Covino B G
Can Anaesth Soc J. 1986 May;33(3 Pt 2):S5-8. doi: 10.1007/BF03019149.
In general, the cardiovascular system is more resistant to the toxic actions of local anaesthetics than is the central nervous system. However, if sufficient doses and blood levels of local anaesthetics are achieved, signs of profound cardiovascular depression may be observed. Differences exist between local anaesthetics in terms of their relative potential for cardiotoxicity. The CC/CNS ratio for bupivacaine and etiodcaine is less than for lidocaine. In addition, bupivacaine may precipitate ventricular arrhythmias and ventricular fibrillation. Local tissue toxicity can occur following the administration of local anaesthetics. In general, neural tissue appears to be relatively resistant to the irritant effects of local anaesthetic drugs. However, large dosages 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, the incidence of toxic reactions to local anaesthetic agents is extremely low. However, as with any class of pharmacological agents, local anaesthetics may cause severe toxic reactions, due usually to the improper use of these drugs.
一般来说，心血管系统比中枢神经系统对局部麻醉药的毒性作用更具耐受性。然而，如果达到足够的局部麻醉药剂量和血药浓度，可能会观察到严重心血管抑制的迹象。不同局部麻醉药在心脏毒性的相对可能性方面存在差异。布比卡因和依替卡因的CC/CNS比值低于利多卡因。此外，布比卡因可能会引发室性心律失常和心室颤动。局部麻醉药给药后可能会发生局部组织毒性。一般来说，神经组织似乎对局部麻醉药的刺激作用相对耐受。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，局部麻醉药毒性反应的发生率极低。然而，与任何一类药物一样，局部麻醉药可能会引起严重的毒性反应，这通常是由于这些药物使用不当所致。
