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.

Avsnitt(1149)

Episode 939: Serotonin Syndrome

Episode 939: Serotonin Syndrome

Contributor: Jorge Chalit-Hernandez, OMS3 Educational Pearls: Serotonin syndrome occurs most commonly due to the combination of monoamine oxidase inhibition with concomitant serotonergic medications...

13 Jan 20253min

Episode 938: AHA Policy on Management of Elevated Blood Pressure (BP) in the Acute Care Setting

Episode 938: AHA Policy on Management of Elevated Blood Pressure (BP) in the Acute Care Setting

Contributor: Aaron Lessen, MD Educational Pearls: Many patients present to the ED with elevated BP Many are referred from outpatient surgery centers or present after an elevated measurement at ho...

6 Jan 20252min

Episode 937: Pneumomediastinum

Episode 937: Pneumomediastinum

Contributor: Megan Hurley MD Educational Pearls: What is the mediastinum? The thoracic cavity is separated into different compartments by membranes The lungs exist in their own pleural cavities, a...

30 Dec 20245min

Episode 936: Etomidate vs. Ketamine for Rapid Sequence Intubation

Episode 936: Etomidate vs. Ketamine for Rapid Sequence Intubation

Contributor: Ricky Dhaliwal MD Educational Pearls: Etomidate was previously the drug of choice for rapid sequence intubation (RSI) However, it carries a risk of adrenal insufficiency as an adver...

23 Dec 20244min

Episode 935: Pregnancy Extremis - TOLDD

Episode 935: Pregnancy Extremis - TOLDD

Contributor: Aaron Lessen MD Educational Pearls: Pregnant patients at high risk of cardiac arrest, in cardiac arrest, or in extremis require special care A useful mnemonic to recall the appropriat...

16 Dec 20243min

Episode 934: Subendocardial Ischemia

Episode 934: Subendocardial Ischemia

Contributor: Travis Barlock MD Educational Pearls: What is the ST segment? The ST segment on an ECG represents the interval between the end of ventricular depolarization (QRS) and the beginning of v...

9 Dec 20243min

Episode 933: Benign Convulsions with Gastroenteritis

Episode 933: Benign Convulsions with Gastroenteritis

Contributor: Alec Coston MD Educational Pearls: Causes of seizures in a fairly well-appearing child with diarrhea: Electrolyte abnormalities: hypocalcemia, hyponatremia Also hyperkalemia which...

2 Dec 20243min

Episode 932: Induction Agent Hypotension

Episode 932: Induction Agent Hypotension

Contributor: Aaron Lessen MD Educational Pearls: Induction agent selection during rapid sequence intubation involves accounting for hemodynamic stability in the post-intubation setting Many emerge...

25 Nov 20242min

Populärt inom Vetenskap

dumma-manniskor
svd-nyhetsartiklar
p3-dystopia
allt-du-velat-veta
kapitalet-en-podd-om-ekonomi
rss-ufo-bortom-rimligt-tvivel
rss-vetenskapsradion-2
det-morka-psyket
rss-vetenskapsradion
medicinvetarna
vetenskapsradion
bildningspodden
rss-geopodden-2
sexet
rss-spraket
halsorevolutionen
rss-arkeologi-historia-podden-som-graver-i-vart-kulturlandskap
rss-experimentet
hacka-livet
ideer-som-forandrar-varlden