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Guan X, Lu Q, Zhao X, Yan X, Zenobi R. Spatio-Temporal Analysis of Anesthetics in Mice by Solid-Phase Microextraction: Dielectric Barrier Discharge Ionization Mass Spectrometry. Anal Chem 2023; 95:12470-12477. [PMID: 37560898 DOI: 10.1021/acs.analchem.3c02123] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Local anesthetics, drugs that only affect a restricted area of the body, are widely used in daily clinical practice. Less studied but equally important is the distribution of local anesthetics inside organisms. Here, we present a rapid in situ testing method of drug distribution in various organs. The temporal and spatial distribution of anesthetics in mice was measured by solid-phase microextraction (SPME), thermal desorption (TD), and dielectric barrier discharge ionization (DBDI) atmospheric pressure mass spectrometry. A coated SPME probe using a tungsten wire as the support covered with a carbonaceous material was prepared by a simple, low-cost flame method. An in-line structure of the inlet allows TD and DBDI to share the same capillary tube, which greatly improves the transmission efficiency. Nine kinds of anesthetics, such as lidocaine and dyclonine, were detected, and the limit of detection was determined to be as low as 13 pg/mL. In addition, the time-dependent distribution of drugs in mice organs was studied. We also found that macromolecules in organisms do not noticeably interfere with the detection. This method is convenient and efficient because it does not require tissue homogenates and allows direct in situ detection. Compared with the conventional analytical methods, this method is simple and rapid, works in situ, and allows microscale analysis of trace analytes in biological organisms with high sensitivity.
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Affiliation(s)
- Xiaokang Guan
- Department of Chemistry and the MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, College of Chemistry and Chemical Engineering, and Discipline of Intelligent Instruments and Equipment, Xiamen University, Xiamen 361005, China
| | - Qiao Lu
- Department of Chemistry and the MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, College of Chemistry and Chemical Engineering, and Discipline of Intelligent Instruments and Equipment, Xiamen University, Xiamen 361005, China
- Department of Laboratory Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
| | - Xiangxu Zhao
- Department of Chemistry and the MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, College of Chemistry and Chemical Engineering, and Discipline of Intelligent Instruments and Equipment, Xiamen University, Xiamen 361005, China
| | - Xiaowen Yan
- Department of Chemistry and the MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, College of Chemistry and Chemical Engineering, and Discipline of Intelligent Instruments and Equipment, Xiamen University, Xiamen 361005, China
| | - Renato Zenobi
- Department of Chemistry and the MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, College of Chemistry and Chemical Engineering, and Discipline of Intelligent Instruments and Equipment, Xiamen University, Xiamen 361005, China
- Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich CH-8093, Switzerland
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Schweitzer-Chaput A, Callot D, Bouazza N, Lesage F, Oualha M, Paret N, Boyer-Gervoise M, Treluyer JM, Chouchana L. Local anesthetics systemic toxicity in children: analysis of the French pharmacovigilance database. BMC Pediatr 2023; 23:321. [PMID: 37355586 PMCID: PMC10290397 DOI: 10.1186/s12887-023-04126-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/11/2023] [Indexed: 06/26/2023] Open
Abstract
PURPOSE To characterize clinical profile of pediatric local anesthetic (LA) systemic toxicity (LAST) and to identify determinants of life-threatening outcomes. METHODS Spontaneous reports notified to the French Pharmacovigilance Network were retrieved and followed by a case-by-case review, according to the following criteria: LA as suspected drug, age < 18 years, adverse drug reactions related to nervous system, cardiac, respiratory, psychiatric or general disorders. Multivariate logistic regression analysis was performed to identify factors leading to life-threatening reaction (i.e. continuous seizures or cardiorespiratory arrest). RESULTS Among 512 cases retrieved, 64 LAST cases were included (neonates 11%, infants 30%, children 36%, adolescents 23%) mainly involving lidocaine (47%), lidocaine + prilocaine (22%) and ropivacaine (14%). Toxicity profiles were neurological (58%), cardiac (11%) or mixed (20%) and 7 patients (11%) developed methemoglobinemia. LAST was life-threatening for 23 patients (36%) and 2 patients died. Doses were above recommendations in 26 patients (41%) and were not different between life-threatening and non-life-threatening cases. The context of use (general and orthopedic surgery, p = 0.006) and the type of LA agent (lidocaine, p = 0.016) were independently associated with a life-threatening outcome. CONCLUSION In this national retrospective analysis, LAST in children appear to be a rare event. Neurological and cardiac signs were the most frequently reported reactions. LAST in children can be life-threatening, even at therapeutic doses. Although a fatal outcome may anecdotally occur, the vast majority of patients recovered after appropriate medical care.
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Affiliation(s)
- Arnaud Schweitzer-Chaput
- Centre Régional de Pharmacovigilance, Service de Pharmacologie, Hôpital Cochin, AP-HP, Paris, France
| | - Delphine Callot
- Centre Régional de Pharmacovigilance, Service de Pharmacologie, Hôpital Cochin, AP-HP, Paris, France
| | - Naim Bouazza
- Pharmacologie Et Évaluation Des Thérapeutiques Chez L'enfant Et La Femme Enceinte (EA 7323), Université de Paris, Paris, France
- Unité de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, Paris, France
| | - Fabrice Lesage
- Service de Réanimation Pédiatrique, Hôpital Necker, Paris, France
| | - Mehdi Oualha
- Pharmacologie Et Évaluation Des Thérapeutiques Chez L'enfant Et La Femme Enceinte (EA 7323), Université de Paris, Paris, France
- Service de Réanimation Pédiatrique, Hôpital Necker, Paris, France
| | - Nathalie Paret
- Centre Antipoison, Hospices Civils De Lyon, Lyon, France
| | - Marie Boyer-Gervoise
- Centre Régional de Pharmacovigilance, Service de Pharmacologie Clinique, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Jean-Marc Treluyer
- Centre Régional de Pharmacovigilance, Service de Pharmacologie, Hôpital Cochin, AP-HP, Paris, France
- Pharmacologie Et Évaluation Des Thérapeutiques Chez L'enfant Et La Femme Enceinte (EA 7323), Université de Paris, Paris, France
- Unité de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, Paris, France
| | - Laurent Chouchana
- Centre Régional de Pharmacovigilance, Service de Pharmacologie, Hôpital Cochin, AP-HP, Paris, France.
- Pharmacologie Et Évaluation Des Thérapeutiques Chez L'enfant Et La Femme Enceinte (EA 7323), Université de Paris, Paris, France.
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Determination of Local Anesthetic Drugs in Human Plasma Using Magnetic Solid-Phase Extraction Coupled with High-Performance Liquid Chromatography. Molecules 2022; 27:molecules27175509. [PMID: 36080279 PMCID: PMC9457896 DOI: 10.3390/molecules27175509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
In this work, magnetic tetraethylenepentamine (TEPA)-modified carboxyl–carbon nanotubes were synthesized, characterized, and used as adsorbents to conduct magnetic solid-phase extraction (MSPE) for the preconcentration of seven local anesthetic drugs (procaine, lidocaine, mepivacaine, oxybuprocaine, bupivacaine, tetracaine, and cinchocaine) from human plasma. The separation and determination of analytes were performed on high-performance liquid chromatography with UV detection. Several factors affected the extraction efficiency, such as the amount of adsorbents used, extraction time, sample pH, and optimization of elution conditions. Under optimal conditions, satisfactory linear relationships were obtained in the range of 0.02–5.00 mg/L, with the limits of detection (LOD) ranging from 0.003 mg/L to 0.008 mg/L. The recoveries of analytes for spiked human plasma were in the range of 82.0–108%. Moreover, the precision with intra-day and inter-day RSD values were obtained in the range of 1.5–7.7% and 1.5–8.3%. The results indicated that this method could determine the concentration of seven local anesthetic drugs in human plasma with high precision and repeatability and provide support for the clinical monitoring of the concentration of local anesthetic drugs in human plasma.
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García-Ramos S, Fernandez I, Zaballos M. Lipid emulsions in the treatment of intoxications by local anesthesics and other drugs. Review of mechanisms of action and recommendations for use. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:421-432. [PMID: 35871141 DOI: 10.1016/j.redare.2021.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/25/2021] [Indexed: 06/15/2023]
Abstract
Intravenous lipid emulsions (ILEs) have been used widely for the treatment of local anesthetic (LA) poisoning and have been proposed as a treatment for intoxication by other drugs. However, the degree of evidence for this kind of therapy is not strong, as it comes mostly from clinical cases. The aim of this narrative review is to describe the proposed mechanisms of action for ILEs in poisoning by LA and other drugs and to evaluate recent studies in animals that support the recommendations for their use and the experience in humans that support the use of ILESs in both LA and other drug poisoning. For this purpose, a search was performed in the Embase, Medline and Google Scholar databases covering relevant articles over the last 10 years. In the case of AL poisoning, we recommend applying the protocols dictated by international guidelines, knowing that the degree of evidence is not very high. In poisoning by other drugs, ILEs are recommended in serious situations induced by liposoluble xenobiotics that do not respond to standard treatment.
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Affiliation(s)
- S García-Ramos
- Servicio de Anestesia y Reanimación, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - I Fernandez
- Servicio de Anestesia y Reanimación, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - M Zaballos
- Servicio de Anestesia y Reanimación, Hospital Universitario Gregorio Marañón, Madrid, Spain; Departamento de Toxicología, Universidad Complutense de Madrid, Madrid, Spain
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Liu Y, Zhang J, Yu P, Niu J, Yu S. Mechanisms and Efficacy of Intravenous Lipid Emulsion Treatment for Systemic Toxicity From Local Anesthetics. Front Med (Lausanne) 2021; 8:756866. [PMID: 34820396 PMCID: PMC8606423 DOI: 10.3389/fmed.2021.756866] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Local anesthetics are widely used clinically for perioperative analgesia to achieve comfort in medical treatment. However, when the concentration of local anesthetics in the blood exceeds the tolerance of the body, local anesthetic systemic toxicity (LAST) will occur. With the development and popularization of positioning technology under direct ultrasound, the risks and cases of LAST associated with direct entry of the anesthetic into the blood vessel have been reduced. Clinical occurrence of LAST usually presents as a series of severe toxic reactions such as myocardial depression, which is life-threatening. In addition to basic life support (airway management, advanced cardiac life support, etc.), intravenous lipid emulsion (ILE) has been introduced as a treatment option in recent years and has gradually become the first-line treatment for LAST. This review introduces the mechanisms of LAST and identifies the clinical symptoms displayed by the central nervous system and cardiovascular system. The paper features the multimodal mechanism of LAST reversal by ILE, describes research progress in the field, and identifies other anesthetics involved in the resuscitation process of LAST. Finally, the review presents key issues in lipid therapy. Although ILE has achieved notable success in the treatment of LAST, adverse reactions and contraindications also exist; therefore, ILE requires a high degree of attention during use. More in-depth research on the treatment mechanism of ILE, the resuscitation dosage and method of ILE, and the combined use with other resuscitation measures is needed to improve the efficacy and safety of clinical resuscitation after LAST in the future.
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Affiliation(s)
- Yang Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Key Laboratory of Anesthesiology of Jiangxi Province, Nanchang, China
| | - Jing Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Key Laboratory of Anesthesiology of Jiangxi Province, Nanchang, China
| | - Peng Yu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jiangfeng Niu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Key Laboratory of Anesthesiology of Jiangxi Province, Nanchang, China
| | - Shuchun Yu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Key Laboratory of Anesthesiology of Jiangxi Province, Nanchang, China
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García-Ramos S, Fernandez I, Zaballos M. Lipid emulsions in the treatment of intoxications by local anesthesics and other drugs. Review of mechanisms of action and recommendations for use. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 69:S0034-9356(21)00143-2. [PMID: 34140161 DOI: 10.1016/j.redar.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/24/2021] [Accepted: 03/25/2021] [Indexed: 11/21/2022]
Abstract
Intravenous lipid emulsions (ILEs) have been used widely for the treatment of local anesthetic (LA) poisoning and have been proposed as a treatment for intoxication by other drugs. However, the degree of evidence for this kind of therapy is not strong, as it comes mostly from clinical cases. The aim of this narrative review is to describe the proposed mechanisms of action for ILEs in poisoning by LA and other drugs and to evaluate recent studies in animals that support the recommendations for their use and the experience in humans that support the use of ILESs in both LA and other drug poisoning. For this purpose, a search was performed in the Embase, Medline and Google Scholar databases covering relevant articles over the last 10 years. In the case of AL poisoning, we recommend applying the protocols dictated by international guidelines, knowing that the degree of evidence is not very high. In poisoning by other drugs, ILEs are recommended in serious situations induced by liposoluble xenobiotics that do not respond to standard treatment.
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Affiliation(s)
- S García-Ramos
- Servicio de Anestesia y Reanimación, Hospital Universitario Gregorio Marañón, Madrid, España.
| | - I Fernandez
- Servicio de Anestesia y Reanimación, Hospital Universitario Gregorio Marañón, Madrid, España
| | - M Zaballos
- Servicio de Anestesia y Reanimación, Hospital Universitario Gregorio Marañón, Madrid, España; Departamento de Toxicología, Universidad Complutense de Madrid, Madrid, España
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Application of carbon nanosorbent for PRiME pass-through cleanup of 10 selected local anesthetic drugs in human plasma samples. Anal Chim Acta 2017; 960:72-80. [DOI: 10.1016/j.aca.2017.01.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/20/2017] [Accepted: 01/26/2017] [Indexed: 01/07/2023]
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Tonooka K, Naruki N, Honma K, Agei K, Okutsu M, Hosono T, Kunisue Y, Terada M, Tomobe K, Shinozuka T. Sensitive liquid chromatography/tandem mass spectrometry method for the simultaneous determination of nine local anesthetic drugs. Forensic Sci Int 2016; 265:182-5. [DOI: 10.1016/j.forsciint.2016.02.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 02/19/2016] [Accepted: 02/22/2016] [Indexed: 11/25/2022]
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