Reg Anesth Pain Med. 2018 Feb;43(2):113-123. doi: 10.1097/AAP.0000000000000720.
The American Society of Regional Anesthesia and Pain Medicine's Third Practice Advisory on local anesthetic systemic toxicity is an interim update from its 2010 advisory. The advisory focuses on new information regarding the mechanisms of lipid resuscitation, updated frequency estimates, the preventative role of ultrasound guidance, changes to case presentation patterns, and limited information related to local infiltration anesthesia and liposomal bupivacaine. In addition to emerging information, the advisory updates recommendations pertaining to prevention, recognition, and treatment of local anesthetic systemic toxicity. WHAT'S NEW IN THIS UPDATE?: This interim update summarizes recent scientific findings that have enhanced our understanding of the mechanisms that lead to lipid emulsion reversal of LAST, including rapid partitioning, direct inotropy, and post-conditioning. Since the previous practice advisory, epidemiological data have emerged that suggest a lower frequency of LAST as reported by single institutions and some registries, nevertheless a considerable number of events still occur within the general community. Contemporary case reports suggest a trend toward delayed presentation, which may mirror the increased use of ultrasound guidance (fewer intravascular injections), local infiltration techniques (slower systemic uptake), and continuous local anesthetic infusions. Small patient size and sarcopenia are additional factors that increase potential risk for LAST. An increasing number of reported events occur outside of the traditional hospital setting and involve non-anesthesiologists.
美国区域麻醉与疼痛医学学会的第三次局部麻醉全身毒性实践咨询是对其 2010 年咨询的中期更新。该咨询重点关注有关脂质复苏机制的新信息、更新的频率估计、超声引导的预防作用、病例呈现模式的变化，以及与局部浸润麻醉和脂质体布比卡因相关的有限信息。除了新出现的信息外，该咨询还更新了有关局部麻醉全身毒性的预防、识别和治疗的建议。
本次更新的新内容是什么？：本中期更新总结了最近的科学发现，这些发现增强了我们对导致 LAST 脂质乳剂逆转的机制的理解，包括快速分配、直接正性肌力作用和后处理。自上次实践咨询以来，出现了一些流行病学数据，表明单机构和一些登记处报告的 LAST 频率较低，但在普通人群中仍有相当数量的事件发生。当代病例报告表明，出现了延迟出现的趋势，这可能反映了超声引导（较少的血管内注射）、局部浸润技术（较慢的全身吸收）和持续局部麻醉输注的使用增加。患者体型小和肌肉减少症是增加 LAST 潜在风险的其他因素。越来越多的报告事件发生在传统医院环境之外，涉及非麻醉师。
