Lokal anestezik toksisitesinin yönetimi ve lipid infüzyonunun önemi

Year 2019, , 406 - 410, 28.05.2019

Gökhan Kılınç

https://doi.org/10.28982/josam.518417

Abstract

Lokal anestezikler (LA), klinik anestezide yaygın olarak kullanılan duyusal, motor ve otonom sinir sinirlerinin iletimini engelleyen ilaçlardır. Klinik kullanımdaki tüm lokal anestezik moleküller üç bölümden oluşur: bir lipofilik (aromatik) uç, bir hidrofilik (amin) uç ve uçlar arasında bağlantı sağlayan bir zincir. Lokal anesteziklerin klinik etkinliğini fizikokimyasal özellikler belirler. Lokal anesteziklerin lipid çözünürlüğünü belirleyen kısım aromatik halkadır. Kardiyovasküler sistem (CVS) toksisitesi için daha yüksek dozda lokal anestezikler gerekir. Hipertansiyon, taşikardi ve ventriküler aritmi, ilk görülen CVS yanetkileridir. Hipotansiyon, aritmi, bradikardi ve kalp durması kanda lokal anesteziklerin artmasıyla gelişir. LA ile ilişkili merkezi sinir sistemi (CNS) toksisitesinin semptomları, ilaçların plazma seviyeleri ile ilişkilidir. İlk başta uyuşukluk, baş dönmesi, sedasyon, oryantasyon bozukluğu, kulak çınlaması, nystagmus, metalik tat, bulantı ve kusma vardır. Sonra, huzursuzluk, sinirlilik, titreme ve kas seğirmesi meydana gelir. Bundan sonra, tonik-klonik nöbet ve bilinç kaybı, sonunda apne, kardiyovasküler kollaps ve koma gelişir. Lokal anestezik toksisitesinin tedavisinde, hava yolunun sağlanması, nöbet meydana gelirse propofoldan kaçınılması ve benzodiazepin ile tedavi edilmesi önerilir. Eğer kardiyak arrest gelişirse, verilen adrenalin dozunu azaltmak, lipit emülsiyonu uygulamak (%20) ve kardiyopulmoner bypass sağlanamadığında tedaviye yanıt vermek için ileri yaşam desteğine geçilmesi önerilir.

Keywords

Lokal anestezik, Toksisite, Lipid emulsiyonu

Management of local anesthetic toxicity and importance of lipid infusion

Abstract

Local anesthetics (LA) are one of the groups that block the transmission of sensory, motor and autonomic nerve impulses commonly used in clinical anesthesia. All local anesthetic molecules in clinical use consist of three parts: a lipophilic (aromatic) end, a hydrophilic (amine) end, and a chain that provides the connection between the ends. Physicochemical properties determine the clinical efficacy of local anaesthetics The part that determines the lipid solubility of local anesthetics is the aromatic ring. A higher dose of local anesthetics is required for cardiovascular system (CVS) toxicity. Hypertension, tachycardia and ventricular arrhythmia are the first of the diseases of CVS. Hypotension, arrhythmia, bradycardia and cardiac arrest develop as local anesthetics increase in blood. The symptoms of central nervous system (CNS) toxicity associated with LA are related to the plasma levels of drugs. Initially, there are drowsiness, dizziness, sedation, disorientation, tinnitus, nystagmus, metallic taste, nausea and vomiting. Then, restlessness, irritability, tremors and muscle twitches occur. After this, the tonic-clonic seizure and loss of consciousness develops, finally, apnea, cardiovascular collapse and coma. In the treatment of local anesthetic toxicity, it is recommended to provide airway, avoid the propofol if seizure occurs and treat with benzodiazepine. If cardiac arrest develops, it is recommended to switch to advanced life support, to reduce the given dose of adrenaline, to administer lipid emulsion (20%) and to respond to treatment if cardiopulmonary bypass is not provided.

Keywords

Local anesthetic, Toxicity, Lipid infusion

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