[Prevention of toxic accidents of local anesthetics]

The prevention of toxic accidents due to local anesthetics is simple. The doses used must be carefully selected according to the drug chosen, the areas to be anaesthetized, and whether or not the local anaesthetic solution contains adrenaline. Continuous infusions of local anaesthetics should be used with great care. Bupivacaine must be avoided for intravenous regional anaesthesia, as well as in patients with hyperkaliemia or severe myocardiopathy with a high risk of arrhythmia. Diazepam is a useful premedication but cannot prevent toxic accidents. Using a test dose of adrenaline to detect accidental vascular puncture is simple, but not foolproof (patients treated with beta-blockers, obstetrical cases). The slow injection of local anaesthetics is the best way of preventing this type of accident. Finally, the technique for intravenous regional anaesthesia must be very strict.