James Baden|David Conn|V.S. Devaraj
Use of Short-Acting Local Anesthetics in Hand Surgery Patients
Royal Devon and Exeter Hospital|Royal Devon and Exeter Hospital|Royal Devon and Exeter Hospital
read interest article local anesthetics hand surgery would like thank drs katz laporte work1katz rd laporte dm use shortacting local anesthetics hand surgery patientsj hand surg 2009 34a 19021907google scholar read particular interest section toxicity manifestation manner treatment 3 points would like clarify first understanding although benzodiazepines role management seizures role determined phenytoin2association anesthetists great britain irelandsafety guidelinesmanagement severe local anesthetic toxicity 2007httpwwwaagbiorgpublicationsguidelinesdocslatoxicity07pdfgoogle scholar phenytoin also blocks na channels use may even compound intoxication section unfortunately unreferenced would grateful could clarify source statement great care needs taken administering barbiturates patient may sufficient toxicity cause cardiovascular collapse would compounded negatively inotropic effects barbiturates furthermore sedation without adequate control airway breathing may cause complications aspiration obstructed airway consequent increasing acidosis worsen effects local anesthetic toxicity create complications second regard seizures selflimiting would seem undermine importance adequate aggressive treatment potentially dangerous condition essential appreciate seizure may first sign impending cardiovascular collapse finally surprised omission lipid emulsion intralipid 20 baxter healthcare corporation clintec nutrition division deerfield il management local anesthetic toxicity lipid emulsion shown animal models improve chances resuming effective cardiac output overwhelming overdose local anesthetic3weinberg g ripper r feinstein dl hoffman w lipid emulsion infusion rescues dogs bupivacaineinduced cardiac toxicityreg anesth pain med 2003 28 198202pubmed google scholar 4weinberg gl vadeboncouer ramaraju ga garciaamaro mf cwik mj pretreatment resuscitation lipid infusion shifts doseresponse bupivacaine induced asystole ratsanesthesiology 1998 88 10711075crossref pubmed scopus 497 google scholar various case reports effective use humans5rosenblatt abel fischer gw itzkovich cj eisenkraft jb successful use 20 lipid emulsion resuscitate patient presumed bupivacainerelated cardiac arrestanesthesiology 2006 105 217218crossref pubmed scopus 467 google scholar 6litz rj popp stehr sn koch successful resuscitation patient ropivacaineinduced asystole axillary plexus block using lipid infusionanaesthesia 2006 61 800801crossref pubmed scopus 310 google scholar moreover use lipid emulsion integral guidelines management severe local anesthetic toxicity produced association anaesthetist great britain northern ireland2association anesthetists great britain irelandsafety guidelinesmanagement severe local anesthetic toxicity 2007httpwwwaagbiorgpublicationsguidelinesdocslatoxicity07pdfgoogle scholar considered essential addition resuscitation trolley united kingdom would grateful authors thoughts use lipid emulsion setting use shortacting local anesthetics hand surgery patientsjournal hand surgeryvol 34issue 10previewlocal anesthetics cause reversible loss nociception targeted anatomic site region many hand upper extremity procedures safely performed local anesthetics alone hand surgeons skilled techniques administering local anesthesia knowledgeable properties local anesthetic agents fulltext pdf replyjournal hand surgeryvol 35issue 5previewwe appreciate interest expressed drs baden conn devaraj contributions article local anesthetics hand surgery agree importance seizures seizure management setting local anesthetic toxicity deserves emphasis make excellent point note whereas phenytoin dilantin used seizure management likely avoided setting seizures induced local anesthetics shares pharmacologic properties sodium channel blockade lidocaine may potentiate toxicity fulltext pdf