Ott K
Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg, Stenglinstr. 2, 86156 Augsburg, Deutschland.
Anaesthesist. 2010 Jun;59(6):575-83; quiz 584-6. doi: 10.1007/s00101-010-1724-8.
Intoxication due to local anaesthetic drugs poses a rare but potentially life-threatening complication. In particular long-acting local anaesthetics can cause refractory cardiac arrest due to their lipophilic properties. This is often preceded by neurological symptoms such as confusion, vertigo and tonic-clonic seizures. The clinical efficacy of lipid emulsions in resuscitation from local anaesthetic toxicity has been documented in multiple publications. The injection of local anaesthetics should be stopped immediately upon the first presentation of symptoms. Securing the airway is mandatory to avoid hypoxia and concurrent acidosis. A seizure should be controlled with adequate doses of anticonvulsants. In case of cardiac arrest standard protocols for cardiopulmonary resuscitation have to be implemented immediately. The use of lipid emulsion can then be initiated as a supplement to standard resuscitation. It is recommended that lipid emulsions are instantly accessible in all facilities where local anaesthetics are administered.
局部麻醉药中毒是一种罕见但可能危及生命的并发症。特别是长效局部麻醉药因其亲脂性可导致难治性心脏骤停。在此之前通常会出现如意识模糊、眩晕和强直性阵挛性惊厥等神经症状。脂质乳剂用于局部麻醉药中毒复苏的临床疗效已在多篇文献中得到记载。一旦出现症状应立即停止注射局部麻醉药。确保气道通畅以避免缺氧和并发酸中毒是必须的。应使用足够剂量的抗惊厥药控制惊厥。一旦发生心脏骤停必须立即实施标准的心肺复苏方案。然后可开始使用脂质乳剂作为标准复苏的补充。建议在所有使用局部麻醉药的场所都应随时备有脂质乳剂。
