Vasques Francesco, Behr Astrid U, Weinberg Guy, Ori Carlo, Di Gregorio Guido
From the *Department of Medicine (DIMED), Anesthesia and Intensive Care Unit, Padua University Hospital; and †Istituto di Anestesia e Rianimazione, Azienda Ospedaliera di Padova, Padova, Italy; and ‡Department of Anesthesiology, University of Illinois College of Medicine; and §Research and Development Service, Jesse Brown Veterans Affairs Medical Center, Chicago, IL.
Reg Anesth Pain Med. 2015 Nov-Dec;40(6):698-705. doi: 10.1097/AAP.0000000000000320.
Local anesthetic systemic toxicity (LAST) occurrence may cross several medical specialties. In 2010, the American Society of Regional Anesthesia and Pain Medicine (ASRA) published the first algorithm on LAST management, introducing the use of lipid emulsion (ILE) treatment. In the present study, we retrieved the cases of LAST published between ASRA guidelines dissemination and March 2014. We analyzed the reported clinical manifestations of LAST, characteristics of affected patients, onset time of toxicity, and clinical setting. We also focused on the treatment measures that were applied in the different cases, especially on the use of ILE and adherence to ASRA recommendations. Despite the limits of a review of case reports, the present study calls attention to the insidious nature of LAST, especially its atypical manifestations, and shows that ILE may currently be underadministered in daily clinical practice, especially in nonanesthesiology practice.
局部麻醉药全身毒性反应（LAST）的发生可能涉及多个医学专业领域。2010年，美国区域麻醉与疼痛医学学会（ASRA）发布了首份关于LAST处理的算法，引入了脂质乳剂（ILE）治疗方法。在本研究中，我们检索了在ASRA指南发布至2014年3月期间发表的LAST病例。我们分析了所报道的LAST临床表现、受影响患者的特征、毒性发作时间以及临床背景。我们还重点关注了不同病例中所采用的治疗措施，尤其关注ILE的使用情况以及对ASRA建议的遵循情况。尽管病例报告综述存在局限性，但本研究仍提请注意LAST的隐匿性，尤其是其非典型表现，并表明目前在日常临床实践中，ILE的使用可能不足，特别是在非麻醉学实践中。
