Sedef GÜLÇİN URAL, Meltem AKTAY İNAL, İsmail Hakkı BAKIR

Düşük doz lidokain kullanımı sonrası gelişen lokal anestezik toksisitesi

Periferik sinir bloklarında mortal komplikasyonlara neden olabilen lokal anestezikler, doğru anatomik bölgeye ve uygun dozda kullanıldığında oldukça güvenli ajanlardır. Lidokain hızlı etkisi sebebiyle ekstremite sinir blokları ve intravenöz rejyonel anestezide sıklıkla tercih edilir. Lipid emülsiyon infüzyonu, lokal anestezi toksisitesinin tedavisinde oldukça tatmin edicidir. Olgumuzda 1,5 mg/kg %2 lidokain ile yapılan intravenoz rejyonel anestezide gelişen toksisite ve 400 ml %20 lipid içeriğine sahip total parenteral nutrisyon ile yapılan tedavi yaklaşımını sunmayı amaçladık.

Local anesthetic toxicity after low dose lidocaine

Local anesthetics may cause mortal complications in peripheral nerve blocks. However, when applied to the right anatomical locations with proper dose they are quite safe. Because of rapid effect, lidocaine is frequently preferred for extremity nerve blocks and intravenous regional anesthesia. Lipid emulsion infusion is very satisfying for treatment of local anesthetic toxicity. In our case, we aimed to present toxicity of 1.5 mg/kg %2 lidocaine in intravenous regional anesthesia and treatment approach with 400 ml total parenteral nutrition with %20 lipid.

Keywords:

Lidocain, local anesthetic toxicity,

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1. Madison SJ, Ilfeld BM. Peripheral Nerve Blocks. In Lange Clinical Anesthesiology, 5th edition (Eds GE Morgan, MS Mikhail, MJ Murray):975-1002. New York, McGraw-Hill, 2013
2. Choyce A, Peng P. A systematic review of adjuncts for intravenous regional anesthesia for surgical procedures. Can J Anaesth. 2002;49:32-45.
3. Luire SD, Reuben SS, Gibson CS, DeLuca PA, Maciolek HA. Effect of clonidine on upper extremity tourniquet pain in healthy volunteers. Reg Anesth Pain Med. 2000;25:502-5.
4. Gentili M, Bernard JM, Bonnet F. Adding clonidine to lidocaine for intravenous regional anesthesia prevents tourniguet pain. Anesth Analg. 1999;88:1327-30.
5. Bigger JT, Hoffman BF. Antiarrhythmic drugs. In The Pharmacological Basis of Therapeutics. 8th ed., Newyork: Goodman&Gillman; 1990;857-61.
6. Morgan GE, Mikhail MS, Murray MJ (editors). Local Anesthetics. In Lange Clinical Anesthesiology, 5th ed. New York: McGraw-Hill. 2013;263-76.
7. Felice K, Pharm D, Schumann HM. Intravenous lipid emulsion for local anesthetic toxicity: A review of the literature. J Med Toxicol. 2008;4:184-92.
8. Ökten F. Hasdoğan M. Tarhan A. What is the importance of bupivacaine cardiotoxicity. Anestezi Dergisi. 2010;18:189-93.
9. Berde CB, Strichartz GR. Local anaesthetics. In Miller’s Anesthesia (Volume I). Miller RD (editor). 7th ed. Philadelphia: Churchill Livingstone. 2010;913-39.
10. Covino BG, Wildsmith CAW, Wildsmith JAW. Clinical pharmacology of local anesthetic agents. Cousins MJ, Bridenbaugh PO (editors). In Neural Blockage in Clinical Anesthesia and Management of Pain. 3th ed. Philadelphia: Lippincott Raven Press. 1998;97-128.
11. Englesson S: The influence of acid-base changes on central nervous system toxicity of local anaesthetic agents. I: An experimental study in cats. Acta Anaesthesiol Scand. 1974;18:79-87.
12. Burney RG, DiFazio CA, Foster JA. Effects of pH on protein binding of lidocaine. Anesth Analg. 1978;57:478-80.
13. Dickerson DM, Apfelbaum JL. Local anesthetic systemic toxicity. Aesthet Surg J. 2014;34:1111-9.
14. Fettiplace MR, Weinberg G. Past, present, and future of lipid resuscitation therapy. JPEN J Parenter Enteral Nutr. 2015;39:72-83.
15. Vasques F, Behr AU, Weinberg G, Ori C, Gregorio GD. A review of local anesthetic systemic toxicity cases since publication of the American Society of Regional Anesthesia Recommendations to whom it may concern. Reg Anesth Pain Med. 2015;40:698-705.
16. Ayas M, Işık B. Düşük Doz Lidokain Konvülsiyon Yapar mı? Turk J Anaesth Reanim. 2014;42:106-8.
17. Reinikainen M, Hedman A, Pelkonen O, Ruokonen E. Cardiac arrest after interscalene brachial plexus block with ropivacaine and lidocaine. Acta Anaesthesiol Scand. 2003;47:904-6.
18. Gönüllü H, Gönüllü E, Soyoral L, Özbay FÖ, Kaya Y. Lipid emülsiyon tedavisi ile düzelen lidokain toksisitesi: olgu sunumu. Journal of Clinical and Analytical Medicine. 2015;6:222-4.
19. Foxall G, McCahon R, Lamb J, Hardman JG, Bedforth NM. Levobupivacaine-induced seizures and cardiovascular collapse treated with Intralipid. Anaesthesia. 2007;62:516-8.
20. Mörwald EE, Zubizarreta N, Cozowicz C, Poeran J, Memtsoudis SG. Incidence of Local Anesthetic Systemic Toxicity in Orthopedic Patients Receiving Peripheral Nerve Blocks. Reg Anesth Pain Med 2017:Post Author Corrections: January 9, 2017 doi: 10.1097/AAP.000000000000054419.
21. Karasu D, Yılmaz C, Özgünay ŞE, Dayıoğlu M, Baytar Ç, Korfalı G. Lokal anestezikler ve toksisitesi hakkında araştırma görevlilerinin bilgi düzeyleri. Turk J Anaesthesiol Reanim. 2016;44:201-5.
22. Neal JM, Mulroy MF, Weinberg GL. American Society of Regional Anesthesia and Pain Medicine. American Society of Regional Anesthesia and Pain Medicine check list for managing local anesthetic systemic toxicity: 2012 version. Reg Anesth Pain Med. 2012;37:16-8.