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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 4/2010

01-04-2010 | Review Article/Brief Review

Local anesthetic systemic toxicity

Authors: Derek Dillane, MB, Brendan T. Finucane, MB

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 4/2010

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Abstract

Purpose

The practice of regional anesthesia has been revitalized of late with the popularization of ultrasound-guided techniques. Advocates must be vigilant for the effects of unintentionally high blood levels of local anesthetic. Systemic local anesthetic toxicity, though rare, is a potentially devastating occurrence. This narrative review summarizes the effects of local anesthetic toxicity. We highlight how these toxic effects have motivated the search for a safe and long-acting local anesthetic. We outline current prevention and treatment options and appraise an emerging therapy in light of unfolding evidence.

Sources

A search of the English language literature was conducted using the PubMed database from the National Library of Medicine. Bibliographies of retrieved articles were used to retrieve additional articles.

Principal findings

The advent of multiple safety steps has led to a dramatic reduction in the incidence of local anesthetic toxicity over the past 30 years. Rising plasma levels of local anesthetic lead to a progressive spectrum of neurological and cardiac effects. Seizure activity may herald the onset of myocardial depression and ventricular arrhythmias that are often refractory to treatment. In addition to specific measures, such as lipid emulsion therapy, general supportive measures are warranted, for example, Advanced Life Support Guidelines.

Conclusion

Vigilance during the performance of regional anesthesia and immediate intervention at the earliest sign of toxicity improve the chances of successful treatment.
Footnotes
1
Drug storage at hospital was “chaotic”. 2008; Available from URL: http://​www.​guardian.​co.​uk/​society/​2008/​feb/​05/​nhs.​health2 (accessed December 2009).
 
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Metadata
Title
Local anesthetic systemic toxicity
Authors
Derek Dillane, MB
Brendan T. Finucane, MB
Publication date
01-04-2010
Publisher
Springer-Verlag
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 4/2010
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-010-9275-7

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