Nelsen Jamie, Holland Michael, Dougherty Michelle, Bernad Jason, Stork Christine, Marraffa Jeanna
Department of Emergency Medicine, SUNY Upstate Medical University, Upstate New York Poison Center, Syracuse, NY 13210, USA.
Pediatr Emerg Care. 2009 Oct;25(10):670-3. doi: 10.1097/PEC.0b013e3181b91e8c.
Dibucaine is considered one of the most potent and consequently toxic amide anesthetics available, and despite withdrawal from the US market as a spinal anesthetic, it remains accessible as an over-the-counter preparation in the United States. Dibucaine exposures in children are infrequently encountered, but to date, all reported consequential ingestions have resulted in death. We report the first case of a potentially fatal dibucaine-induced wide-complex arrhythmia in a child who survived her clinical course without sequelae. It is our hope that this report will highlight the toxicity of dibucaine and prompt a review of its over-the-counter status. The rationale and success of a new antidote, 20% lipid emulsion, for the management of local anesthetic toxicity is discussed.
丁卡因被认为是现有最有效的酰胺类麻醉剂之一，因此也是毒性最强的之一。尽管它已作为脊髓麻醉剂退出美国市场，但在美国仍可作为非处方药购得。儿童接触丁卡因的情况并不常见，但迄今为止，所有有后果报告的摄入病例均导致死亡。我们报告了首例丁卡因诱发的潜在致命性宽QRS波心律失常患儿，该患儿临床病程顺利，未留后遗症。我们希望本报告能突出丁卡因的毒性，并促使人们重新审视其非处方药地位。文中还讨论了一种新型解毒剂——20%脂肪乳剂治疗局部麻醉药中毒的原理及成效。
