De Valle Micah K, Adkison Michael, Maredia Ruhi, Stevenson Cooper, Murugan Shobana
John Sealy School of Medicine, University of Texas Medical Branch, Galveston, USA.
Department of Anesthesiology, Baylor College of Medicine, Houston, USA.
Cureus. 2024 Sep 11;16(9):e69215. doi: 10.7759/cureus.69215. eCollection 2024 Sep.
Introduction Local anesthetic systemic toxicity (LAST) is a rare complication of regional anesthesia. Pregnancy is a risk factor due to gestational physiologic changes. Labor and disorders of pregnancy can mask or delay symptoms of LAST, slowing appropriate intervention. This study examines LAST within a larger cohort and identifies features that help distinguish LAST in pregnant women from LAST in nonpregnant patients. Methods The TriNetX database was used to compare pregnant and nonpregnant patients with LAST from 2013 to 2023. Cohorts were matched on age, race, obesity status, diabetes, metabolic disorders, local anesthetic type, and cardiovascular, liver, kidney, and respiratory disease. Outcomes included prodromal symptoms of LAST and symptoms of cardiac and central nervous system excitation and depression. Results Matching occurred for 276 pregnant and 276 nonpregnant patients. Pregnant cohorts had a significantly higher risk of cardiac depression (risk ratio (RR)=1.96 (95% confidence interval (CI): 1.44-2.66), p<0.01) and significantly lower risk of cardiac excitation (RR=0.38 (95% CI: 0.22-0.63), p<0.01), prodromal symptoms (RR=0.17 (95% CI: 0.09-0.33), p<0.01), central nervous system excitation (RR=0.44 (95% CI: 0.21-0.90), p=0.02), and central nervous system depression (RR=0.24 (95% CI: 0.13-0.48), p<0.01) than nonpregnant cohorts. Conclusion Pregnant patients with LAST were more likely to exhibit cardiac depression and less likely to manifest prodromal symptoms, cardiac excitation, and central nervous system excitation and depression than nonpregnant patients. Physiological changes during pregnancy and prompt detection and treatment may explain these differences. These findings highlight the variable nature of LAST and how pregnancy may influence its clinical presentation.
引言 局部麻醉药全身毒性反应（LAST）是区域麻醉的一种罕见并发症。由于妊娠期生理变化，妊娠是一个危险因素。分娩和妊娠相关疾病可能掩盖或延迟LAST的症状，从而延缓适当的干预措施。本研究在一个更大的队列中研究LAST，并确定有助于区分孕妇LAST与非孕妇LAST的特征。方法 使用TriNetX数据库比较2013年至2023年患有LAST的孕妇和非孕妇。队列在年龄、种族、肥胖状况、糖尿病、代谢紊乱、局部麻醉药类型以及心血管、肝脏、肾脏和呼吸系统疾病方面进行匹配。结果包括LAST的前驱症状以及心脏和中枢神经系统兴奋与抑制的症状。结果 匹配了276名孕妇和276名非孕妇。与非孕妇队列相比，孕妇队列发生心脏抑制的风险显著更高（风险比（RR）=1.96（95%置信区间（CI）：1.44 - 2.66），p<0.01），而发生心脏兴奋、前驱症状、中枢神经系统兴奋和中枢神经系统抑制的风险显著更低（RR分别为0.38（95%CI：0.22 - 0.63），p<0.01；RR = 0.17（95%CI：0.09 - 0.33），p<0.01；RR = 0.44（95%CI：0.21 - 0.90），p = 0.02；RR = 0.24（95%CI：0.13 - 0.48），p<0.01）。结论 与非孕妇相比，患有LAST的孕妇更有可能出现心脏抑制，而出现前驱症状、心脏兴奋以及中枢神经系统兴奋和抑制的可能性更小。妊娠期间的生理变化以及及时的检测和治疗可能解释了这些差异。这些发现凸显了LAST的多变性以及妊娠可能如何影响其临床表现。
