Local anesthetic systemic toxicity: Difference between revisions
No edit summary |
|||
| Line 7: | Line 7: | ||
{{Maximum doses of anesthetic agents}} | {{Maximum doses of anesthetic agents}} | ||
== | ==Clinical Features== | ||
*CNS symptoms | *CNS symptoms | ||
**Agitation | **Agitation | ||
| Line 24: | Line 24: | ||
***Conduction block | ***Conduction block | ||
***[[Asystole]] | ***[[Asystole]] | ||
==Differential Diagnosis== | |||
*Anaphylaxis | |||
*Anxiety | |||
==Diagnosis== | |||
*Clinical diagnosis | |||
===Workup=== | |||
*Directed by clinical picture | |||
*Blood levels of anesthetic are available, but not clinically useful. | |||
==Management== | ==Management== | ||
| Line 37: | Line 48: | ||
==See Also== | ==See Also== | ||
*[[Nerve Blocks (Main)]] | |||
*[[Lidocaine]] | *[[Lidocaine]] | ||
==External Links== | |||
[http://emedicine.medscape.com/article/1844551-overview Medscape:Local Anesthetic Toxicity] | |||
==References== | |||
<References/> | |||
[[Category:Tox]] | [[Category:Tox]] | ||
[[Category:Drugs]] | [[Category:Drugs]] | ||
Revision as of 05:47, 16 July 2015
Background
- Complication of lidocaine injection (accidental into systemic circulation)
- 0.2% of nerve blocks
- Occurs within minutes of injection
- 75% occuring within 5 minutes
Maximum Doses of Anesthetic Agents
| Agent | Without Epinephrine | With Epinephrine | Duration | Notes |
| Lidocaine | 5 mg/kg (max 300mg) | 7 mg/kg (max 500mg) | 30-90 min |
|
| Mepivicaine | 7 mg/kg | 8 mg/kg | ||
| Bupivicaine | 2.5 mg/kg (max 175mg) | 3 mg/kg (max 225mg) | 6-8 hr |
|
| Ropivacaine | 3 mg/kg | |||
| Prilocaine | 6 mg/kg | |||
| Tetracaine | 1 mg/kg | 1.5 mg/kg | 3hrs (10hrs with epi) | |
| Procaine | 7 mg/kg | 10 mg/kg | 30min (90min with epi) |
Clinical Features
- CNS symptoms
- Agitation
- Auditory changes
- Metallic taste
- Seizures or drowsiness
- Coma
- Respiratory arrest
- Cardiovascular
- First excitation
- Tachycardia
- Ventricular dysrhythmia
- Hypertension
- Followed by depression
- Bradycardia
- Conduction block
- Asystole
- First excitation
Differential Diagnosis
- Anaphylaxis
- Anxiety
Diagnosis
- Clinical diagnosis
Workup
- Directed by clinical picture
- Blood levels of anesthetic are available, but not clinically useful.
Management
- Lipid emulsion, 20% solution
- 1.5 mL/kg bolus over 1 minute
- Then, 15 mL/kg per hour x 20-minute infusion (0.25 mL/kg/min for 20 min or until hemodynamic stability)
- Manage seizures with benzodiazepines; propofol is an option but may worsen CV toxicity
- ACLS modifications per ASRA (Am Soc of Regional Anesthesia):
- Small initial doses of 100 μg boluses in adults
- No vasopressin
- Avoid CCBs and BBs
- Amiodarone preferred in ventricular dysrhythmias
See Also
External Links
Medscape:Local Anesthetic Toxicity