Regional Anesthesia and Acute Pain ManagementRegional Anesthesia and Acute Pain Management1993-65082687-1394Eco-Vector4386310.17816/RA43863Research ArticleMethodical recommendations of the ministry of health of the Russian Federation on systemic toxicity of local anestheticLachinR. E.<p>Dr. Med. Sci., Docent, Professor, Department of Anesthesiology and Intensive Care</p>doctor-lahin@yandex.ruhttps://orcid.org/0000-0001-6819-9691BayalievaA. Zh.doctor-lahin@yandex.ruhttps://orcid.org/0000-0001-7577-3284EzhevskyA. A.doctor-lahin@yandex.ruhttps://orcid.org/0000-0002-9286-4679ZabolotskyD. V.doctor-lahin@yandex.ruhttps://orcid.org/0000-0002-6127-0798KoryachkinV. A.doctor-lahin@yandex.ruhttps://orcid.org/0000-0002-3400-8989KulikovA. V.doctor-lahin@yandex.ruhttps://orcid.org/0000-0002-7768-4514OvechkinA. M.doctor-lahin@yandex.ruhttps://orcid.org/0000-0002-1500-8430UvarovD. N.doctor-lahin@yandex.ruhttps://orcid.org/0000-0002-1500-8430UlrikhG. E.doctor-lahin@yandex.ruhttps://orcid.org/0000-0001-7491-4153FilippovichG. V.doctor-lahin@yandex.ruhttps://orcid.org/0000-0002-2090-175XShifmanE. M.doctor-lahin@yandex.ruhttps://orcid.org/0000-0002-6113-8498Military Medical Academy named after S.M.Kirov of the Ministry of defence of the Russian FederationKazan State Medical University of the Ministry of health of the Russian FederationPrivolzhsky Research Medical University of the Ministry of Health of the Russian FederationSt. Petersburg State Pediatric Medical University of the Ministry of Healthcare of the Russian FederationUrals State Medical University of the Ministry of Healthcare of the Russian FederationI.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)Northern State Medical University of the Ministry of Healthcare of the Russian Federation,«National Medical Research Center for Obstetrics, Gynecology and Perinatology Named After Academician V.I.Kulakov» of the Ministry of Healthcare of the Russian FederationM.F. Vladimirsky Moscow Regional Research Clinical Institute31122019131-431410909202009092020Copyright © 2019, Eco-Vector2019<p>Methodological recommendations of the Ministry of health of the Russian Federation Systemic toxicity of local anesthetics were prepared by the all-Russian public organization Federation of anesthesiologists and resuscitators. Systemic toxicity of local anesthetics is a rare but dangerous complication of regional anesthesia. These recommendations provide updated indicators of the prevalence of this complication, the preventive value of ultrasound navigation, and the evolution of the clinical picture. The results of the analysis of new reports indicate a trend towards delayed manifestation of symptoms after regional anesthesia. The type of local anesthetic, dosage, volume, injection site, and concomitant diseases of the patient affect the rate of absorption from the injection site and the toxicity of local anesthetics. The article presents new information about the mechanisms of lipid resuscitation, summarizes the latest scientific data on the mechanisms of neutralization of local anesthetics in blood plasma by introducing fat emulsions, including the effect of rapid redistribution, direct inotropic effect and postconditioning. Guidelines for the prevention, recognition and treatment of systemic toxicity of local anesthetics have been updated in accordance with new data.</p>local anestheticsystemic toxicitylipid emulsionlipid resuscitationregional anesthesiaместный анестетиксистемная токсичностьжировая эмульсиялипидная реанимациярегионарная анестезия[Dillane D., Finucane B. T. Local Anesthetic systemic toxicity. Can. J. Anaesth. 2010; 57 (4): 368−80. doi: 10.1007/s12630-010-9275-7.][Neal J.M., Bernards C.M., Butterworth J.F. et al. ASRA practice advisory on local anesthetic systemic toxicity. Reg. Anesth. Pain. Med. 2010; 35 (2): 152−61. doi: 10.1097/AAP.0b013e3181d22fcd.][Neal J.M., Woodward C.M., Harrison T.K. The American Society of Regional Anesthesia and Pain Medicine Checklist for Managing Local Anesthetic Systemic Toxicity: 2017 Version. Reg. Anesth. Pain. Med. 2018; 43 (2): 150−3. doi: 10.1097/AAP.0000000000000726.][The Association of Anaesthetists of Great Britain & Ireland. 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