Covino B G
Harvard Medical School, Boston, Massachusetts.
Acta Anaesthesiol Belg. 1988;39(3 Suppl 2):159-64.
The toxicity of local anesthetic agents can be divided into two categories: (1) systemic toxic reactions due usually to an accidental intravascular injection and (2) local tissue toxicity. The systemic toxicity of local anesthetic agents is primarily characterized by CNS excitation and convulsive activity. The cardiovascular system is more resistant to the toxic actions of local anesthetics. However, local anesthetics can exert a negative chronotropic and inotropic action and cause profound peripheral vasodilation. The combination of cardiac depression and peripheral vascular dilation results in irreversible circulatory collapse. The more potent agents such as bupivacaine appear to be more cardiotoxic and may precipitate ventricular arrhythmias and ventricular fibrillation. Local tissue toxicity is rare following the administration of local anesthetics. However, large doses of chloroprocaine solutions administered intrathecally have been associated with prolonged sensory-motor deficits in a few patients due probably to the low pH and presence of sodium bisulfite in the chloroprocaine solutions. In general, local anesthetic agents are relatively safe if administered properly. However, as with any pharmacological agents, local anesthetics may cause severe toxic reactions due to the improper use of these drugs.
（1）通常由于意外血管内注射引起的全身毒性反应，以及（2）局部组织毒性。局部麻醉药的全身毒性主要表现为中枢神经系统兴奋和惊厥活动。心血管系统对局部麻醉药的毒性作用更具抵抗力。然而，局部麻醉药可产生负性变时性和变力性作用，并导致显著的外周血管扩张。心脏抑制和外周血管扩张相结合会导致不可逆的循环衰竭。布比卡因等更有效的药物似乎心脏毒性更强，可能会引发室性心律失常和心室颤动。局部麻醉药给药后局部组织毒性很少见。然而，鞘内注射大剂量氯普鲁卡因溶液在少数患者中与感觉运动功能长期缺损有关，这可能是由于氯普鲁卡因溶液的低pH值和亚硫酸氢钠的存在。一般来说，如果给药得当，局部麻醉药相对安全。然而，与任何药物一样，局部麻醉药可能由于这些药物使用不当而引起严重的毒性反应。
