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Dik E, Bjorvatn E, Elberling J. Symmetric drug-related intertriginous and flexural exanthema elicited by lidocaine cum adrenaline in a patient allergic to sodium metabisulfite. Contact Dermatitis 2024. [PMID: 38979722 DOI: 10.1111/cod.14636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/14/2024] [Accepted: 06/23/2024] [Indexed: 07/10/2024]
Affiliation(s)
- Emilia Dik
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth Bjorvatn
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Elberling
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Butranova O, Zyryanov S, Gorbacheva A, Asetskaya I, Polivanov V. Drug-Induced Anaphylaxis: National Database Analysis. Pharmaceuticals (Basel) 2024; 17:90. [PMID: 38256923 PMCID: PMC10821106 DOI: 10.3390/ph17010090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
(1) Background: National health system databases represent an important source of information about the epidemiology of adverse drug reactions including drug-induced allergy and anaphylaxis. Analysis of such databases may enhance the knowledge of healthcare professionals regarding the problem of drug-induced anaphylaxis. (2) Methods: A retrospective descriptive analysis was carried out of spontaneous reports (SRs) with data on drug-induced anaphylaxis (SRsAs) extracted from the Russian National Pharmacovigilance database (analyzed period 2 April 2019-21 June 2023). The percentage of SRsAs among SRs of drug-induced allergy (SRsDIAs) was calculated, as well as of pediatric, elderly, and fatal SrsAs. Drugs involved in anaphylaxis were assessed among total SRsAs, pediatric, and elderly SRsAs, and among fatal SRsAs. Demographic parameters of patients were assessed. (3) Results: SRsAs were reported in 8.3% of SRsDIAs (2304/27,727), the mean age of patients was 48.2 ± 15.8 years, and females accounted for 53.2% of cases. The main causative groups of drugs were antibacterials (ABs) for systemic use (44.6%), local anesthetics (20.0%), and cyclooxygenase (COX) inhibitors (10.1%). Fatal SRsAs were reported in 9.5% (218/2304) of cases, the mean age of patients was 48.0 ± 16.7 years, and females accounted for 56.4% of cases. Pediatric SRsAs accounted for 3.9% of pediatric SRsDIAs and 5.8% of all SRsAs, with a mean age of 11.8 ± 4.5 years, and females acccounted for 51.9% of cases. Elderly SRsAs accounted for 2% of elderly SRsDIAs and 2.8% of all SRsAs, and the mean age was 73.0 ± 5.3 years, and females accounted for 43.5% of cases. ABs caused 40% of SRsAs in the elderly, 42.9% in children, and 50% of fatal SRsAs. (4) Conclusions: Our study revealed a relatively high proportion of anaphylaxis among SRs of drug-induced allergy. ABs were the most prevalent causative agents, especially in fatal SRsAs.
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Affiliation(s)
- Olga Butranova
- Department of General and Clinical Pharmacology, Peoples’ Friendship University of Russia Named after Patrice Lumumba (RUDN), 6 Miklukho-Maklaya St., 117198 Moscow, Russia; (S.Z.); (A.G.); (I.A.)
| | - Sergey Zyryanov
- Department of General and Clinical Pharmacology, Peoples’ Friendship University of Russia Named after Patrice Lumumba (RUDN), 6 Miklukho-Maklaya St., 117198 Moscow, Russia; (S.Z.); (A.G.); (I.A.)
- Moscow City Health Department, City Clinical Hospital No. 24, State Budgetary Institution of Healthcare of the City of Moscow, Pistzovaya Srt. 10, 127015 Moscow, Russia
| | - Anastasia Gorbacheva
- Department of General and Clinical Pharmacology, Peoples’ Friendship University of Russia Named after Patrice Lumumba (RUDN), 6 Miklukho-Maklaya St., 117198 Moscow, Russia; (S.Z.); (A.G.); (I.A.)
| | - Irina Asetskaya
- Department of General and Clinical Pharmacology, Peoples’ Friendship University of Russia Named after Patrice Lumumba (RUDN), 6 Miklukho-Maklaya St., 117198 Moscow, Russia; (S.Z.); (A.G.); (I.A.)
| | - Vitaly Polivanov
- Pharmacovigilance Center, Information and Methodological Center for Expert Evaluation, Record and Analysis of Circulation of Medical Products under the Federal Service for Surveillance in Healthcare, 4-1 Slavyanskaya Square, 109074 Moscow, Russia;
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3
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Voss VB, Oh C, Veerabagu S, Nugent S, Giordano C, Golda NJ. Bupivacaine to Reduce Pain and Narcotic Use After Mohs Micrographic Surgery. Dermatol Surg 2022; 48:1135-1139. [PMID: 36342245 DOI: 10.1097/dss.0000000000003567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Limited data exists for bupivacaine injection after Mohs micrographic surgery (MMS). OBJECTIVE Evaluate how bupivacaine affects postoperative pain and narcotic use. MATERIALS AND METHODS In this multicenter, single-blinded, prospective randomized controlled trial, patients received bupivacaine or saline (placebo) immediately after MMS with flap reconstructions identified by American Academy of Dermatology expert consensus as high-risk for pain and narcotic use. For 48 hours postoperatively, patients logged analgesic use, pain scores (0-10), and whether pain was controlled. RESULTS One hundred seventy-four patients were included. Narcotic analgesic use was higher in the placebo group during the first 24 hours (odds ratio 2.18; confidence interval [CI]: 1.08-4.41; p = .03), second 24 hours (odds ratio 2.18; CI: 0.91-5.29; p = .08), and 48 hours combined (odds ratio 2.58; CI: 1.28-5.24; p < .01). Pain scores were lower in the bupivacaine group during the first 8 hours (mean difference 1.6; CI: 0.73-2.38; p < .001). Overall analgesic use (narcotic and non-narcotic) and percentage of patients reporting pain under control were similar between groups. There were no significant differences in demographics or surgical characteristics. No adverse events occurred. CONCLUSION Single-dose bupivacaine decreased postoperative pain and narcotic analgesic use after MMS with reconstructions likely to cause significant pain. Bupivacaine may have a role in postoperative pain management and reducing narcotic use in this population.
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Affiliation(s)
- Vanessa B Voss
- Department of Dermatology, University of Missouri, Columbia, Missouri
| | - Clara Oh
- Department of Dermatology, University of Missouri, Columbia, Missouri
| | - Surya Veerabagu
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shannon Nugent
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cerrene Giordano
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicholas J Golda
- Department of Dermatology, University of Missouri, Columbia, Missouri
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4
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Uppal NN, Jhaveri M, Hong S, Shore-Lesserson L, Jhaveri KD, Izzedine H. Local anesthetics for the Nephrologist. Clin Kidney J 2022; 15:186-193. [PMID: 35145634 PMCID: PMC8824772 DOI: 10.1093/ckj/sfab121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Indexed: 12/03/2022] Open
Abstract
Several specialists in medicine use local anesthetics. In patients with kidney disease, these agents are used during catheter insertions for hemodialysis and peritoneal dialysis, arteriovenous fistula and graft procedures, kidney transplantation, parathyroidectomy, kidney biopsies, and dental and skin procedures. Patients on chronic hemodialysis use a topical application prior to use of needles for arteriovenous fistula cannulation before starting dialysis. They are also used to manage acute and chronic pain conditions, in regional nerve blockade and in multi-modal enhanced recovery protocols. Despite their frequent use by both physicians and patients, data on the use of local anesthetics in patients with kidney impairment are not well reported. This review will summarize the use of local anesthetics in chronic kidney disease, describe their pharmacology and the impact of lower estimated glomerular filtration rate on their pharmacokinetics, and suggest dose regulation in those with kidney dysfunction.
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Affiliation(s)
- Nupur N Uppal
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, NY, USA
| | - Mital Jhaveri
- Department of Pharmacy, Queens Hospital Center, Jamaica, NY, USA
| | - Susana Hong
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, NY, USA
| | - Linda Shore-Lesserson
- Department of Anesthesiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, NY, USA
| | - Kenar D Jhaveri
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, NY, USA
| | - Hassan Izzedine
- Department of Nephrology, Peupliers Private Hospital, Ramsay Générale de Santé, Paris, France
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5
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Green JB, Layt C. Limited Dilute Lidocaine Anesthesia: A Useful Technique with Many Practical Applications. J Cosmet Dermatol 2022; 21:1445-1447. [PMID: 35113474 PMCID: PMC9305289 DOI: 10.1111/jocd.14825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/31/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limited dilute lidocaine infiltration facilitates a comfortable procedure and a rapid recovery process following a novel intervention for reduction of cellulite. Infiltration of dilute lidocaine has many other practical applications in dermatologic surgery. OBJECTIVES This article describes a safe, effective technique for local infiltration of limited volume dilute lidocaine anesthesia in a cellulite reduction procedure. METHODS The limited dilute lidocaine technique was utilized in studies of a novel device designed to reduce the appearance of cellulite by focal release of fibrous septa in a minimally-invasive procedure. No sedation was used. A small (27- to 30-gauge) needle was used to deliver anesthesia to the entry sites. Then, a 20-gauge spinal needle was tunneled under the skin in the superficial plane to manually deliver anesthetic along the advancement pathway of the device and marked cellulite targets. RESULTS During the initial studies, the mean delivered anesthesia volume was 357.2 mL (range, 250-525 mL) or 18.7 mg/kg (range, 11.1-28.4 mg/kg). The mean anesthesia time was 16 minutes (range, 8-32 minutes). The mean number of cellulite depressions treated was 19.8 (range, 11-34). Adverse events were closely monitored, and there were no signs of toxicity in any study patients. There were very low levels of discomfort; all patients reported the procedure was tolerable. This technique facilitates a time-efficient procedure and minimizes weeping of excess fluid during recovery. CONCLUSIONS When administered with care and skill, the limited dilute anesthesia technique is a safe, effective approach for local anesthesia with many practical applications in dermatologic surgery.
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The Safety Profile of General and Local Anaesthetic Agents: Data Collected during 20 Years of Spontaneous Reporting Activities in the Campania Region (Southern Italy). Pharmaceuticals (Basel) 2021; 14:ph14121261. [PMID: 34959662 PMCID: PMC8703922 DOI: 10.3390/ph14121261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/19/2022] Open
Abstract
Background: General and local anaesthetics are widely used during surgery. These drugs have peculiar safety profiles, being commonly associated with mild and reversible local adverse drug reactions (ADRs), but also with more severe and systemic ADRs, including respiratory and cardiovascular depression and anaphylaxis. Methods and Objectives: We carried out a descriptive analysis of Individual Case Safety Reports (ICSRs) sent to the Campania Regional Centre of Pharmacovigilance (Southern Italy) from 2001 to 2021 that reported general or local anaesthetics as suspected drugs, with the aim of describing their overall characteristics, focussing on the ADRs’ seriousness and distribution by System Organ Class (SOC) and Preferred Term (PT). Results: A total of 110 ICSRs documenting general or local anaesthetics were sent to the Italian pharmacovigilance database during 20 years of spontaneous reporting activities in the Campania region. ADRs mainly occurred in patients with a median age of 48 years and in a slightly higher percentage of men. ADRs were more commonly classified as not serious and had a favourable outcome. In terms of ADRs’ distribution by SOC and PT, both general and local anaesthetics were associated with general and cutaneous disorders, with common ADRs that included lack of efficacy, rash, and erythema. In addition, general anaesthetics were associated with the occurrence of respiratory ADRs, while local anaesthetics were associated with the occurrence of nervous ADRs. Conclusion: Even though a limited number of ICSRs documenting anaesthetics-induced ADRs were retrieved from the Italian spontaneous reporting database in the Campania region, we believe that the continuous monitoring of these drugs is highly recommended, especially among the frail population.
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Wang A, Grushchak S, Kaul S, Lee PK, Feldman J. Toxicity of Infiltrative Lidocaine in Dermatologic Surgery: Are Current Limits Valid? Dermatol Pract Concept 2021; 11:e2021120. [PMID: 34631267 DOI: 10.5826/dpc.1104a120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 10/31/2022] Open
Affiliation(s)
- Allison Wang
- Division of Dermatology, Cook County Health, Chicago, IL, USA
| | | | - Subuhi Kaul
- Division of Dermatology, Cook County Health, Chicago, IL, USA
| | - Patrick K Lee
- Department of Dermatology, University of California, Irvine, California, USA
| | - Jerry Feldman
- Division of Dermatology, Cook County Health, Chicago, IL, USA
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Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review. J Clin Med 2021; 10:jcm10204659. [PMID: 34682777 PMCID: PMC8537195 DOI: 10.3390/jcm10204659] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/03/2021] [Accepted: 10/08/2021] [Indexed: 12/29/2022] Open
Abstract
Local anesthetic wound infiltration (WI) provides anesthesia for minor surgical procedures and improves postoperative analgesia as part of multimodal analgesia after general or regional anesthesia. Although pre-incisional block is preferable, in practice WI is usually done at the end of surgery. WI performed as a continuous modality reduces analgesics, prolongs the duration of analgesia, and enhances the patient’s mobilization in some cases. WI benefits are documented in open abdominal surgeries (Caesarean section, colorectal surgery, abdominal hysterectomy, herniorrhaphy), laparoscopic cholecystectomy, oncological breast surgeries, laminectomy, hallux valgus surgery, and radical prostatectomy. Surgical site infiltration requires knowledge of anatomy and the pain origin for a procedure, systematic extensive infiltration of local anesthetic in various tissue planes under direct visualization before wound closure or subcutaneously along the incision. Because the incidence of local anesthetic systemic toxicity is 11% after subcutaneous WI, appropriate local anesthetic dosing is crucial. The risk of wound infection is related to the infection incidence after each particular surgery. For WI to fully meet patient and physician expectations, mastery of the technique, patient education, appropriate local anesthetic dosing and management of the surgical wound with “aseptic, non-touch” technique are needed.
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9
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Tan MG, Li HO, Pratt MD. Systemic allergic dermatitis to sodium metabisulfite in local anesthetic solution. Contact Dermatitis 2021; 86:120-121. [PMID: 34549447 DOI: 10.1111/cod.13978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/11/2021] [Accepted: 09/19/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Marcus G Tan
- Division of Dermatology, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Heidi O Li
- Division of Dermatology, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
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Gaur S, Marimuthu M, Wahab A, Krishnan N, Ramasubbu S. Twin Mixed Local Anesthesia in Third Molar Surgery - Randomized Controlled Trial. J Oral Maxillofac Surg 2021; 80:63-69. [PMID: 34363764 DOI: 10.1016/j.joms.2021.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/18/2021] [Accepted: 07/09/2021] [Indexed: 01/23/2023]
Abstract
PURPOSE The aim of this study was to compare the clinical efficacy of injection of 2 long-acting amide local anesthetic agents - bupivacaine and ropivacaine with and without 4 mg dexamethasone in patients undergoing third molar extraction. METHODS A prospective randomized double blind controlled trial was conducted among 68 patients with impacted mandibular third molars. Group A and B were the control groups and received 1.8 mL of 0.5% bupivacaine hydrochloride and 0.75% ropivacaine hydrochloride, respectively. Group A1 and B1 were experimental groups and received modified twin mixes which were 1.8 mL of 0.5% bupivacaine hydrochloride + 1mL/4mg dexamethasone and 0.75% ropivacaine hydrochloride + 1 mL/4mg dexamethasone, respectively. Visual analog pain scale, mouth opening measurement and facial swelling were assessed at the time of injection and postoperative days 1, 3, and 7. RESULTS The mean visual analogue scale score for pain on local anesthesia injection was found to be less in both experimental groups- Group A1 (2.94) and B1 (2.41) as compared to control groups- Group A (3.59) and B (3.06). The durations of soft tissue anesthesia were higher as compared to their respective controls for both Group A1 and B1. Patients in both control groups A and B had an increased postoperative swelling, pain and trismus. CONCLUSIONS Intraoperative and postoperative comfort in both the experimental groups were higher than those for control groups, thereby establishing the clinical efficacy of both modified twin mixes for use in surgical extraction of mandibular third molars.
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Affiliation(s)
- Shivangi Gaur
- Post graduate Resident, Department of Oral & Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai India
| | - Madhulaxmi Marimuthu
- Professor, Department of Oral & Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai India.
| | - Abdul Wahab
- Professor, Department of Oral & Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai India
| | - Navaneetha Krishnan
- Professor, Department of Anesthesia, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai India
| | - Subhashini Ramasubbu
- Post graduate Resident, Department of Oral & Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai India
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Sweet-Tasting Ionic Conjugates of Local Anesthetics and Vasoconstrictors. Molecules 2021; 26:molecules26040983. [PMID: 33673320 PMCID: PMC7918242 DOI: 10.3390/molecules26040983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 11/18/2022] Open
Abstract
Local anesthetics are widely utilized in dentistry, cosmetology, and medicine. Local anesthesia is essential to providing a pain-free experience during dental and local surgeries as well as cosmetic procedures. However, the injection itself may produce discomfort and be a source of aversion. A novel approach toward the taste modulation of local anesthetics is proposed, in which the anesthetics of the “-caine” family serve as cations and are coupled with anionic sweeteners such as saccharinate and acesulfamate. Ionic conjugates of vasoconstrictor epinephrine such as epinephrine saccharinate and epinephrine acesulfamate have also been synthesized. Novel ionic conjugates were developed using anion exchange techniques. Reported compounds are sweet-tasting and are safe to use both topically and as injections.
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Baltz JO, Jellinek NJ. Nail Surgery: Six Essential Techniques. Dermatol Clin 2021; 39:305-318. [PMID: 33745642 DOI: 10.1016/j.det.2020.12.015] [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: 10/22/2022]
Abstract
Successful nail surgery requires an understanding of specific disease processes, the anatomy of the nail unit, and fluency with only a few key techniques. This article focuses on 6 high-yield procedures, facility with which will allow the clinician to approach most of the clinical scenarios requiring surgical intervention. These encompass surgical approaches to inflammatory nail diseases, melanonychia, erythronychia, and nail melanoma in situ.
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Affiliation(s)
- Julia O Baltz
- Dermatology Professionals, Inc, 1672 South County Trail, Suite 101, East Greenwich, RI 02818, USA; Department of Dermatology, University of Massachusetts Medical School, 281 Lincoln Street, Worcester, MA 01605, USA
| | - Nathaniel J Jellinek
- Dermatology Professionals, Inc, 1672 South County Trail, Suite 101, East Greenwich, RI 02818, USA; Department of Dermatology, University of Massachusetts Medical School, 281 Lincoln Street, Worcester, MA 01605, USA; Department of Dermatology, The Warren Alpert Medical School at Brown University, 593 Eddy Street, Providence, RI 02903, USA.
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Favatela F, Horst M, Bracone M, Gonzalez J, Alvarez V, Lassalle V. Gelatin/Cellulose nanowhiskers hydrogels intended for the administration of drugs in dental treatments: Study of lidocaine as model case. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2020.101886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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14
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Strickler AG, Shah P, Bajaj S, Mizuguchi R, Nijhawan RI, Odueyungbo M, Rossi A, Ratner D. Preventing complications in dermatologic surgery: Presurgical concerns. J Am Acad Dermatol 2021; 84:883-892. [PMID: 33497750 DOI: 10.1016/j.jaad.2020.10.099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 01/19/2023]
Abstract
Cutaneous surgery has become critical to comprehensive dermatologic care, and dermatologists must therefore be equipped to manage the risks associated with surgical procedures. Complications may occur at any point along the continuum of care, and therefore assessing, managing, and preventing risk from beginning to end becomes essential. This review focuses on preventing surgical complications pre- and postoperatively as well as during the surgical procedure.
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Affiliation(s)
- Allen G Strickler
- Department of Dermatology, Geisinger Medical Center of Geisinger Commonwealth School of Medicine, Danville, Pennsylvania; Department of Laboratory Medicine, Geisinger Medical Center of Geisinger Commonwealth School of Medicine, Danville, Pennsylvania.
| | - Payal Shah
- School of Medicine, New York University Langone Health, New York, New York
| | - Shirin Bajaj
- Department of Dermatology, New York University Langone Health, New York, New York
| | - Richard Mizuguchi
- Department of Dermatology, Mount Sinai Medical School, New York, New York
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Anthony Rossi
- Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Désirée Ratner
- Department of Dermatology, New York University Langone Health, New York, New York
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Cao J, Yang L, Wang Y, Liu R, Zhang T, He L. Characterization of interactions between local anesthetics and histamine H 1 receptor by cell membrane chromatography model. J Pharm Biomed Anal 2021; 196:113911. [PMID: 33497977 DOI: 10.1016/j.jpba.2021.113911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/12/2020] [Accepted: 01/16/2021] [Indexed: 01/06/2023]
Abstract
Local anesthetic has a wide application in clinical practice. However, angioedema, an adverse reaction caused by local anesthetics, has been reported to be related to histamine H1 receptor (H1R). Hence, an effective and practical method for investigating the interaction characteristics between local anesthetics and H1R is needed. In this work, the competition binding assay and the relative standard method based on H1R-HEK293/cell membrane chromatography (CMC) were developed to analyze the equilibrium dissociation constant (KD) values of local anesthetics with H1R. The activity of drugs toward H1R was evaluated by intracellular Ca2+ imaging assay. Molecular docking was used to verify the interaction modes that occurred at the activate pocket of H1R protein. Results showed that the local anesthetics can directly occupy histamine binding sites on H1R, and the KD values obtained from different CMC methods exhibited positive correlations with each other (p < 0.01). The KD values of tetracaine, procaine, and lidocaine were much closer to that of histamine than bupivacaine and ropivacaine. This was not only in line with the Ca2+ responses in activating H1R, but also consistent with the same amino acid residues shared with histamine in the H1R active site. In conclusion, this study provided new insight into the interactions between local anesthetics and H1R. The H1R-HEK293/CMC methods developed in this study could be used to evaluate the interaction characteristics of those compounds acting on H1R.
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Affiliation(s)
- Jiao Cao
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Liu Yang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yuejin Wang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Rui Liu
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Tao Zhang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Langchong He
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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Cao J, Zhang Y, Che D, Liu R, Yang L, Zhang T, He L. H 1R mediates local anesthetic-induced vascular permeability in angioedema. Toxicol Appl Pharmacol 2020; 392:114921. [PMID: 32061592 DOI: 10.1016/j.taap.2020.114921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/30/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022]
Abstract
Angioedema may occur during local anesthetic (LA) injection in the perioperative period. Histaminergic angioedema is the most common form of angioedema. It has been reported that LA is a potential exogenous ligand for histamine receptor 1 (H1R). Whether H1R participates in LA-induced angioedema is still controversial. By using a constructed H1R high-expressed cell model, siRNA transfection, pharmacologic means, and genetically modified animal models, here we showed that H1R mediated LA-induced hyperpermeability. LA with uncycled N-methyl scaffold in the side chain (procaine, tetracaine and lidocaine) had a better strength of drug-H1R affinity than that for LA with cycled N atom (bupivacaine and ropivacaine) by the molecular docking assay and equilibrium dissociation constant (KD values) obtained from the cell membrane chromatography (CMC) relative standard method. Procaine, tetracaine, and lidocaine triggered big calcium mobilization in H1R-HEK293 cells and human umbilical vein endothelial cells (HUVECs) but much weaker in NC-HEK293 cells or H1R knockdown HUVECs. Besides, the results of transendothelial resistance measurement, paracellular flux assay and immunofluorescence showed that procaine induced H1R-dependent hyperpermeability, which involved in PLCγ/IP3R/PKC, ERK1/2, Akt signaling pathways, downstream vascular endothelial cadherin (VE-cad) destabilization. Furthermore, H1R gene knockout prevented paw swelling and vascular leakage caused by procaine, tetracaine, and lidocaine in vivo. This study supported a key role of H1R in LA-induced angioedema, and suggested that in the design of LA structure, the ring formation of the N-methyl scaffold on the side chain can properly avoid the angioedema.
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Affiliation(s)
- Jiao Cao
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yongjing Zhang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Delu Che
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Rui Liu
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Liu Yang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Tao Zhang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Langchong He
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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Cherobin ACFP, Tavares GT. Safety of local anesthetics. An Bras Dermatol 2019; 95:82-90. [PMID: 31952994 PMCID: PMC7058875 DOI: 10.1016/j.abd.2019.09.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/23/2019] [Indexed: 12/20/2022] Open
Abstract
Local anesthetics are essential medications for the conduction of dermatological procedures. They stop the depolarization of nerve fibers and are divided into two main categories, the amide and ester types. Systemic toxicity with reflex on the central nervous and cardiovascular systems is their most feared adverse reactions, and the anaphylactic reaction is the most concerning one. Although potentially fatal, these events are extremely rare, so local anesthetics are considered safe for use in in-office procedures.
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Affiliation(s)
| | - Glaysson Tassara Tavares
- Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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20
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Vigato AA, Querobino SM, de Faria NC, de Freitas ACP, Leonardi GR, de Paula E, Cereda CMS, Tófoli GR, de Araujo DR. Synthesis and characterization of nanostructured lipid-poloxamer organogels for enhanced skin local anesthesia. Eur J Pharm Sci 2019; 128:270-278. [PMID: 30553060 DOI: 10.1016/j.ejps.2018.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/21/2018] [Accepted: 12/11/2018] [Indexed: 01/06/2023]
Abstract
The aim of this study was to synthesize a novel drug delivery system using organogels (ORGs) and characterize its physicochemical properties, in vitro and ex vivo permeation abilities, cytotoxicity and in vivo local anesthetic effects. The ORG formulations contained a mixture of oleic acid-lanolin (OA-LAN), poloxamer (PL407), and the commonly used local anesthetic lidocaine (LDC). The main focus was to evaluate the impact of LAN and PL407 concentrations on the ORG structural features and their biopharmaceutical performance. Results revealed that LDC, OA, and LAN incorporation separately shifted the systems transitions phase temperatures and modified the elastic/viscous moduli relationships (G'/G″ = ~15×). Additionally, the formulation with the highest concentrations of LAN and PL407 reduced the LDC flux from ~17 to 12 μg·cm-2·h-1 and the permeability coefficients from 1.2 to 0.62 cm·h-1 through ex vivo skin. In vivo pharmacological evaluation showed that the ORG-based drug delivery system presented low cytotoxicity, increased and prolonged the local anesthetic effects compared to commercial alternatives. The data from this study indicate that ORG represent a promising new approach to effectively enhance the topical administration of local anesthetics.
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Razavi BM, Fazly Bazzaz BS. A review and new insights to antimicrobial action of local anesthetics. Eur J Clin Microbiol Infect Dis 2019; 38:991-1002. [PMID: 30680564 DOI: 10.1007/s10096-018-03460-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 12/17/2018] [Indexed: 11/25/2022]
Abstract
Local anesthetics (LAs) are medications which can provide analgesia in distinct body regions through the blockade of voltage-gated sodium channels. Besides pain management, the supplemental role of LAs as antimicrobial agents has been documented in several studies. Different databases including PubMed, Scopus, and Web of Science with the name of different local anesthetics and related names for antimicrobial keywords were searched without time limitation. This review summarized different in vitro and in vivo studies regarding antimicrobial effects of different LAs with focuses on antimicrobial applications of most studied LAs, interaction with different agents which combined with LAs, and mechanisms of action and structural dependence of LAs antibacterial effects. Among different LAs, lidocaine is the most studied preparation. Reduction of the incidence of endophthalmitis after intravitreal injection, prophylaxis for surgical wound infections, prevention of the incidence of catheter-associated infections, oral biofilm reduction on the buccal mucosa, and prevention against bacteria that produced nosocomial infection are some examples of lidocaine antimicrobial application. Studies showed that different factors including structure, concentration, duration of exposure, type of microorganism tested, and temperature affect the degree of LA antimicrobial activity. In addition, various agents such as antibiotics, preservatives, opioids, epinephrine, and propofol can combine with LAs and affect their antimicrobial properties through synergistic or antagonistic action. Due to antibacterial activities, LAs could be applied in a clinic for prophylaxis of surgical site infection. In the application of LAs prior to diagnostic procedures caution should be needed; otherwise, when culturing the specimen, they could lead to false negative results.
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Affiliation(s)
- Bibi Marjan Razavi
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bibi Sedigheh Fazly Bazzaz
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
- Pharmaceutical Control Department, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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