Queen's Hospital, Anaesthetics, Romford, Essex, UK.
Br Dent J. 2012 Mar 9;212(5):237-41. doi: 10.1038/sj.bdj.2012.187.
The accidental overdose of local anaesthetics may prove fatal. The commonly used amide local anaesthetics have varying adverse effects on the myocardium and beyond a certain dose all are capable of causing death. Local anaesthetics are the most frequently used drugs in dentistry and although uncommon, local anaesthetic systemic toxicity (LAST) accounts for a high proportion of mortalities in the dental office, with local anaesthetic-induced cardiac arrest particularly resistant to standard resuscitation methods. Over the last decade there has been convincing evidence of using intravenous lipid emulsions as a rescue in local anaesthetic - cardiotoxicity and anaesthetic organisations over the globe have developed guidelines on the use of this drug. Despite this, however, awareness among practitioners appears to be lacking. All who use local anaesthetics in their practice should have an appreciation of patients at high risk of toxicity, early symptoms and signs of toxicity, preventative measures when using these drugs and the initial management of systemic toxicity with intravenous lipid emulsion. In this review we intend to discuss the pharmacology and pathophysiology of local anaesthetic toxicity, and the rationale for intravenous lipid emulsion therapy.
局部麻醉剂的意外过量可能是致命的。常用的酰胺类局部麻醉剂对心肌有不同的不良反应，超过一定剂量，所有局部麻醉剂都有可能导致死亡。局部麻醉剂是牙科最常用的药物，尽管不常见，但局部麻醉剂全身毒性（LAST）在牙科诊所的死亡率中占很大比例，局部麻醉剂引起的心脏骤停尤其对标准复苏方法有抵抗力。在过去的十年中，已经有令人信服的证据表明使用静脉内脂质乳剂作为局部麻醉剂心脏毒性的抢救药物，全球麻醉组织已经制定了关于使用这种药物的指南。尽管如此，然而，从业者的意识似乎仍然缺乏。所有在实践中使用局部麻醉剂的人都应该了解毒性风险高的患者、毒性的早期症状和体征、使用这些药物时的预防措施以及静脉内脂质乳剂治疗全身毒性的初始管理。在这篇综述中，我们旨在讨论局部麻醉剂毒性的药理学和病理生理学，以及静脉内脂质乳剂治疗的原理。
