Podcast #357: Local Anesthetic Toxicity

Podcast #357: Local Anesthetic Toxicity

Author: Michael Hunt, MD

Educational Pearls:

  • Toxicity happens from local anesthetics being given too fast, too much, or in the unintended spot
  • Systemic toxicity manifests first with neurologic symptoms like circumoral numbness, tinnitus, blurred vision, nausea, and even seizures. Severe toxicity can then progress to arrhythmias and cardiac arrest.
  • Maximum doses of lidocaine: 4 mg/kg; and with epinephrine: 7mg/kg.
  • Maximum dose of bupivacaine: 2mg/kg; with epinephrine 3mg/kg

Editor note: treat seizures with benzodiazepines and avoid propofol for sedation; severe toxicity can also be treated with a 20% lipid emulsion, though there is debate on its efficacy

References

Dickerson DM, Apfelbaum JL. Local anesthetic systemic toxicity. Aesthet Surg J. 2014 Sep;34(7):1111-9. doi: 10.1177/1090820X14543102.

Neal JM, Mulroy MF, Weinberg GL; American Society of Regional Anesthesia and Pain Medicine.. American Society of Regional Anesthesia and Pain Medicine checklist for managing local anesthetic systemic toxicity: 2012 version. Reg Anesth Pain Med. 2012 Jan-Feb;37(1):16-8. doi: 10.1097/AAP.0b013e31822e0d8a.

Vasques F, Behr AU, Weinberg G, Ori C, Di Gregorio G. A Review of Local Anesthetic Systemic Toxicity Cases Since Publication of the American Society of Regional Anesthesia Recommendations: To Whom It May Concern. Reg Anesth Pain Med. 2015 Nov-Dec;40(6):698-705. doi: 10.1097/AAP.0000000000000320.

Jaksot(1145)

Episode 959: The KLM Flight Disaster and Lessons in Healthcare Communication

Episode 959: The KLM Flight Disaster and Lessons in Healthcare Communication

Contributor: Taylor Lynch, MD Educational Pearls: The KLM Flight Disaster, also known as the Tenerife Airport Disaster, occurred on 27 March 1977. It involved the collision of two Boeing 747 passenger...

2 Kesä 20256min

Episode 958: Intranasal Fentanyl

Episode 958: Intranasal Fentanyl

Contributor: Aaron Lessen, MD Educational Pearls: How do we take care of kids in severe pain? There are many non-pharmacologic options for pain (i.e. ice, elevation) as well as more conventional medi...

26 Touko 20251min

Episode 957: Cardiac Asthma

Episode 957: Cardiac Asthma

Contributor: Travis Barlock, MD Educational Pearls: Wheezing is classically heard in asthma and COPD, but it can be the result of a wide range of processes that cause airflow limitation Narrowed bro...

19 Touko 20253min

Episode 956: Psychedelics and Risk of Schizophrenia

Episode 956: Psychedelics and Risk of Schizophrenia

Contributor: Jorge Chalit-Hernandez, OMS3 Educational Pearls: Psychedelics are being studied for their therapeutic effects in mental illnesses, including major depressive disorder, post-traumatic str...

12 Touko 20252min

Episode 955: Cardiac Effects of COVID-19

Episode 955: Cardiac Effects of COVID-19

Contributor: Ricky Dhaliwal, MD Educational Pearls: What factors are considered in a COVID-19 infection? The viral load: Understood as the impact of SARS-CoV-2 viral particles infecting host cell tis...

5 Touko 20254min

Episode 954: Combo Rescue Inhalers - New Guidelines

Episode 954: Combo Rescue Inhalers - New Guidelines

Contributor: Aaron Lessen, MD Educational Pearls: What is a Rescue Inhaler? A rescue inhaler is a medication for people with asthma to quickly reverse the symptoms of an asthma attack.  Historical...

30 Huhti 20253min

Episode 953: Penicillin Allergies

Episode 953: Penicillin Allergies

Contributor: Geoff Hogan MD Educational Pearls: Penicillin allergies are relatively uncommon despite their frequent reports 10% of the population reports a penicillin allergy but only 5% of these...

21 Huhti 20252min

Episode 952: Heart Transplants

Episode 952: Heart Transplants

Contributor: Travis Barlock, MD Educational Pearls: Key clinical considerations when managing heart transplant patients due to their unique pathophysiology 1. Arrhythmias A transplanted heart i...

14 Huhti 20253min

Suosittua kategoriassa Tiede

tiedekulma-podcast
rss-mita-tulisi-tietaa
rss-poliisin-mieli
docemilia
radio-antro
utelias-mieli
filocast-filosofian-perusteet
rss-sosiopodi
ihanat-ipanat
mielipaivakirja
rss-bios-podcast
rss-duodecim-lehti
rss-ammamafia
rss-laakaripodi
rss-opeklubi