Department of Obstetrics and Gynecology, Saiseikai Mastusaka General Hospital, Mastusaka, Mie, Japan.
Japan Resuscitation Council, Shinjuku, Tokyo, Japan.
BMC Pregnancy Childbirth. 2024 Feb 14;24(1):138. doi: 10.1186/s12884-024-06309-1.
Local anaesthetic systemic toxicity (LAST) is a rare but life-threatening complication that can occur after local anaesthetic administration. Various clinical guidelines recommend an intravenous lipid emulsion as a treatment for local anaesthetic-induced cardiac arrest. However, its therapeutic application in pregnant patients has not yet been established. This scoping review aims to systematically identify and map the evidence on the efficacy and safety of intravenous lipid emulsion for treating LAST during pregnancy.
We searched electronic databases (Medline, Embase and Cochrane Central Register Controlled Trials) and a clinical registry (lipidrescue.org) from inception to Sep 30, 2022. No restriction was placed on the year of publication or the language. We included any study design containing primary data on obstetric patients with signs and symptoms of LAST.
After eliminating duplicates, we screened 8,370 titles and abstracts, retrieving 41 full-text articles. We identified 22 women who developed LAST during pregnancy and childbirth, all presented as case reports or series. The most frequent causes of LAST were drug overdose and intravascular migration of the epidural catheter followed by wrong-route drug errors (i.e. intravenous anaesthetic administration). Of the 15 women who received lipid emulsions, all survived and none sustained lasting neurological or cardiovascular damage related to LAST. No adverse events or side effects following intravenous lipid emulsion administration were reported in mothers or neonates. Five of the seven women who did not receive lipid emulsions survived; however, the other two died.
Studies on the efficacy and safety of lipids in pregnancy are scarce. Further studies with appropriate comparison groups are needed to provide more robust evidence. It will also be necessary to accumulate data-including adverse events-to enable clinicians to conduct risk-benefit analyses of lipids and to facilitate evidence-based decision-making for clinical practice.
局部麻醉药全身毒性（LAST）是一种罕见但危及生命的并发症，可在局部麻醉给药后发生。各种临床指南建议使用静脉内脂肪乳剂作为治疗局部麻醉引起的心脏骤停的方法。然而，其在孕妇中的治疗应用尚未确定。本范围综述旨在系统地确定和绘制关于静脉内脂肪乳剂在治疗妊娠期间 LAST 时的疗效和安全性的证据。
我们从开始到 2022 年 9 月 30 日在电子数据库（Medline、Embase 和 Cochrane 中央对照试验注册中心）和一个临床注册中心（lipidrescue.org）中进行了搜索。对出版物年份和语言没有限制。我们纳入了任何包含有 LAST 症状和体征的产科患者的原始数据的研究设计。
消除重复项后，我们筛选了 8370 篇标题和摘要，获取了 41 篇全文文章。我们确定了 22 名在妊娠和分娩期间发生 LAST 的孕妇，均为病例报告或系列。LAST 最常见的原因是药物过量和硬膜外导管的血管内迁移，其次是错误途径的药物错误（即静脉麻醉剂给药）。在接受脂肪乳剂的 15 名妇女中，所有妇女均存活，且无一例因 LAST 发生持久的神经或心血管损害。母亲或新生儿未报告静脉内脂肪乳剂给药后出现不良反应或副作用。未接受脂肪乳剂的 7 名妇女中有 5 名存活；然而，另外两名妇女死亡。
关于脂肪在妊娠中的疗效和安全性的研究很少。需要进一步开展有适当对照组的研究，以提供更有力的证据。还需要积累数据，包括不良事件，以使临床医生能够对脂肪进行风险效益分析，并促进基于证据的临床实践决策。
