Emperaire-Le Pouleuf N, Manelli J C, Bimar J
Département d'Anesthésie-Réanimation, Hôpital de la Conception, Marseille.
Ann Fr Anesth Reanim. 1988;7(3):198-203. doi: 10.1016/s0750-7658(88)80111-4.
The central nervous toxicity of local anaesthetics has long been thought to be limited to the generalized tonicoclonic convulsions which follow the appearance of such symptoms as sleepiness, tingling of the lips, slurred speech, numbness, etc. Also the central nervous system was considered to be more sensitive than the cardiovascular system. However, recent experimental studies would seem to indicate that at least the more potent local anaesthetics, such as bupivacaine, have deleterious effects on parts of the brain other than the cerebral hemispheres. This may point to an involvement of the central nervous system (the amygdala and vasopressor areas of the floor of the fourth ventricle) in the pathogenesis of the hypotension and arrhythmias which may be seen at the same time as central nervous system signs of systemic toxicity. This is important for the treatment of such accidents: should a convulsion occur alone, sodium thiopentone, a muscle relaxant and a benzodiazepine, with oxygen and assisted breathing, will be the treatment; should an arrhythmia occur, its treatment should also include an anticonvulsant drug, such as a benzodiazepine. The prophylactic use of benzodiazepines should also be encouraged.
长期以来，人们一直认为局部麻醉药的中枢神经毒性仅限于在出现嗜睡、嘴唇刺痛、言语含糊、麻木等症状后发生的全身性强直阵挛性惊厥。而且，中枢神经系统被认为比心血管系统更敏感。然而，最近的实验研究似乎表明，至少像布比卡因这样效力更强的局部麻醉药，对大脑半球以外的部分脑组织也有有害影响。这可能表明中枢神经系统（第四脑室底部的杏仁核和血管加压区）参与了低血压和心律失常的发病机制，这些情况可能与全身毒性的中枢神经系统体征同时出现。这对于此类意外情况的治疗很重要：如果单独发生惊厥，治疗方法将是使用硫喷妥钠、肌肉松弛剂和苯二氮䓬类药物，并给予氧气和辅助呼吸；如果发生心律失常，其治疗还应包括使用抗惊厥药物，如苯二氮䓬类药物。还应鼓励预防性使用苯二氮䓬类药物。
