Title:Local Anesthetics, Clinical Uses, and Toxicity: Recognition and Management
Volume: 29
Issue: 18
Author(s): Sedat Ozbay, Mustafa Ayan and Ozgur Karcioglu*
Affiliation:
- Department of Emergency Medicine, University of Health Sciences, Taksim Education and Research Hospital, PK 34098, Beyoglu, Istanbul, Turkey
Keywords:
Local anesthetic, toxicity, overdose, children, diagnosis, treatment, intravenous lipid emulsion.
Abstract: Local anesthetic (LA) compounds decrease the permeability of the ion channels to sodium, which in
turn, reduces the rate of depolarization. These agents (a.k.a. -caines) are also used to depress mucosal sensations,
e.g., gag reflex in the form of topical anesthetics. Overdose of LA can lead to local anesthetic systemic
toxicity (LAST), which is the precursor of potentially lethal consequences on clinical grounds. There is a wide
array of possible presentations of LAST, from mild findings, such as temporary hypertensive events, to serious
conditions, including refractory cardiac dysfunction, dysrhythmias and prearrest situations. Lidocaine, prilocaine,
mepivacaine, ropivacaine, and bupivacaine are among the most commonly used members of the family.
The agents’ dosages should be adjusted in children, elderly and fragile individuals and those with organ failures,
as the metabolism of the compounds will be impaired. The ideal body weight, along with hepatic and renal
functional reserves, will have an impact on elimination kinetics. Systemic absorption is an untoward consequence
of LA administration which deserves every means of prevention. Intravenous lipid emulsion is an important
life-saving treatment in severe, life-threatening cases. This narrative review article is designed to cover the
clinical uses of LA in children, recognition, and management of untoward effects of the agents, with special emphasis
on the LAST.