Araştırma Makalesi
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Lokal Anestezik Toksisitesinde Ortopedi Hekimlerinin Yaklaşımının Değerlendirilmesi

Yıl 2019, Cilt: 3 Sayı: 2, 111 - 115, 23.08.2019
https://doi.org/10.30565/medalanya.549378

Öz

Amaç: Ortopedi hekimlerinin lokal anestezik toksisitesi sendromu (LATS) tanı, tedavi ve önlemleri ile ilgili bilgilerini gözden geçirerek bu konu ile ilgili farkındalığın artırılması amaçlanmıştır. 

Gereç- Yöntem: Türkiye’de farklı hastanelerde ve farklı akademik seviyede olan ortopedi hekimlerine demografik bilgileri, lokal anestezik ilaçlar ile ilgili genel bilgileri, toksisite ile ilgili genel bilgi ve güncel tedavi seçeneklerini sorgulayan 16 soruluk anketi cevaplamaları istendi. 

Bulgular: Toplamda 172 ortopedi hekiminin (%18,6‘sı ortopedi asistanı, %51,7’si ortopedi ve travmatoloji uzmanı, %29,7’si öğretim üyesi) katıldığı çalışmada hekimlerin %45,3’ü 10 yıldan fazla süredir ortopedi alanında çalışmakta olduğu görüldü. Lokal anestezik kullanım yerleri açısından en sık ameliyathane, daha sonra acil servis, poliklinik müdahale odası ve servis olarak sıralandığı tespit edild. LATS tedavisinde lipid kullanımı ile ilgili çalışmaya katılanların %59,6’sı lipid kullanımını daha önce hiç duymadıklarını, %29,8’i daha önce duyduklarını ama anımsamadıklarını, %5,3’ü lipid tedavisinin kullanım alanı ve şeklini bildiklerini belirtmiştir. 













Sonuç: LATS konusunda hekimlerin bilinçli olması ve bu komplikasyon konusunda hazırlıklı olmaları ile lokal anesteziklerin daha güvenli kullanımları sağlanabilir. 

Kaynakça

  • 1. Di Gregorio G, Neal JM, Rosenquist RW, Weinberg GL. Clinical presentation of local anesthetic systemic toxicity: a review of published cases, 1979 to 2009. Reg Anesth Pain Med.2010;35:181-7. DOI: http://dx.doi.org/10.1097/AAP.0b013e3181d2310b
  • 2. Corcoran W, Butterworth J, Weller RS, et al. Local anesthetic-induced cardiac toxicity: a survey of contemporary practice strategies among academic anesthesiology departments. Anesth Analg. 2006;103: 1322–1326. DOI: http://dx.doi.org/10.1213/01.ane.0000242515.03653.bb
  • 3. 3-Drasner K. Local anesthetic systemic toxicity: a historical perspective. Reg Anesth Pain Med. 2010;35:160–164. DOI: http://dx.doi.org/10.1097/AAP.0b013e3181d2306c
  • 4. Mulroy MF, Hejtmanek MR. Prevention of local anesthetic systemic toxicity. Reg Anesth Pain Med. 2010;35:177–180. PMID: 20216035
  • 5. Neal JM, Bernards CM, Butterworth JF, et al. ASRA practice advisory on local anesthetic systemic toxicity. Reg AnesthPainMed. 2010; 35:152–161. PMID: 20216033
  • 6. Neal JM, Woodward CM, Harrison TK The American Society of Regional Anesthesia and Pain Medicine Checklist for Managing Local Anesthetic Systemic Toxicity: 2017 Version.Reg Anesth Pain Med. 2018 Feb; 43(2):150-153. DOI: 10.1097/AAP.0000000000000726
  • 7. Başaranoğlu G, Teker MG, Saidoğlu L, Muhammedoğlu N, Özdemir H. Lokal anestezik kullanan hekimlerin toksisite ve intralipid tedavisi hakkında bilgileri. J Turk Anaest Int Care. 2010;38: 262-267. DOI:10.5222/JTAICS.2010.262
  • 8. Oksuz G, Urfalıoglu A, Sekmen T, Akkeçeci N, Alpay N, Bilal B. Dentists knowledge of lipid treatment of local anaesthetic systemic toxicity. Niger J Clin Pract 2018;21: 327-31. DOI: 10.4103/njcp.njcp_12_17
  • 9. Neal JM, Mulroy MF, Weinberg GL; American Society of Regional Anesthesia and Pain Medicine. American Society of Regional Anesthesia and Pain Medicine checklist for managing local anesthetic systemic toxicity: 2012 version. Reg Anesth Pain Med. 2012;37:16-18. DOI: 10.1097/AAP.0b013e31822e0d8a
  • 10. Nath S, Häggmark S, Johansson G, Reiz S. Differential depressant and electrophysiologic cardiotoxicity of local anesthetics: an experimental study with special reference to lidocaine and bupivacaine. Anesth Analg. 1986;65(12):1263-1270. PMID:3777454
  • 11. Rosen MA, Thigpen JW, Shnider SM, Foutz SE, Levinson G, Koike M. Bupivacaine-induced cardiotoxicity in hypoxic and acidotic sheep. Anesth Analg. 1985;64(11):1089-1096 PMID: 4051206
  • 12. Moller RA, Covino BG. Effect of progesterone on the cardiac electrophysiologic alterations produced by ropivacaine and bupivacaine. Anesthesiology 1992;77:735-741. PMID:1416171
  • 13. Gitman M, Barrington MJ. Local anesthetic systemic toxicity: a review of recent case reports and registries. Reg Anesth Pain Med. 2018;43: 124–130. DOI: 10.1097/AAP.0000000000000721
  • 14. Picard J, Ward SC, Zumpe R, Meek T, Barlow J, Harrop-Grifiths W. Guidelines and the adoption of “lipid rescue” therapy for local anaesthetic toxicity. Anaesthesia 2009;64:122-5. DOI:10.1111/j.1365-2044.2008.05816.x
  • 15. FettiplaceMR,Weinberg G. The mechanisms underlying lipid resuscitation therapy. Reg Anesth Pain Med. 2018;43:138–149 PMID: 29356774

An Evaluation of the Approach of Orthopaedic Surgeons to Local Anaesthetic Toxicity

Yıl 2019, Cilt: 3 Sayı: 2, 111 - 115, 23.08.2019
https://doi.org/10.30565/medalanya.549378

Öz

Aim: To review the knowledge of orthopaedic surgeons related to the diagnosis, treatment and prevention of local anaesthetic systemic toxicity (LAST) and to raise awareness related to this subject. 

Material and Method: A 16-item questionnaire was applied to orthopaedic surgeons of different academic levels in different hospitals in Turkey. The items 












sought to identify demographic information, general knowledge related to local anaesthetic drugs, general knowledge related to toxicity and current treatment options. 

Results: The study included a
total of 172 orthopaedic surgeons in Turkey, of which 18.6% were orthopaedic
residents, 51.7% orthopaedic and traumatology specialists, and 29.7% faculty
members. Tenure in the orthopaedic area was determined to be >10 years in
45.3% of the participants. Local anaesthetic was seen to be used most in the
operating theatre, followed by the Emergency Department, polyclinic
intervention rooms, and on the wards. Of the total participants, 59.6% stated
that they had never heard of the use of lipids in the treatment of LAST, 29.8%
had heard of it but did not use it and 5.3% knew about the manner and area of
use of lipid treatments.























Conclusion: Awareness of physicians about LAST and preparedness for complications can ensure safer use of these local anaesthetics. 

Kaynakça

  • 1. Di Gregorio G, Neal JM, Rosenquist RW, Weinberg GL. Clinical presentation of local anesthetic systemic toxicity: a review of published cases, 1979 to 2009. Reg Anesth Pain Med.2010;35:181-7. DOI: http://dx.doi.org/10.1097/AAP.0b013e3181d2310b
  • 2. Corcoran W, Butterworth J, Weller RS, et al. Local anesthetic-induced cardiac toxicity: a survey of contemporary practice strategies among academic anesthesiology departments. Anesth Analg. 2006;103: 1322–1326. DOI: http://dx.doi.org/10.1213/01.ane.0000242515.03653.bb
  • 3. 3-Drasner K. Local anesthetic systemic toxicity: a historical perspective. Reg Anesth Pain Med. 2010;35:160–164. DOI: http://dx.doi.org/10.1097/AAP.0b013e3181d2306c
  • 4. Mulroy MF, Hejtmanek MR. Prevention of local anesthetic systemic toxicity. Reg Anesth Pain Med. 2010;35:177–180. PMID: 20216035
  • 5. Neal JM, Bernards CM, Butterworth JF, et al. ASRA practice advisory on local anesthetic systemic toxicity. Reg AnesthPainMed. 2010; 35:152–161. PMID: 20216033
  • 6. Neal JM, Woodward CM, Harrison TK The American Society of Regional Anesthesia and Pain Medicine Checklist for Managing Local Anesthetic Systemic Toxicity: 2017 Version.Reg Anesth Pain Med. 2018 Feb; 43(2):150-153. DOI: 10.1097/AAP.0000000000000726
  • 7. Başaranoğlu G, Teker MG, Saidoğlu L, Muhammedoğlu N, Özdemir H. Lokal anestezik kullanan hekimlerin toksisite ve intralipid tedavisi hakkında bilgileri. J Turk Anaest Int Care. 2010;38: 262-267. DOI:10.5222/JTAICS.2010.262
  • 8. Oksuz G, Urfalıoglu A, Sekmen T, Akkeçeci N, Alpay N, Bilal B. Dentists knowledge of lipid treatment of local anaesthetic systemic toxicity. Niger J Clin Pract 2018;21: 327-31. DOI: 10.4103/njcp.njcp_12_17
  • 9. Neal JM, Mulroy MF, Weinberg GL; American Society of Regional Anesthesia and Pain Medicine. American Society of Regional Anesthesia and Pain Medicine checklist for managing local anesthetic systemic toxicity: 2012 version. Reg Anesth Pain Med. 2012;37:16-18. DOI: 10.1097/AAP.0b013e31822e0d8a
  • 10. Nath S, Häggmark S, Johansson G, Reiz S. Differential depressant and electrophysiologic cardiotoxicity of local anesthetics: an experimental study with special reference to lidocaine and bupivacaine. Anesth Analg. 1986;65(12):1263-1270. PMID:3777454
  • 11. Rosen MA, Thigpen JW, Shnider SM, Foutz SE, Levinson G, Koike M. Bupivacaine-induced cardiotoxicity in hypoxic and acidotic sheep. Anesth Analg. 1985;64(11):1089-1096 PMID: 4051206
  • 12. Moller RA, Covino BG. Effect of progesterone on the cardiac electrophysiologic alterations produced by ropivacaine and bupivacaine. Anesthesiology 1992;77:735-741. PMID:1416171
  • 13. Gitman M, Barrington MJ. Local anesthetic systemic toxicity: a review of recent case reports and registries. Reg Anesth Pain Med. 2018;43: 124–130. DOI: 10.1097/AAP.0000000000000721
  • 14. Picard J, Ward SC, Zumpe R, Meek T, Barlow J, Harrop-Grifiths W. Guidelines and the adoption of “lipid rescue” therapy for local anaesthetic toxicity. Anaesthesia 2009;64:122-5. DOI:10.1111/j.1365-2044.2008.05816.x
  • 15. FettiplaceMR,Weinberg G. The mechanisms underlying lipid resuscitation therapy. Reg Anesth Pain Med. 2018;43:138–149 PMID: 29356774
Toplam 15 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Bölüm Araştırma Makalesi
Yazarlar

Bora Bilal 0000-0003-3884-8042

Duran Topak

Fatih Vatansever

Ömer Faruk Boran

Yayımlanma Tarihi 23 Ağustos 2019
Gönderilme Tarihi 4 Nisan 2019
Kabul Tarihi 6 Mayıs 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 3 Sayı: 2

Kaynak Göster

Vancouver Bilal B, Topak D, Vatansever F, Boran ÖF. An Evaluation of the Approach of Orthopaedic Surgeons to Local Anaesthetic Toxicity. Acta Med. Alanya. 2019;3(2):111-5.

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