Viderman D, Ben-David B, Sarria-Santamera A
Department of Biomedical Sciences, Nazarbayev University School of Medicine, Nur-sultan, Kazakhstan.
Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, United States.
Rev Esp Anestesiol Reanim (Engl Ed). 2021 Oct;68(8):472-483. doi: 10.1016/j.redare.2020.10.005. Epub 2021 Sep 17.
Regional anesthesia as a component of multimodal analgesia protocols has become more and more a part of modern perioperative pain management. The widespread adoption of ultrasound guidance in regional anesthesia has surely played an important role in that growth and it has significantly improved patient safety, decreased the incidence of block failure, cardiac arrest, and reduced complication rates. The objective of this systematic review is to extract, analyze, and synthesize clinical information about bupivacaine and ropivacaine related cardiac arrest that we might have a clearer picture of the clinical presentation. The literature search identified 268 potentially relevant publications and 22 relevant case reports were included in the review. Patients' demographics, types of regional anesthesia, hypotension, heart rhythm disorders, seizures, cardiac arrest, fatal outcome, recommendations and limitations on prevention and treatment of bupivacaine and ropivacaine related cardiac arrest are analyzed and discussed in the systematic review. Both bupivacaine and ropivacaine-induced local anesthetic toxicity can result in cardiac arrest. Lipid emulsion, telemetry, local anesthetic toxicity resuscitation training appears to be promising in improvement of survival but more research is needed. Improvement and encouragement of reporting the local anesthetic toxicity are warranted to improve the quality of information that can be analyzed in order to make more precise conclusion.
区域麻醉作为多模式镇痛方案的一个组成部分，已越来越成为现代围手术期疼痛管理的一部分。超声引导在区域麻醉中的广泛应用无疑在其发展中发挥了重要作用，它显著提高了患者安全性，降低了阻滞失败、心脏骤停的发生率，并降低了并发症发生率。本系统评价的目的是提取、分析和综合有关布比卡因和罗哌卡因相关心脏骤停的临床信息，以便我们能更清楚地了解其临床表现。文献检索确定了268篇潜在相关出版物，本评价纳入了22篇相关病例报告。在该系统评价中，分析并讨论了患者的人口统计学特征、区域麻醉类型、低血压、心律失常、癫痫发作、心脏骤停、致命结局、布比卡因和罗哌卡因相关心脏骤停的预防和治疗建议及局限性。布比卡因和罗哌卡因引起的局部麻醉药毒性均可导致心脏骤停。脂质乳剂、遥测、局部麻醉药毒性复苏培训在提高生存率方面似乎很有前景，但还需要更多研究。有必要改进并鼓励报告局部麻醉药毒性，以提高可分析信息的质量，从而得出更精确的结论。
