Regional Anesthesia and Acute Pain ManagementRegional Anesthesia and Acute Pain ManagementРегионарная анестезия и лечение острой боли1993-65082687-1394Eco-Vector3617410.17816/RA36174ArticlesСтатьиReview ArticleLocal anesthetic toxicity during pregnancy and labourТоксичность местных анестетиков во время беременности и родовShifmanE. M.ШифманЕ. М.

Faculty of refresher training for health care professionals, Department of anesthesiology and resuscitation

ФПК МР, кафедра анестезиологии и реаниматологии

People’s Friendship University of RussiaРУДН1503201371VOL VII, NO1 (2013)ТОМ 7, №1 (2013)182421072020Copyright ©; 2013, Eco-VectorCopyright ©; 2013, ООО "Эко-Вектор"2013Eco-VectorООО "Эко-Вектор"https://rjraap.com/1993-6508/article/view/36174

The author overviews and discusses the problem of using fat emulsion as an antidote for local anesthetic toxicity, potentially life-threatening complication of regional anesthesia. The local anesthetic toxicity during pregnancy is still a serious problem and applying a new measure of treatment using fat emulsion should be beneficial both for patients and for anesthetist. However there are many questions unanswered due to substantial difference in standpoints to this problem, poor evidence base as well as absence of protocol for applying the fat emulsion during resuscitation.

В обзоре обсуждается вопрос использования внутривенных жировых эмульсий (ВЖЭ) как антидота при проявлениях токсичности местных анестетиков, потенциально опасного осложнения регионарной анестезии. Токсичность местных анестетиков во время беременности остается серьезной проблемой, и использование нового способа лечения с помощью ВЖЭ принесет пользу и пациенткам, и анестезиологам-реаниматологам. Однако многие вопросы остаются еще без ответа из-за существования различных точек зрения на данную проблему, слабой доказательной базы, а также отсутствия протоколов применения ВЖЭ во время реанимационных мероприятий.

pregnancyintravenous fat emulsionlocal anestheticsresuscitationбеременностьвнутривенная жировая эмульсиялипидыместные анестетикиреанимацияGroban L., Butterworth J. Lipid reversal of bupivacaine toxicity: has the silver bullet been identified? Reg Anesth Pain Med. 2003; 28: 167-169.Weinberg G., Ripper R., Feinstein D. L., Hoffman W. Lipid emulsion infusion rescues dogs from bupivacaine-induced cardiac toxicity. Reg Anesth Pain Med. 2003; 28: 198-202.Weinberg G. L. Lipid infusion therapy: translation to clinical practice. Anesth Analg. 2008; 106: 1340-1342.Litz R. J., Roessel T., Heller A. R., Stehr S. N. Reversal of central nervous system and cardiac toxicity after local anesthetic intoxication by lipid emulsion injection. Anesth Analg. 2008; 106: 1575-1577; table of contents.Rosenblatt M. A., Abel M., Fischer G. W. et al. Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. Anesthesiology. 2006; 105: 217-218.Warren J. A., Thoma R. B., Georgescu A., Shah S. J. Intravenous lipid infusion in the successful resuscitation of local anesthetic-induced cardiovascular collapse after supraclavicular brachial plexus block. Anesth Analg. 2008; 106: 1578-1580; table of contents.Weinberg G. L., Ripper R., Murphy P. et al. Lipid infusion accelerates removal of bupivacaine and recovery from bupivacaine toxicity in the isolated rat heart. Reg Anesth Pain Med. 2006; 31: 296-303.Santos A. C., DeArmas P. I. Systemic toxicity of levobupivacaine, bupivacaine, and ropivacaine during continuous intravenous infusion to nonpregnant and pregnant ewes. Anesthesiology. 2001; 95: 1256-1264.Moller R. A., Datta S., Fox J. et al. Effects of progesterone on the cardiac electrophysiologic action of bupivacaine and lidocaine. Anesthesiology. 1992; 76: 604-608.Moller R. A., Datta S., Strichartz G. R. Beta-estradiol acutely potentiates the depression of cardiac excitability by lidocaine and bupivacaine. J Cardiovasc Pharmacol. 1999; 34: 718-727.Neal J. M., Bernards C. M., Butterworth J. Ft. et al. ASRA practice advisory on local anesthetic systemic toxicity. Reg Anesth Pain Med. 2010; 35: 152-161.Kasten G. W., Martin S. T. Resuscitation from bupivacaine-induced cardiovascular toxicity during partial inferior vena cava occlusion. Anesth Analg. 1986; 65: 341-344.Arendt K. W., Segal S. Present and emerging strategies for reducing anesthesia-related maternal morbidity and mortality. Curr Opin Anesthesiol. 2009; 22: 330-335.Albright G. A. Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiology. 1979; 51: 285-287.Agarwal A., Kishore K. Complications and controversies of regional anaesthesia: a review. Indian J. Anaesth. 2009; 53: 543-553.Santos A. C., Pedersen H., Harmon T. W. et al. Does pregnancy alter the systemic toxicity of local anesthetics? Anesthesiology. 1989; 70: 991-995.Tsen L. C., Tarshis J., Denson D. D. et al. Measurements of maternal protein binding of bupivacaine throughout pregnancy. Anesth Analg. 1999; 89: 965-968.Denson D. D., Coyle D. E., Thompson G. A. et al. Bupivacaine protein binding in the term parturient: effects of lactic acidosis. Clin Pharmacol Ther. 1984; 35: 702-709.Kopp S. L., Horlocker T. T., Warner M. E. et al. Cardiac arrest during neuraxial anesthesia: frequency and predisposing factors associated with survival. Anesth Analg. 2005; 100: 855-865; table of contents.Auroy Y., Narchi P., Messiah A. et al. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology 1997; 87: 479-486.Brown D. L., Ransom D. M., Hall J. A. et al. Regional anesthesia and local anesthetic-induced systemic toxicity: seizure frequency and accompanying cardiovascular changes. Anesth Analg. 1995; 81: 321-328.Regan K. J., O’Sullivan G. The extension of epidural blockade for emergency Caesarean section: a survey of current UK practice. Anaesthesia. 2008; 63: 136-142.Dijkman A., Huisman C. M., Smit M. et al. Cardiac arrest in pregnancy: increasing use of perimortem caesarean section due to emergency skills training? BJOG 2010; 117: 282-287.Rosenberg P H., Veering В. Т., Urmey W. F. Maximum recommended doses of local anesthetics: a multifactorial concept. Reg Anesth Pain Med. 2004; 29: 564-575; discussion 24.Vanden Hoek T. L., Morrison U., Shuster M. et al. Part 12: cardiac arrest in •• special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010; 122 (Suppl 3): S829-S861.Elkus R., Popovich J. Jr. Respiratory physiology in pregnancy. Clin Chest Med. 1992; 13: 555-565.Lapinsky S. E., Kruczynski K., Slutsky A. S. Critical care in the pregnant patient. Am J Respir Crit Care Med. 1995; 152: 427455.Izci B., Vennelle M., Liston W. A. et al. Sleep-disordered breathing and upper airway size in pregnancy and postpartum. Eur Respir J. 2006; 27: 321-327.Cheun J. K., Choi K. T. Arterial oxygen desaturation rate following obstructive apnea in parturients. J Korean Med Sci. 1992; 7: 6-10.Cohen S. E., Andes L. C., Carvalho B. Assessment of knowledge regarding cardiopulmonary resuscitation of pregnant women. Int J Obstet Anesth. 2008; 17: 20-25.Page-Rodriguez A., Gonzalez-Sanchez J. A. Perimortem cesarean section of twin pregnancy: case report and review of the literature. Acad Emerg Med. 1999; 6: 1072-1074.Cardosi R. J., Porter K. B. Cesarean delivery of twins during maternal cardiopulmonary arrest. Obstet Gynecol 1998; 92: 695-697.McDonnell N. J. Cardiopulmonary arrest in pregnancy: two case reports of • successful outcomes in association with perimortem Caesarean delivery. Br J Anaesth. 2009; 103: 406-409.Katz V., Balderston K., DeFreest M. Perimortem cesarean delivery: were our assumptions correct? Am J Obstet Gynecol. 2005; 192: 1916-1920; discussion 1920-1921.Lofsky A. Doctors company reviews maternal arrests cases: APSF Newsletter. Summer 2007; 22: 28-30.Carvalho B., Cohen S. E. Resuscitation after maternal arrest clarified: APSF Newsletter. Winter. 2007; 22: 80.Spence A. G. Lipid reversal of central nervous system symptoms of bupivacaine toxicity. Anesthesiology. 2007; 107: 516517.Hiller D. B., Di Gregorio G., Kelly K. et al. Safety of high volume lipid emulsion infusion: a first approximation of LD50 in rats. Reg Anesth Pain Med. 2010; 35: 140-144.Hiller D. B., Gregorio G. D., Ripper R. et al. Epinephrine impairs lipid resuscitation from bupivacaine overdose: a threshold effect. Anesthesiology. 2009; 111: 498-505.Bania T. C., Chu J., Perez E. et al. Hemodynamic effects of intravenous fat emulsion in an animal model of severe verapamil toxicity resuscitated with atropine, calcium, and saline. Acad Emerg Med. 2007; 14: 105-111.Harvey M., Cave G. Intralipid outperforms sodium bicarbonate in a rabbit model of clomipramine toxicity. Ann Emerg Med. 2007; 49: 178-185; 185 e1-e4.Caruso A., De Carolis S., Ferrazzani S. et al. Pregnancy outcome and total parenteral nutrition in malnourished pregnant women. Fetal Diagn Ther. 1998; 13: 136-140.Jasnosz K. M., Pickeral J. J., Graner S. Fat deposits in the placenta following maternal total parenteral nutrition with intravenous lipid emulsion. Arch Pathol Lab Med. 1995; 119: 555557.Puntis J. W., Rushton D. I. Pulmonary intravascular lipid in neonatal necropsy specimens. Arch Dis Child. 1991; 66: 26Ramos-Silva V., Castello J. S., da Motta L. L, et al. Pulmonary lesions and total parenteral nutrition in children admitted to a pediatric intensive care unit. J Pediatr (Rio J). 2005; 81: 155161.Einav S., Matot I., Berkenstadt H. et al. A survey of labour ward clinicians' knowledge of maternal cardiac arrest and resuscitation. Int J Obstet Anesth. 2008; 17: 238-242.Smith H. M., Jacob A. K., Segura L. G. et al. Simulation education in anesthesia training: a case report of successful resuscitation of bupivacaine-induced cardiac arrest linked to recent simulation training. Anesth Analg. 2008; 106: 1581-1584; table of contents.Williamson R. M., Haines J. Availability of lipid emulsion in obstetric anaesthesia in the UK: a national questionnaire survey. Anaesthesia. 2008; 63: 385-388.