How does bupivacaine affect the heart?
Bupivacaine produces a concentration-related depression of intra-atrial, A-V nodal, intraventricular conduction and myocardial contractility owing to a fast sodium channel blocking in both nerve and cardiac tissue.
How is local anesthetic toxicity diagnosed?
Initial signs and symptoms include agitation, confusion, dizziness, drowsiness, dysphoria, auditory changes, tinnitus, perioral numbness, metallic taste, and dysarthria. Without adequate recognition and treatment, these signs as symptoms can progress to seizures, respiratory arrest, and/or coma.
What is bupivacaine toxicity?
It is well documented that bupivacaine toxicity first manifests as central nervous system disorders (tinnitus, a metallic taste in the mouth, dizziness, seizures). Cardiovascular signs follow the neurologic signs and include bradycardia, dysrhythmias and, in severe cases, asystole.
How do local anesthetics affect cardiac function?
Local anesthetics have directs effects on the heart and peripheral blood vessels. They block the fast sodium channels in the fast-conducting tissue of Purkinje fibers and ventricles resulting in a decrease rate of depolarization.
How is bupivacaine toxicity treated?
Total cardiovascular collapse may be treated with CPR plus 1.5-4 mL/kg bolus of 20% lipid solution followed by 0.25-0.5 mL/kg/min for 10-60 minutes. Dose-dependent blockade of sodium channels.
How long does bupivacaine stay in your system?
Results: There were three main findings: (1) the pain block of bupivacaine lasts only half as long (15 hours) as the return to normal sensation (30 hours); (2) the effect of adding epinephrine to bupivacaine prolongs the duration of pain relief in a finger block for only an additional 1.5 hours; (3) in addition to pain …
What are signs of systemic toxicity?
Classically, systemic toxicity begins with symptoms of CNS excitement such as the following:
- Circumoral and/or tongue numbness.
- Metallic taste.
- Visual and auditory disturbances (difficulty focusing and tinnitus)
What is used to treat local anesthetic systemic toxicity?
Intravenous infusion of a lipid emulsion has become part of the treatment for systemic toxicity from LAs, particularly for refractory cardiac arrest. The ASRA guidelines recommend starting lipid emulsion therapy at the first signs of systemic toxicity from LAs, after airway management (Fig. 2B).
What are the symptoms of systemic toxicity of local anesthetics?
Which local anesthetic is the safest?
Novocaine is a safe and effective local anesthetic. It is most commonly used in dentistry for procedures that take less than 90 minutes to perform. Several factors affect the time Novocaine lasts, including the dose and the use of epinephrine.
What is the antidote for bupivacaine?
Although it is not widely accepted, combined boluses of glucose, insulin, and potassium were recommended as a successful treatment in reversing bupivacaine‐induced cardiovascular events.
What worsens lignocaine toxicity?
Hypoxemia and metabolic acidosis may potentiate the cardiovascular toxicity of lidocaine and other local anesthetics. Early control of seizures and aggressive airway management to treat hypoxemia and acidosis may prevent cardiac arrest. Use of sodium bicarbonate may be considered to treat severe acidosis.