Ultrasound-directed positioning technology has greatly improved the safety and accuracy of local anesthesia. If the dose is too large, malignant arrhythmia and severe myocardial depression may occur, and cardiovascular failure will eventually endanger life and safety ( 4). When the concentration of local anesthetics in the blood exceeds the tolerance of the body, although, corresponding systemic toxicity that excites or inhibits the central nervous system (CNS) and cardiovascular system will occur. It is often used clinically, alone or in combination with general anesthesia, to reduce the use of opioids after surgery and to provide patients with satisfactory perioperative analgesia. Local anesthesia is simple and easy to perform. Local anesthesia temporarily blocks the conducting function of the nerve plexus so that the corresponding area innervated by the nerve plexus loses sensation. Local Anesthetic Systemic Toxicity (LAST) Local Anesthetics However, its mechanism of action is still unclear. As a result, lipid emulsion has become known as not only a parenteral nutrition option but also a treatment for LAST with the publication of many experimental results, it has now become the first-line treatment of LAST. ( 3) pretreated rats with bupivacaine-induced cardiac arrest with a lipid infusion and found that the time to cardiac arrest was prolonged and the recovery time was earlier. Therefore, reasonable early approaches to LAST treatment involve operations for airway management and advanced life support ( 2). The deadliest symptoms of local anesthetic systemic toxicity (LAST) are suffocation caused by airway spasm and heart failure caused by myocardial suppression.
#Lipid emulsion therapy series
In addition to a series of preventive measures such as using the lowest dose of local anesthetics and precise injection of anesthesiology drugs according to the basic situation of the patient, the timely detection and the treatment of the systemic toxicity from local anesthetics are crucial. Fortunately, the use of ultrasound technology has greatly reduced, but not eliminated, the occurrence and the risk of such incidents. However, local anesthetic poisoning incidents caused by the mistaken entry of local anesthetics into blood vessels can occur. Since then, local anesthetics have become widely used clinically and are considered indispensable. In the 1880s, cocaine was first used as a local anesthetic in ophthalmology and dental anesthesia ( 1). More in-depth research on the treatment mechanism of ILE, the resuscitation dosage and method of ILE, and the combined use with other resuscitation measures is needed to improve the efficacy and safety of clinical resuscitation after LAST in the future. Although ILE has achieved notable success in the treatment of LAST, adverse reactions and contraindications also exist therefore, ILE requires a high degree of attention during use.
Finally, the review presents key issues in lipid therapy.
The paper features the multimodal mechanism of LAST reversal by ILE, describes research progress in the field, and identifies other anesthetics involved in the resuscitation process of LAST. This review introduces the mechanisms of LAST and identifies the clinical symptoms displayed by the central nervous system and cardiovascular system. In addition to basic life support (airway management, advanced cardiac life support, etc.), intravenous lipid emulsion (ILE) has been introduced as a treatment option in recent years and has gradually become the first-line treatment for LAST. Clinical occurrence of LAST usually presents as a series of severe toxic reactions such as myocardial depression, which is life-threatening. With the development and popularization of positioning technology under direct ultrasound, the risks and cases of LAST associated with direct entry of the anesthetic into the blood vessel have been reduced. However, when the concentration of local anesthetics in the blood exceeds the tolerance of the body, local anesthetic systemic toxicity (LAST) will occur. Local anesthetics are widely used clinically for perioperative analgesia to achieve comfort in medical treatment. 3Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, China.2Key Laboratory of Anesthesiology of Jiangxi Province, Nanchang, China.1Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.Yang Liu 1,2, Jing Zhang 1,2, Peng Yu 3, Jiangfeng Niu 1,2 and Shuchun Yu 1,2 *
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