El-Boghdadly Kariem, Pawa Amit, Chin Ki Jinn
Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK,
School of Medicine, King's College London, London, UK,
Local Reg Anesth. 2018 Aug 8;11:35-44. doi: 10.2147/LRA.S154512. eCollection 2018.
Local anesthetic systemic toxicity (LAST) is a life-threatening adverse event that may occur after the administration of local anesthetic drugs through a variety of routes. Increasing use of local anesthetic techniques in various healthcare settings makes contemporary understanding of LAST highly relevant. Recent data have demonstrated that the underlying mechanisms of LAST are multifactorial, with diverse cellular effects in the central nervous system and cardiovascular system. Although neurological presentation is most common, LAST often presents atypically, and one-fifth of the reported cases present with isolated cardiovascular disturbance. There are several risk factors that are associated with the drug used and the administration technique. LAST can be mitigated by targeting the modifiable risk factors, including the use of ultrasound for regional anesthetic techniques and restricting drug dosage. There have been significant developments in our understanding of LAST treatment. Key advances include early administration of lipid emulsion therapy, prompt seizure management, and careful selection of cardiovascular supportive pharmacotherapy. Cognizance of the mechanisms, risk factors, prevention, and therapy of LAST is vital to any practitioner using local anesthetic drugs in their clinical practice.
局部麻醉药全身毒性反应（LAST）是一种危及生命的不良事件，可在通过多种途径给予局部麻醉药后发生。在各种医疗环境中，局部麻醉技术的使用日益增加，使得当代对LAST的理解具有高度相关性。最近的数据表明，LAST的潜在机制是多因素的，在中枢神经系统和心血管系统中具有多种细胞效应。虽然神经学表现最为常见，但LAST通常表现不典型，报告病例中有五分之一表现为孤立的心血管紊乱。有几个与所用药物和给药技术相关的危险因素。通过针对可改变的危险因素，包括使用超声进行区域麻醉技术和限制药物剂量，可以减轻LAST。我们对LAST治疗的理解有了重大进展。关键进展包括早期给予脂质乳剂治疗、及时控制癫痫发作以及谨慎选择心血管支持性药物治疗。认识LAST的机制、危险因素、预防和治疗对于任何在临床实践中使用局部麻醉药的从业者来说都至关重要。
