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Related Concept Videos

Local Anesthetics: Pharmacokinetics01:13

Local Anesthetics: Pharmacokinetics

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The potency and duration of action of local anesthetics (LAs) are determined by their pharmacokinetics. Pharmacokinetics describes how LAs are absorbed, distributed, metabolized, and eliminated from the body. When administered to the vascular tissues, LAs are quickly absorbed and enter the systemic circulation, reducing their localized effects. Adding vasoconstrictors such as epinephrine to LAs reduces their absorption into the systemic circulation, making them clinically effective. The...
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Local Anesthetics: Mechanism of Action01:23

Local Anesthetics: Mechanism of Action

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Local anesthetics (LAs) block sensory and motor impulses by inhibiting the sodium channels on the nerve cell membranes. This induces temporary loss of sensation, relieving pain in a specific body area.
Local anesthetics are amphiphilic molecules consisting of a hydrophobic aromatic part linked to a hydrophilic group by an ester or amide linkage. They are weak bases and are usually available as salts, which increases their solubility and stability. Once administered, LAs exist in the body either...
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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.
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
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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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Local Anesthetics: Differential Sensitivity of Nerve Fibers01:24

Local Anesthetics: Differential Sensitivity of Nerve Fibers

1.5K
Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...
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Local Anesthetics: Chemistry and Structure-Activity Relationship01:30

Local Anesthetics: Chemistry and Structure-Activity Relationship

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Local anesthetics (LAs) are drugs that induce a temporary loss of sensation in a limited body area, preventing pain. Cocaine was the first local anesthetic discovered in the late 19th century. Cocaine is a benzoic acid ester obtained from the leaves of coca shrubs and was often used for its psychotropic effects. Cocaine was first isolated in 1860 by Albert Niemann. Sigmund Freud studied the physiological actions of cocaine. Carl Koller later introduced it into clinical practice in 1884 as a...
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Related Experiment Video

Updated: Feb 6, 2026

Assessing Changes in Volatile General Anesthetic Sensitivity of Mice after Local or Systemic Pharmacological Intervention
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Local anesthetic systemic toxicity: current perspectives.

Kariem El-Boghdadly1,2, Amit Pawa1, Ki Jinn Chin3

  • 1Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK, elboghdadly@gmail.com.

Local and Regional Anesthesia
|August 21, 2018
PubMed
Summary
This summary is machine-generated.

Local anesthetic systemic toxicity (LAST) is a dangerous complication of local anesthetic drugs. Early recognition and management, including lipid emulsion therapy, are vital for patient survival.

Keywords:
local anestheticregional anesthesiatherapytoxicity

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Area of Science:

  • Anesthesiology
  • Toxicology
  • Pharmacology

Background:

  • Local anesthetic systemic toxicity (LAST) is a critical adverse event associated with local anesthetic administration.
  • The increasing application of local anesthetic techniques necessitates a thorough understanding of LAST.
  • LAST involves complex multifactorial mechanisms affecting the central nervous and cardiovascular systems.

Purpose of the Study:

  • To review the current understanding of LAST mechanisms, risk factors, prevention strategies, and treatment advancements.
  • To highlight the importance of recognizing both typical and atypical presentations of LAST.
  • To emphasize the clinical relevance of LAST for practitioners administering local anesthetics.

Main Methods:

  • Review of recent data and literature on Local Anesthetic Systemic Toxicity (LAST).
  • Analysis of underlying mechanisms, clinical presentations, and associated risk factors.
  • Evaluation of current and emerging treatment modalities for LAST.

Main Results:

  • LAST mechanisms are multifactorial, impacting the central nervous system and cardiovascular system.
  • Atypical presentations, including isolated cardiovascular disturbances, occur in one-fifth of cases.
  • Modifiable risk factors, such as drug dosage and administration technique (e.g., ultrasound guidance), can mitigate LAST.
  • Lipid emulsion therapy, prompt seizure management, and appropriate pharmacotherapy are key treatment advances.

Conclusions:

  • Understanding the mechanisms, risk factors, and prevention of LAST is crucial for safe clinical practice.
  • Early recognition and prompt, targeted treatment, including lipid emulsion, significantly improve outcomes.
  • Practitioners must be aware of diverse clinical presentations and risk factors to effectively manage LAST.