Methodical recommendations of the ministry of health of the Russian Federation on systemic toxicity of local anesthetic

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  • Authors: Lachin R.E.1, Bayalieva A.Z.2, Ezhevsky A.A.3, Zabolotsky D.V.4, Koryachkin V.A.4, Kulikov A.V.5, Ovechkin A.M.6, Uvarov D.N.7, Ulrikh G.E.4, Filippovich G.V.8, Shifman E.M.9
  • Affiliations:
    1. Military Medical Academy named after S.M.Kirov of the Ministry of defence of the Russian Federation
    2. Kazan State Medical University of the Ministry of health of the Russian Federation
    3. Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation
    4. St. Petersburg State Pediatric Medical University of the Ministry of Healthcare of the Russian Federation
    5. Urals State Medical University of the Ministry of Healthcare of the Russian Federation
    6. I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
    7. Northern State Medical University of the Ministry of Healthcare of the Russian Federation,
    8. «National Medical Research Center for Obstetrics, Gynecology and Perinatology Named After Academician V.I.Kulakov» of the Ministry of Healthcare of the Russian Federation
    9. M.F. Vladimirsky Moscow Regional Research Clinical Institute
  • Issue: Vol 13, No 1-4 (2019)
  • Pages: 31-41
  • Section: Forum
  • URL: https://journals.rcsi.science/1993-6508/article/view/43863
  • DOI: https://doi.org/10.17816/ра.v13i1-4.43863
  • ID: 43863

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Abstract

Methodological recommendations of the Ministry of health of the Russian Federation “Systemic toxicity of local anesthetics” were prepared by the all-Russian public organization “Federation of anesthesiologists and resuscitators”. Systemic toxicity of local anesthetics is a rare but dangerous complication of regional anesthesia. These recommendations provide updated indicators of the prevalence of this complication, the preventive value of ultrasound navigation, and the evolution of the clinical picture. The results of the analysis of new reports indicate a trend towards delayed manifestation of symptoms after regional anesthesia. The type of local anesthetic, dosage, volume, injection site, and concomitant diseases of the patient affect the rate of absorption from the injection site and the toxicity of local anesthetics. The article presents new information about the mechanisms of lipid resuscitation, summarizes the latest scientific data on the mechanisms of neutralization of local anesthetics in blood plasma by introducing fat emulsions, including the effect of rapid redistribution, direct inotropic effect and postconditioning. Guidelines for the prevention, recognition and treatment of systemic toxicity of local anesthetics have been updated in accordance with new data.

About the authors

R. E. Lachin

Military Medical Academy named after S.M.Kirov of the Ministry of defence of the Russian Federation

Author for correspondence.
Email: doctor-lahin@yandex.ru
ORCID iD: 0000-0001-6819-9691

Dr. Med. Sci., Docent, Professor, Department of Anesthesiology and Intensive Care

Russian Federation, 194044, Saint Petersburg

A. Zh. Bayalieva

Kazan State Medical University of the Ministry of health of the Russian Federation

Email: doctor-lahin@yandex.ru
ORCID iD: 0000-0001-7577-3284
Russian Federation, 420012, Kazan’

A. A. Ezhevsky

Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation

Email: doctor-lahin@yandex.ru
ORCID iD: 0000-0002-9286-4679
Russian Federation, 603005, Nizhniy Novgorod

D. V. Zabolotsky

St. Petersburg State Pediatric Medical University of the Ministry of Healthcare of the Russian Federation

Email: doctor-lahin@yandex.ru
ORCID iD: 0000-0002-6127-0798
Russian Federation, 194100, Saint Petersburg

V. A. Koryachkin

St. Petersburg State Pediatric Medical University of the Ministry of Healthcare of the Russian Federation

Email: doctor-lahin@yandex.ru
ORCID iD: 0000-0002-3400-8989
Russian Federation, 194100, Saint Petersburg

A. V. Kulikov

Urals State Medical University of the Ministry of Healthcare of the Russian Federation

Email: doctor-lahin@yandex.ru
ORCID iD: 0000-0002-7768-4514
Russian Federation, 620014, Ekaterinburg

A. M. Ovechkin

I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)

Email: doctor-lahin@yandex.ru
ORCID iD: 0000-0002-1500-8430
Russian Federation, 119146, Moscow

D. N. Uvarov

Northern State Medical University of the Ministry of Healthcare of the Russian Federation,

Email: doctor-lahin@yandex.ru
ORCID iD: 0000-0002-1500-8430
Russian Federation, 163000, Arkhangelsk

G. E. Ulrikh

St. Petersburg State Pediatric Medical University of the Ministry of Healthcare of the Russian Federation

Email: doctor-lahin@yandex.ru
ORCID iD: 0000-0001-7491-4153
Russian Federation, 194100, Saint Petersburg

G. V. Filippovich

«National Medical Research Center for Obstetrics, Gynecology and Perinatology Named After Academician V.I.Kulakov» of the Ministry of Healthcare of the Russian Federation

Email: doctor-lahin@yandex.ru
ORCID iD: 0000-0002-2090-175X
Russian Federation, 117198, Moscow

E. M. Shifman

M.F. Vladimirsky Moscow Regional Research Clinical Institute

Email: doctor-lahin@yandex.ru
ORCID iD: 0000-0002-6113-8498
Russian Federation, 129110, Moscow

References

  1. Dillane D., Finucane B. T. Local Anesthetic systemic toxicity. Can. J. Anaesth. 2010; 57 (4): 368−80. doi: 10.1007/s12630-010-9275-7.
  2. Neal J.M., Bernards C.M., Butterworth J.F. et al. ASRA practice advisory on local anesthetic systemic toxicity. Reg. Anesth. Pain. Med. 2010; 35 (2): 152−61. doi: 10.1097/AAP.0b013e3181d22fcd.
  3. Neal J.M., Woodward C.M., Harrison T.K. The American Society of Regional Anesthesia and Pain Medicine Checklist for Managing Local Anesthetic Systemic Toxicity: 2017 Version. Reg. Anesth. Pain. Med. 2018; 43 (2): 150−3. doi: 10.1097/AAP.0000000000000726.
  4. The Association of Anaesthetists of Great Britain & Ireland. Guidelines for the Management of Severe Local Anaesthetic Toxicity. Available at: http://aagbi.org/sites/default/files/la_toxicity_2010_0.pdf. doi: 10.21466/g.MOSLAT2.2010
  5. Mellin-Olsen, J., Staender, S., Whitaker, D. K., Smith, A. F. The Helsinki Declaration on Patient Safety in Anaesthesiology. European Journal of Anaesthesiology. 2010; 27 (7): 592–7. doi: 10.1097/eja.0b013e32833b1adf.
  6. International classification of diseases, injuries and conditions affecting the health of 10-th revision (ICD-10) (World Health Organization, 1994). Available at: https://mkb-10.com/ (access 18.05.2020). (In Russian)
  7. Nomenclature of medical services (Ministry of health and social development of the Russian Federation, 2011). Available at: https://www.rosminzdrav.ru/documents/6975-prikaz-minzdravsotsrazvitiya-rossii-1664n-ot-27dekabrya-2011-g (access 18.05.2020). (In Russian)
  8. Di Gregorio G., Neal J.M., Rosenquist R.W., Weinberg G.L. Clinical presentation of local anesthetic systemic toxicity: a review of published cases, 1979 to 2009. Reg. Anesth. Pain Med. 2010; 35 (2): 181−7. doi: 10.1097/aap.0b013e3181d2310b
  9. Ruan W., French D., Wong A., Drasner K., Wu A.H.B A mixed (long and mediumchain) triglyceride lipid emulsion extracts local anesthetic from human serum in vitro more effectively than a longchain emulsion. Anesthesiology. 2012; 116 (2): 334−9. doi: 10.1097/ALN.0b013e318242a5f1.
  10. Weinberg G.L. Lipid emulsion infusion: resuscitation for local anesthetic and other drug overdose. Anesthesiology. 2012; 117 (1): 180−7. doi: 10.1097/ALN.0b013e31825ad8de.
  11. Neal J.M., Barrington M.J., Fettiplace M.R., Gitman M., Memtsoudis S.G. et al. The Third American society of regional anesthesia and pain medicine practice advisory on local anesthetic systemic toxicity: executive summary 2017. Reg. Anesth. Pain Med. 2018; 43 (2): 113−23. doi: 10.1097/AAP.0000000000000720.
  12. Abrahams M.S., Aziz M.F., Fu R.F., Horn J.L. Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials. Br. J. Anaesth. 2009; 102 (3): 408−17. doi: 10.1093/bja/aen384.
  13. Barrington M.J., Kluger R. Ultrasound guidance reduces the risk of local anesthetic systemic toxicity following peripheral nerve blockade. Reg. Anesth. Pain Med. 2013; 38 (4): 289−99. doi: 10.1097/AAP.0b013e318292669b.
  14. Fettiplace M.R., McCabe D.J. Lipid emulsion improves survival in animal models of local anesthetic toxicity: a meta-analysis. Clin. Toxicol. (Phila). 2017; 55 (7): 617−23. doi: 10.1080/15563650.2017.1288911.
  15. Hoegberg L.C., Bania T.C., Lavergne V. et al Systematic review of the effect of intravenous lipid emulsion therapy for local anesthetic toxicity. Clin. Toxicol. (Phila). 2016; 54 (3): 167−93. doi: 10.3109/15563650.2015.1121270.
  16. Wang Q.-G., Wu C., Xia Y. et al. Epinephrine Deteriorates Pulmonary Gas Exchange in a Rat Model of Bupivacaine-Induced Cardiotoxicity: A Threshold Dose of Epinephrine. Reg. Anesth. Pain Med. 2017; 42 (3): 342−50. doi: 10.1097/AAP.0000000000000541.
  17. Di Gregorio G., Schwartz D., Ripper R. et al. Lipid emulsion is superior to vasopressin in a rodent model of resuscitation from toxin-induced cardiac arrest. Crit. Care Med. 2009; 37 (3): 993−9. doi: 10.1097/CCM.0b013e3181961a12.

Supplementary files

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2. Mechanisms of STMA neutralization during the introduction of fat emulsions, including “Shuttle” transport of lipophilic molecules of local anesthetic from the heart and brain to muscle tissue and liver. Adapted from Neal J. M. et al. 2018 [11]

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