, airway control, symptomatic treatment for arrhythmia and convulsions. The aim of this study is to present the knowledge of research assistants, who used local anaesthetics in daily practice, regarding these medications and toxicity treatment and to raise awareness. METHODS The questionnaire comprising 20 questions was administered to 115 research assistants who worked at different specialities in our hospital. RESULTS One hundred and two (88.6%) research assistants answered the questionnaire. Participants' mean age was 28.93 years. Most of them were from the Emergency Department (15.7%). A total of 40.6% of participants worked for 2-5 years at their departments. Local anaesthetics were used in daily practice for 44.4% of them, but 70.3% of them had not been educated about local anaesthetics. Research assistants from anaesthesiology and reanimation participated at a significantly higher rate than other departments (76.9%), in terms of training programs regarding local anaesthetics. While the most popular answers about early toxicity symptoms were anaphylaxis (12.7%) and arrthymia (12.7%), late toxicity was hepatotoxicity (10.8%). However, 87.9% of participants had never encountered local anaesthetic toxicity. The great majority of participants had never heard of lipid therapy (67.4%), and those who were aware had heard it from their trainers (52.2%). Although lipid solution was available in our hospital, only 8.4% of participants knew this. CONCLUSION We believe that additional training programs regarding local anaesthetics and toxicity are needed.
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Affiliation(s)
- Derya Karasu
- Clinic of Anaesthesiology and Reanimation, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Canan Yılmaz
- Clinic of Anaesthesiology and Reanimation, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Şeyda Efsun Özgünay
- Clinic of Anaesthesiology and Reanimation, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Mürüvvet Dayıoğlu
- Clinic of Anaesthesiology and Reanimation, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Çağdaş Baytar
- Clinic of Anaesthesiology and Reanimation, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Gülsen Korfalı
- Clinic of Anaesthesiology and Reanimation, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
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