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[How should a toxic accident be treated?].

F d'Athis1

  • 1Département d'Anesthésie-Réanimation, CHRU, Nimes.

Annales Francaises D'Anesthesie Et De Reanimation
|January 1, 1988
PubMed
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Local anesthetic systemic toxicity (LAST) is a rare complication. Midazolam is recommended for convulsions, with cardiopulmonary resuscitation for cardiac arrest, emphasizing prolonged efforts for potential late successes.

Area of Science:

  • Anesthesiology
  • Toxicology
  • Emergency Medicine

Background:

  • Local anesthetic systemic toxicity (LAST) is a rare but severe complication of regional anesthesia.
  • It can lead to central nervous system excitation (convulsions) followed by depression, hypoxia, and hypercapnia.
  • Cardiac complications, particularly severe myocardial depression and arrest, are associated with agents like bupivacaine and etidocaine.

Purpose of the Study:

  • To review the management of local anesthetic systemic toxicity (LAST).
  • To discuss the efficacy and limitations of various treatment options for convulsions and cardiac depression.
  • To provide guidance on resuscitation protocols for cardiac arrest secondary to LAST.

Main Methods:

  • Review of existing literature on local anesthetic systemic toxicity.

Related Experiment Videos

  • Analysis of pharmacological interventions for managing central nervous system and cardiovascular complications.
  • Discussion of resuscitation strategies for cardiac arrest.

    • Main Results:

    • Thiopentone and diazepam can manage convulsions, but midazolam is suggested as a preferred agent due to its rapid action and potentially fewer cardiovascular side effects.
    • Severe cardiac depression, especially with bupivacaine, can lead to arrest and requires immediate cardiopulmonary resuscitation.
    • Standard resuscitation measures including oxygen, sodium bicarbonate, adrenaline, and calcium are crucial, with potential for late success.

    Conclusions:

    • Prompt recognition and management of LAST are critical.
    • Midazolam is a suitable choice for treating local anesthetic-induced convulsions.
    • Effective cardiopulmonary resuscitation, potentially prolonged, is essential for patients experiencing cardiac arrest due to LAST.