Mechanisms and Efficacy of Intravenous Lipid Emulsion Treatment for Systemic Toxicity From Local Anesthetics

Local anesthetics are widely used clinically for perioperative analgesia to achieve comfort in medical treatment. However, when the concentration of local anesthetics in the blood exceeds the tolerance of the body, local anesthetic systemic toxicity (LAST) will occur. With the development and popula...

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Autores principales:	Yang Liu, Jing Zhang, Peng Yu, Jiangfeng Niu, Shuchun Yu
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	local anesthetic systemic toxicity lipid emulsion mechanism resuscitation bupivacaine Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/5418ba9551a24ac293a05a23eb904b15
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spelling	oai:doaj.org-article:5418ba9551a24ac293a05a23eb904b152021-11-08T05:00:51ZMechanisms and Efficacy of Intravenous Lipid Emulsion Treatment for Systemic Toxicity From Local Anesthetics2296-858X10.3389/fmed.2021.756866https://doaj.org/article/5418ba9551a24ac293a05a23eb904b152021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.756866/fullhttps://doaj.org/toc/2296-858XLocal anesthetics are widely used clinically for perioperative analgesia to achieve comfort in medical treatment. However, when the concentration of local anesthetics in the blood exceeds the tolerance of the body, local anesthetic systemic toxicity (LAST) will occur. With the development and popularization of positioning technology under direct ultrasound, the risks and cases of LAST associated with direct entry of the anesthetic into the blood vessel have been reduced. Clinical occurrence of LAST usually presents as a series of severe toxic reactions such as myocardial depression, which is life-threatening. In addition to basic life support (airway management, advanced cardiac life support, etc.), intravenous lipid emulsion (ILE) has been introduced as a treatment option in recent years and has gradually become the first-line treatment for LAST. This review introduces the mechanisms of LAST and identifies the clinical symptoms displayed by the central nervous system and cardiovascular system. The paper features the multimodal mechanism of LAST reversal by ILE, describes research progress in the field, and identifies other anesthetics involved in the resuscitation process of LAST. Finally, the review presents key issues in lipid therapy. Although ILE has achieved notable success in the treatment of LAST, adverse reactions and contraindications also exist; therefore, ILE requires a high degree of attention during use. More in-depth research on the treatment mechanism of ILE, the resuscitation dosage and method of ILE, and the combined use with other resuscitation measures is needed to improve the efficacy and safety of clinical resuscitation after LAST in the future.Yang LiuYang LiuJing ZhangJing ZhangPeng YuJiangfeng NiuJiangfeng NiuShuchun YuShuchun YuFrontiers Media S.A.articlelocal anesthetic systemic toxicitylipid emulsionmechanismresuscitationbupivacaineMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	local anesthetic systemic toxicity lipid emulsion mechanism resuscitation bupivacaine Medicine (General) R5-920
spellingShingle	local anesthetic systemic toxicity lipid emulsion mechanism resuscitation bupivacaine Medicine (General) R5-920 Yang Liu Yang Liu Jing Zhang Jing Zhang Peng Yu Jiangfeng Niu Jiangfeng Niu Shuchun Yu Shuchun Yu Mechanisms and Efficacy of Intravenous Lipid Emulsion Treatment for Systemic Toxicity From Local Anesthetics
description	Local anesthetics are widely used clinically for perioperative analgesia to achieve comfort in medical treatment. However, when the concentration of local anesthetics in the blood exceeds the tolerance of the body, local anesthetic systemic toxicity (LAST) will occur. With the development and popularization of positioning technology under direct ultrasound, the risks and cases of LAST associated with direct entry of the anesthetic into the blood vessel have been reduced. Clinical occurrence of LAST usually presents as a series of severe toxic reactions such as myocardial depression, which is life-threatening. In addition to basic life support (airway management, advanced cardiac life support, etc.), intravenous lipid emulsion (ILE) has been introduced as a treatment option in recent years and has gradually become the first-line treatment for LAST. This review introduces the mechanisms of LAST and identifies the clinical symptoms displayed by the central nervous system and cardiovascular system. The paper features the multimodal mechanism of LAST reversal by ILE, describes research progress in the field, and identifies other anesthetics involved in the resuscitation process of LAST. Finally, the review presents key issues in lipid therapy. Although ILE has achieved notable success in the treatment of LAST, adverse reactions and contraindications also exist; therefore, ILE requires a high degree of attention during use. More in-depth research on the treatment mechanism of ILE, the resuscitation dosage and method of ILE, and the combined use with other resuscitation measures is needed to improve the efficacy and safety of clinical resuscitation after LAST in the future.
format	article
author	Yang Liu Yang Liu Jing Zhang Jing Zhang Peng Yu Jiangfeng Niu Jiangfeng Niu Shuchun Yu Shuchun Yu
author_facet	Yang Liu Yang Liu Jing Zhang Jing Zhang Peng Yu Jiangfeng Niu Jiangfeng Niu Shuchun Yu Shuchun Yu
author_sort	Yang Liu
title	Mechanisms and Efficacy of Intravenous Lipid Emulsion Treatment for Systemic Toxicity From Local Anesthetics
title_short	Mechanisms and Efficacy of Intravenous Lipid Emulsion Treatment for Systemic Toxicity From Local Anesthetics
title_full	Mechanisms and Efficacy of Intravenous Lipid Emulsion Treatment for Systemic Toxicity From Local Anesthetics
title_fullStr	Mechanisms and Efficacy of Intravenous Lipid Emulsion Treatment for Systemic Toxicity From Local Anesthetics
title_full_unstemmed	Mechanisms and Efficacy of Intravenous Lipid Emulsion Treatment for Systemic Toxicity From Local Anesthetics
title_sort	mechanisms and efficacy of intravenous lipid emulsion treatment for systemic toxicity from local anesthetics
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/5418ba9551a24ac293a05a23eb904b15
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Mechanisms and Efficacy of Intravenous Lipid Emulsion Treatment for Systemic Toxicity From Local Anesthetics

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