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Related Concept Videos

Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

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Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
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Depolarizing Blockers: Mechanism of Action01:28

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Depolarizing blockers act on skeletal muscle fibers' membranes and induce their depolarization. Most depolarizing blockers have two quaternary N+ atoms that bind the nicotinic acetylcholine receptors and cause neuromuscular blockade within minutes.
Succinylcholine is the most commonly used depolarizing blocker. Chemically, it constitutes two molecules of acetylcholine joined together by an acetate methyl group. They act on the receptors in the same way as acetylcholine. Because...
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Local Anesthetics: Adverse Effects01:12

Local Anesthetics: Adverse Effects

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While local anesthetics are generally safe and well-tolerated, they can occasionally cause adverse effects that vary in severity. Local anesthetics can induce toxicity at two distinct levels. They can either produce local effects through direct contact with the neural elements or be absorbed into the bloodstream from the injection site, leading to systemic effects.
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Cardiopulmonary Resuscitation IV: Pharmacological Management01:25

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Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
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Skeletal Muscle Relaxants: Adverse Effects01:21

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Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
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Local Anesthetics: Common Agents and Their Applications01:23

Local Anesthetics: Common Agents and Their Applications

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Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...
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Related Experiment Video

Updated: Mar 29, 2026

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[Delayed convulsion after lidocaine instillation for bronchoscopy].

E Gaïes1, N Jebabli2, M Lakhal1

  • 1Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de pharmacologie clinique, centre national de pharmacovigilance de Tunis, 9, avenue Dr. Zouheir Essafi, 1006 Tunis, Tunisie.

Revue Des Maladies Respiratoires
|November 25, 2015
PubMed
Summary
This summary is machine-generated.

Late-onset lidocaine toxicity can occur after bronchoscopy due to slow absorption from the lungs. Patients, especially those with lung disease, require prolonged monitoring after high-dose lidocaine instillation.

Keywords:
Bronchiolite oblitéranteBronchiolitis obliteransConvulsionDosage plasmatiqueLidocaineLidocaïnePlasma drug monitoringSeizureToxicityToxicité

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Area of Science:

  • Anesthesiology
  • Pulmonology
  • Toxicology

Background:

  • Lidocaine toxicity typically manifests rapidly and correlates with plasma drug concentrations.
  • Bronchiolitis obliterans is a severe fibrosing lung disease affecting small airways.

Observation:

  • A case of delayed neurologic toxicity following lidocaine instillation during fiber-optic bronchoscopy is presented.
  • The patient experienced recurrent tonic-clonic seizures 3.5 and 7 hours after lidocaine administration.
  • Lidocaine plasma levels were significantly elevated, indicating toxicity, at the time of the first seizure.

Findings:

  • Slow absorption of lidocaine from the bronchial tree led to delayed systemic toxicity.
  • Neurologic adverse events, including seizures, occurred hours after the procedure.
  • Plasma lidocaine concentrations confirmed toxicity and showed a decrease over 24 hours.

Implications:

  • This case highlights the risk of late-onset lidocaine toxicity from bronchial instillation, particularly in patients with compromised lung function.
  • Extended patient monitoring is crucial when exceeding recommended lidocaine doses, especially in individuals with fibrosing lung conditions.
  • Awareness of delayed toxicity is essential for preventing severe complications in anesthetic practice.