SlideShare une entreprise Scribd logo
1  sur  2
Télécharger pour lire hors ligne
AAGBI Safety Guideline
Management of Severe Local Anaesthetic Toxicity


    1
                                        Signs of severe toxicity:
                                        • Sudden alteration in mental status, severe agitation or loss of consciousness,
                                          with or without tonic-clonic convulsions
                                        • Cardiovascular collapse: sinus bradycardia, conduction blocks, asystole and
    Recognition                           ventricular tachyarrhythmias may all occur
                                        • Local anaesthetic (LA) toxicity may occur some time after an initial injection



    2
                                        • Stop injecting the LA
                                        • Call for help
                                        • Maintain the airway and, if necessary, secure it with a tracheal tube
    Immediate                           • Give 100% oxygen and ensure adequate lung ventilation (hyperventilation may
                                          help by increasing plasma pH in the presence of metabolic acidosis)
    management                          • Confirm or establish intravenous access
                                        • Control seizures: give a benzodiazepine, thiopental or propofol in small
                                          incremental doses
                                        • Assess cardiovascular status throughout
                                        • Consider drawing blood for analysis, but do not delay definitive treatment to do
                                          this



    3
                                        In cIrculatory arreSt                                      WIthout cIrculatory arreSt
                                        • Start cardiopulmonary resuscitation                      Use conventional therapies to treat:
                                          (CPR) using standard protocols                           • hypotension,
                                                                                                   • bradycardia,
    Treatment                           • Manage arrhythmias using the
                                          same protocols, recognising that                         • tachyarrhythmia
                                          arrhythmias may be very refractory to
                                          treatment
                                        • Consider the use of cardiopulmonary
                                          bypass if available

                                        GIve IntravenouS                                           conSIder IntravenouS
                                        lIpId emulSIon                                             lIpId emulSIon
                                        (following the regimen overleaf)                           (following the regimen overleaf)
                                        • Continue CPR throughout treatment                        • Propofol is not a suitable substitute
                                          with lipid emulsion                                        for lipid emulsion
                                        • Recovery from LA-induced cardiac                         • Lidocaine should not be used as an
                                          arrest may take >1 h                                       anti-arrhythmic therapy
                                        • Propofol is not a suitable substitute
                                          for lipid emulsion
                                        • Lidocaine should not be used as an
                                          anti-arrhythmic therapy



    4
                                        • Arrange safe transfer to a clinical area with appropriate equipment and suitable
                                          staff until sustained recovery is achieved
                                        • Exclude pancreatitis by regular clinical review, including daily amylase or lipase
                                          assays for two days
    Follow-up                           • Report cases as follows:
                                              in the United Kingdom to the National Patient Safety Agency
                                              (via www.npsa.nhs.uk)
                                              in the Republic of Ireland to the Irish Medicines Board (via www.imb.ie)
                                        If Lipid has been given, please also report its use to the international registry at
                                        www.lipidregistry.org. Details may also be posted at www.lipidrescue.org

your nearest bag of lipid emulsion is kept
This guideline is not a standard of medical care. The ultimate judgement with regard to a particular clinical procedure or treatment plan
must be made by the clinician in the light of the clinical data presented and the diagnostic and treatment options available.
© The Association of Anaesthetists of Great Britain & Ireland 2010
ImmedIately


               Give an initial intravenous bolus
                                                                                  Start an intravenous infusion of 20%
               injection of 20% lipid emulsion                       and
                                                                                     lipid emulsion at 15 ml.kg –1.h –1
                      1.5 ml.kg –1 over 1 min




   after 5 mIn


           Give a maximum of two repeat                                          Continue infusion at same rate, but:
           boluses (same dose) if:                                               Double the rate to 30 ml.kg –1.h –1 at
           • cardiovascular stability has not                                    any time after 5 min, if:
             been restored or                                                    • cardiovascular stability has not been
           • an adequate circulation                                 and           restored or
             deteriorates                                                        • an adequate circulation deteriorates
           Leave 5 min between boluses                                           Continue infusion until stable and
           A maximum of three boluses can be                                     adequate circulation restored or
           given (including the initial bolus)                                   maximum dose of lipid emulsion given



                               Do not exceed a maximum cumulative dose of 12 ml.kg–1




An approximate dose regimen for a 70-kg patient would be as follows:


   ImmedIately


               Give an initial intravenous bolus
                                                                                  Start an intravenous infusion of 20%
               injection of 20% lipid emulsion                       and
                                                                                      lipid emulsion at 1000 ml.h –1
                      100 ml over 1 min




   after 5 mIn


                                                                                     Continue infusion at same rate
               Give a maximum of two repeat                          and            but double rate to 2000 ml.h –1 if
                      boluses of 100 ml
                                                                                         indicated at any time


                                  Do not exceed a maximum cumulative dose of 840 ml




                    This AAGBI Safety Guideline was produced by a Working Party that comprised:
                    Grant Cave, Will Harrop-Griffiths (Chair), Martyn Harvey, Tim Meek, John Picard, Tim Short and Guy Weinberg.

                    this Safety Guideline is endorsed by the australian and new Zealand college of anaesthetists (anZca).



© The Association of Anaesthetists of Great Britain & Ireland 2010

Contenu connexe

Tendances

Anesthesia Consideration in Pediatric and Obstetrics
Anesthesia Consideration in Pediatric and ObstetricsAnesthesia Consideration in Pediatric and Obstetrics
Anesthesia Consideration in Pediatric and ObstetricsRifhan Kamaruddin
 
Monitored anaesthesia care
Monitored anaesthesia careMonitored anaesthesia care
Monitored anaesthesia careAnaestHSNZ
 
Local anestheticst systemic toxicity
Local  anestheticst systemic toxicityLocal  anestheticst systemic toxicity
Local anestheticst systemic toxicityram krishna
 
Pre anesthetic evaluation
Pre anesthetic evaluationPre anesthetic evaluation
Pre anesthetic evaluationSai Divya Varre
 
Fluid management & anesthesia
Fluid management & anesthesiaFluid management & anesthesia
Fluid management & anesthesiaSandro Zorzi
 
Minimum alveolar concentration (mac)
Minimum alveolar concentration (mac)Minimum alveolar concentration (mac)
Minimum alveolar concentration (mac)Torrentz Tiku
 
Hypotensive Anaesthesia
Hypotensive AnaesthesiaHypotensive Anaesthesia
Hypotensive AnaesthesiaPulkit Agarwal
 
Airway local blocks
Airway local blocksAirway local blocks
Airway local blocksNisar Arain
 
Interscalene & supraclavicular nerve blocks
Interscalene  & supraclavicular nerve blocksInterscalene  & supraclavicular nerve blocks
Interscalene & supraclavicular nerve blocksDavis Kurian
 
Anesthesia in ophthalmic surgery and complications
Anesthesia in ophthalmic surgery and complicationsAnesthesia in ophthalmic surgery and complications
Anesthesia in ophthalmic surgery and complicationsDR SHADAB KAMAL
 
Hypotensive anesthesia
Hypotensive anesthesiaHypotensive anesthesia
Hypotensive anesthesiaDr Kumar
 
Lower limb blocks
Lower limb blocksLower limb blocks
Lower limb blocksgaganbrar18
 
Anaesthesia for Ophthalmology surgery
Anaesthesia for Ophthalmology surgeryAnaesthesia for Ophthalmology surgery
Anaesthesia for Ophthalmology surgeryAnor Abidin
 
Total Intravenous Anesthesia(TIVA), recent updates
Total Intravenous Anesthesia(TIVA), recent updatesTotal Intravenous Anesthesia(TIVA), recent updates
Total Intravenous Anesthesia(TIVA), recent updatesdr tushar chokshi
 
Cardiac reflexes & Anaesthetic Implications
Cardiac reflexes & Anaesthetic ImplicationsCardiac reflexes & Anaesthetic Implications
Cardiac reflexes & Anaesthetic ImplicationsDr.Daber Pareed
 

Tendances (20)

Anesthesia Consideration in Pediatric and Obstetrics
Anesthesia Consideration in Pediatric and ObstetricsAnesthesia Consideration in Pediatric and Obstetrics
Anesthesia Consideration in Pediatric and Obstetrics
 
Monitored anaesthesia care
Monitored anaesthesia careMonitored anaesthesia care
Monitored anaesthesia care
 
Local anestheticst systemic toxicity
Local  anestheticst systemic toxicityLocal  anestheticst systemic toxicity
Local anestheticst systemic toxicity
 
Brachial plexus block
Brachial plexus blockBrachial plexus block
Brachial plexus block
 
Pre anesthetic evaluation
Pre anesthetic evaluationPre anesthetic evaluation
Pre anesthetic evaluation
 
Fluid management & anesthesia
Fluid management & anesthesiaFluid management & anesthesia
Fluid management & anesthesia
 
Minimum alveolar concentration (mac)
Minimum alveolar concentration (mac)Minimum alveolar concentration (mac)
Minimum alveolar concentration (mac)
 
Post extubation stridor
Post extubation stridorPost extubation stridor
Post extubation stridor
 
Hypotensive Anaesthesia
Hypotensive AnaesthesiaHypotensive Anaesthesia
Hypotensive Anaesthesia
 
Intravenous induction agents
Intravenous induction agentsIntravenous induction agents
Intravenous induction agents
 
Airway local blocks
Airway local blocksAirway local blocks
Airway local blocks
 
Interscalene & supraclavicular nerve blocks
Interscalene  & supraclavicular nerve blocksInterscalene  & supraclavicular nerve blocks
Interscalene & supraclavicular nerve blocks
 
Anesthesia in ophthalmic surgery and complications
Anesthesia in ophthalmic surgery and complicationsAnesthesia in ophthalmic surgery and complications
Anesthesia in ophthalmic surgery and complications
 
Hypotensive anesthesia
Hypotensive anesthesiaHypotensive anesthesia
Hypotensive anesthesia
 
Lower limb blocks
Lower limb blocksLower limb blocks
Lower limb blocks
 
Anaesthesia for Ophthalmology surgery
Anaesthesia for Ophthalmology surgeryAnaesthesia for Ophthalmology surgery
Anaesthesia for Ophthalmology surgery
 
Total Intravenous Anesthesia(TIVA), recent updates
Total Intravenous Anesthesia(TIVA), recent updatesTotal Intravenous Anesthesia(TIVA), recent updates
Total Intravenous Anesthesia(TIVA), recent updates
 
Cardiac reflexes & Anaesthetic Implications
Cardiac reflexes & Anaesthetic ImplicationsCardiac reflexes & Anaesthetic Implications
Cardiac reflexes & Anaesthetic Implications
 
Dexmedetomidine
DexmedetomidineDexmedetomidine
Dexmedetomidine
 
Awake intubation
Awake intubationAwake intubation
Awake intubation
 

En vedette

Low cardiac output syndrome- minati
Low cardiac output syndrome- minatiLow cardiac output syndrome- minati
Low cardiac output syndrome- minatiMinati Choudhury
 
Triggering Rise Time E Sens
Triggering Rise Time E SensTriggering Rise Time E Sens
Triggering Rise Time E SensDang Thanh Tuan
 
Ventilator graphics
Ventilator graphicsVentilator graphics
Ventilator graphicsAhmed Hegazy
 
Non conventional ventilator modes
Non conventional ventilator modesNon conventional ventilator modes
Non conventional ventilator modesAnaestHSNZ
 
pathophysiological changes in ckd patients for anaesthetic concern
pathophysiological changes in ckd patients for anaesthetic concernpathophysiological changes in ckd patients for anaesthetic concern
pathophysiological changes in ckd patients for anaesthetic concerndrshowketdar
 
Anatomy of neuroaxial system final
Anatomy of neuroaxial system finalAnatomy of neuroaxial system final
Anatomy of neuroaxial system finaldr anurag giri
 
Optimizing Critical Care Ventilation: What can we learn from Ventilator Wavef...
Optimizing Critical Care Ventilation: What can we learn from Ventilator Wavef...Optimizing Critical Care Ventilation: What can we learn from Ventilator Wavef...
Optimizing Critical Care Ventilation: What can we learn from Ventilator Wavef...Dr.Mahmoud Abbas
 
Amikor a munkavállalód építi a cég márkáját
Amikor a munkavállalód építi a cég márkájátAmikor a munkavállalód építi a cég márkáját
Amikor a munkavállalód építi a cég márkájátFerenc Pécsi
 
Anatomy for lumber neuraxial anesthesia
Anatomy for lumber neuraxial anesthesiaAnatomy for lumber neuraxial anesthesia
Anatomy for lumber neuraxial anesthesiaFaizul Hoque
 
Cholinergic system model questions & answers
Cholinergic system model questions & answersCholinergic system model questions & answers
Cholinergic system model questions & answersRathnakar U P
 
Waveforms, lecture about mechanical ventilation, by Prof Ahmed Tarek, Prof of...
Waveforms, lecture about mechanical ventilation, by Prof Ahmed Tarek, Prof of...Waveforms, lecture about mechanical ventilation, by Prof Ahmed Tarek, Prof of...
Waveforms, lecture about mechanical ventilation, by Prof Ahmed Tarek, Prof of...mohamed osama hussein
 
Complications of anaesthesia in opthalmic surgery
Complications of anaesthesia in opthalmic surgeryComplications of anaesthesia in opthalmic surgery
Complications of anaesthesia in opthalmic surgeryDevdutta Nayak
 
epidural anesthesia
epidural anesthesiaepidural anesthesia
epidural anesthesiaShibinath VM
 
Monitoring depth of anaesthesia
Monitoring depth of anaesthesiaMonitoring depth of anaesthesia
Monitoring depth of anaesthesiaShamita Roy
 
Delayed recovery from anaesthesia by prof. minnu m. panditrao
Delayed recovery from anaesthesia by prof. minnu m. panditraoDelayed recovery from anaesthesia by prof. minnu m. panditrao
Delayed recovery from anaesthesia by prof. minnu m. panditraoMinnu Panditrao
 
Anticholinesterases
AnticholinesterasesAnticholinesterases
AnticholinesterasesKanav Bhanot
 
The postanesthesia care unit
The postanesthesia care unitThe postanesthesia care unit
The postanesthesia care unitTelma Santos
 

En vedette (20)

Low cardiac output syndrome- minati
Low cardiac output syndrome- minatiLow cardiac output syndrome- minati
Low cardiac output syndrome- minati
 
Triggering Rise Time E Sens
Triggering Rise Time E SensTriggering Rise Time E Sens
Triggering Rise Time E Sens
 
Ventilator graphics
Ventilator graphicsVentilator graphics
Ventilator graphics
 
Non conventional ventilator modes
Non conventional ventilator modesNon conventional ventilator modes
Non conventional ventilator modes
 
Prolong apneu
Prolong apneuProlong apneu
Prolong apneu
 
pathophysiological changes in ckd patients for anaesthetic concern
pathophysiological changes in ckd patients for anaesthetic concernpathophysiological changes in ckd patients for anaesthetic concern
pathophysiological changes in ckd patients for anaesthetic concern
 
Anatomy of neuroaxial system final
Anatomy of neuroaxial system finalAnatomy of neuroaxial system final
Anatomy of neuroaxial system final
 
Optimizing Critical Care Ventilation: What can we learn from Ventilator Wavef...
Optimizing Critical Care Ventilation: What can we learn from Ventilator Wavef...Optimizing Critical Care Ventilation: What can we learn from Ventilator Wavef...
Optimizing Critical Care Ventilation: What can we learn from Ventilator Wavef...
 
Amikor a munkavállalód építi a cég márkáját
Amikor a munkavállalód építi a cég márkájátAmikor a munkavállalód építi a cég márkáját
Amikor a munkavállalód építi a cég márkáját
 
Anatomy for lumber neuraxial anesthesia
Anatomy for lumber neuraxial anesthesiaAnatomy for lumber neuraxial anesthesia
Anatomy for lumber neuraxial anesthesia
 
Cholinergic system model questions & answers
Cholinergic system model questions & answersCholinergic system model questions & answers
Cholinergic system model questions & answers
 
Ventilator graphics
Ventilator graphicsVentilator graphics
Ventilator graphics
 
Ventilator graphics
Ventilator graphicsVentilator graphics
Ventilator graphics
 
Waveforms, lecture about mechanical ventilation, by Prof Ahmed Tarek, Prof of...
Waveforms, lecture about mechanical ventilation, by Prof Ahmed Tarek, Prof of...Waveforms, lecture about mechanical ventilation, by Prof Ahmed Tarek, Prof of...
Waveforms, lecture about mechanical ventilation, by Prof Ahmed Tarek, Prof of...
 
Complications of anaesthesia in opthalmic surgery
Complications of anaesthesia in opthalmic surgeryComplications of anaesthesia in opthalmic surgery
Complications of anaesthesia in opthalmic surgery
 
epidural anesthesia
epidural anesthesiaepidural anesthesia
epidural anesthesia
 
Monitoring depth of anaesthesia
Monitoring depth of anaesthesiaMonitoring depth of anaesthesia
Monitoring depth of anaesthesia
 
Delayed recovery from anaesthesia by prof. minnu m. panditrao
Delayed recovery from anaesthesia by prof. minnu m. panditraoDelayed recovery from anaesthesia by prof. minnu m. panditrao
Delayed recovery from anaesthesia by prof. minnu m. panditrao
 
Anticholinesterases
AnticholinesterasesAnticholinesterases
Anticholinesterases
 
The postanesthesia care unit
The postanesthesia care unitThe postanesthesia care unit
The postanesthesia care unit
 

Similaire à La toxicity 2010_0

BTEI CPR lecture slides 2012
BTEI CPR lecture slides 2012BTEI CPR lecture slides 2012
BTEI CPR lecture slides 2012eyedogtor
 
02intravenousinductionagents-160226094535 (1).pptx
02intravenousinductionagents-160226094535 (1).pptx02intravenousinductionagents-160226094535 (1).pptx
02intravenousinductionagents-160226094535 (1).pptxKeerthy Unnikrishnan
 
Some of local anesthetics used in dentistry
Some of local anesthetics used in dentistrySome of local anesthetics used in dentistry
Some of local anesthetics used in dentistrymohamedashraf384
 
(Anesthesia) spinal anesthesia english by dr. kalimullah wardak
(Anesthesia) spinal anesthesia english by dr. kalimullah wardak(Anesthesia) spinal anesthesia english by dr. kalimullah wardak
(Anesthesia) spinal anesthesia english by dr. kalimullah wardakKalimullah Wardak
 
Emergency situations during hair transplant and how to avoid them.
Emergency situations during hair transplant and how to avoid them.Emergency situations during hair transplant and how to avoid them.
Emergency situations during hair transplant and how to avoid them.DrAnilKumarGargRejuv
 
Contrast media safety aspects
Contrast media   safety aspectsContrast media   safety aspects
Contrast media safety aspectsSwapnil Shetty
 
Total Parenteral Nutrition.pptx
Total Parenteral Nutrition.pptxTotal Parenteral Nutrition.pptx
Total Parenteral Nutrition.pptxNikethana1
 
Induction Agents - Propofol, Sodium Thiopental, Ketamine,
Induction Agents - Propofol, Sodium Thiopental, Ketamine, Induction Agents - Propofol, Sodium Thiopental, Ketamine,
Induction Agents - Propofol, Sodium Thiopental, Ketamine, Mr.Harshad Khade
 
An urgent call to the labour ward
An urgent call to the labour wardAn urgent call to the labour ward
An urgent call to the labour wardChamika Huruggamuwa
 

Similaire à La toxicity 2010_0 (20)

Haemorrhagic shock
Haemorrhagic shockHaemorrhagic shock
Haemorrhagic shock
 
Acute medical problems in GIpractice
Acute medical problems in GIpractice Acute medical problems in GIpractice
Acute medical problems in GIpractice
 
BTEI CPR lecture slides 2012
BTEI CPR lecture slides 2012BTEI CPR lecture slides 2012
BTEI CPR lecture slides 2012
 
02intravenousinductionagents-160226094535 (1).pptx
02intravenousinductionagents-160226094535 (1).pptx02intravenousinductionagents-160226094535 (1).pptx
02intravenousinductionagents-160226094535 (1).pptx
 
POISONING - PDF.pdf
POISONING - PDF.pdfPOISONING - PDF.pdf
POISONING - PDF.pdf
 
Some of local anesthetics used in dentistry
Some of local anesthetics used in dentistrySome of local anesthetics used in dentistry
Some of local anesthetics used in dentistry
 
(Anesthesia) spinal anesthesia english by dr. kalimullah wardak
(Anesthesia) spinal anesthesia english by dr. kalimullah wardak(Anesthesia) spinal anesthesia english by dr. kalimullah wardak
(Anesthesia) spinal anesthesia english by dr. kalimullah wardak
 
Anaesthesia.pptx
Anaesthesia.pptxAnaesthesia.pptx
Anaesthesia.pptx
 
SNAKEBITE.pptx
SNAKEBITE.pptxSNAKEBITE.pptx
SNAKEBITE.pptx
 
Emergency situations during hair transplant and how to avoid them.
Emergency situations during hair transplant and how to avoid them.Emergency situations during hair transplant and how to avoid them.
Emergency situations during hair transplant and how to avoid them.
 
Guidelines poster septic shock
Guidelines poster septic shockGuidelines poster septic shock
Guidelines poster septic shock
 
Guidelines poster septic shock
Guidelines poster septic shockGuidelines poster septic shock
Guidelines poster septic shock
 
Contrast media safety aspects
Contrast media   safety aspectsContrast media   safety aspects
Contrast media safety aspects
 
Snake bite
Snake biteSnake bite
Snake bite
 
Total Parenteral Nutrition.pptx
Total Parenteral Nutrition.pptxTotal Parenteral Nutrition.pptx
Total Parenteral Nutrition.pptx
 
Induction Agents - Propofol, Sodium Thiopental, Ketamine,
Induction Agents - Propofol, Sodium Thiopental, Ketamine, Induction Agents - Propofol, Sodium Thiopental, Ketamine,
Induction Agents - Propofol, Sodium Thiopental, Ketamine,
 
An urgent call to the labour ward
An urgent call to the labour wardAn urgent call to the labour ward
An urgent call to the labour ward
 
Isonized overdose
Isonized overdose Isonized overdose
Isonized overdose
 
Hemophila
HemophilaHemophila
Hemophila
 
Anaesthesia and its types. aga umar tariq
Anaesthesia and its types. aga umar tariqAnaesthesia and its types. aga umar tariq
Anaesthesia and its types. aga umar tariq
 

Plus de AnaestHSNZ

Anesthesia for neurosurgery (zuhura)
Anesthesia for neurosurgery (zuhura)Anesthesia for neurosurgery (zuhura)
Anesthesia for neurosurgery (zuhura)AnaestHSNZ
 
Anaesthesia for elective neurosurgery journal (zuhura)
Anaesthesia for elective neurosurgery   journal (zuhura)Anaesthesia for elective neurosurgery   journal (zuhura)
Anaesthesia for elective neurosurgery journal (zuhura)AnaestHSNZ
 
Guidelines mng hemophilia
Guidelines mng hemophiliaGuidelines mng hemophilia
Guidelines mng hemophiliaAnaestHSNZ
 
Mmr presentation anaesth
Mmr presentation anaesthMmr presentation anaesth
Mmr presentation anaesthAnaestHSNZ
 
Disorder of ca metabolism
Disorder of ca metabolismDisorder of ca metabolism
Disorder of ca metabolismAnaestHSNZ
 
One lung ventilation kweq part 1
One lung ventilation kweq part 1One lung ventilation kweq part 1
One lung ventilation kweq part 1AnaestHSNZ
 
Anaesthesia for patient with anticoagulant
Anaesthesia for patient with anticoagulantAnaesthesia for patient with anticoagulant
Anaesthesia for patient with anticoagulantAnaestHSNZ
 

Plus de AnaestHSNZ (9)

Mmr03032011
Mmr03032011Mmr03032011
Mmr03032011
 
Anesthesia for neurosurgery (zuhura)
Anesthesia for neurosurgery (zuhura)Anesthesia for neurosurgery (zuhura)
Anesthesia for neurosurgery (zuhura)
 
Anaesthesia for elective neurosurgery journal (zuhura)
Anaesthesia for elective neurosurgery   journal (zuhura)Anaesthesia for elective neurosurgery   journal (zuhura)
Anaesthesia for elective neurosurgery journal (zuhura)
 
Guidelines mng hemophilia
Guidelines mng hemophiliaGuidelines mng hemophilia
Guidelines mng hemophilia
 
Hemophilia
HemophiliaHemophilia
Hemophilia
 
Mmr presentation anaesth
Mmr presentation anaesthMmr presentation anaesth
Mmr presentation anaesth
 
Disorder of ca metabolism
Disorder of ca metabolismDisorder of ca metabolism
Disorder of ca metabolism
 
One lung ventilation kweq part 1
One lung ventilation kweq part 1One lung ventilation kweq part 1
One lung ventilation kweq part 1
 
Anaesthesia for patient with anticoagulant
Anaesthesia for patient with anticoagulantAnaesthesia for patient with anticoagulant
Anaesthesia for patient with anticoagulant
 

Dernier

Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdfHongBiThi1
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.pptRamDBawankar1
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 

Dernier (20)

Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...
 

La toxicity 2010_0

  • 1. AAGBI Safety Guideline Management of Severe Local Anaesthetic Toxicity 1 Signs of severe toxicity: • Sudden alteration in mental status, severe agitation or loss of consciousness, with or without tonic-clonic convulsions • Cardiovascular collapse: sinus bradycardia, conduction blocks, asystole and Recognition ventricular tachyarrhythmias may all occur • Local anaesthetic (LA) toxicity may occur some time after an initial injection 2 • Stop injecting the LA • Call for help • Maintain the airway and, if necessary, secure it with a tracheal tube Immediate • Give 100% oxygen and ensure adequate lung ventilation (hyperventilation may help by increasing plasma pH in the presence of metabolic acidosis) management • Confirm or establish intravenous access • Control seizures: give a benzodiazepine, thiopental or propofol in small incremental doses • Assess cardiovascular status throughout • Consider drawing blood for analysis, but do not delay definitive treatment to do this 3 In cIrculatory arreSt WIthout cIrculatory arreSt • Start cardiopulmonary resuscitation Use conventional therapies to treat: (CPR) using standard protocols • hypotension, • bradycardia, Treatment • Manage arrhythmias using the same protocols, recognising that • tachyarrhythmia arrhythmias may be very refractory to treatment • Consider the use of cardiopulmonary bypass if available GIve IntravenouS conSIder IntravenouS lIpId emulSIon lIpId emulSIon (following the regimen overleaf) (following the regimen overleaf) • Continue CPR throughout treatment • Propofol is not a suitable substitute with lipid emulsion for lipid emulsion • Recovery from LA-induced cardiac • Lidocaine should not be used as an arrest may take >1 h anti-arrhythmic therapy • Propofol is not a suitable substitute for lipid emulsion • Lidocaine should not be used as an anti-arrhythmic therapy 4 • Arrange safe transfer to a clinical area with appropriate equipment and suitable staff until sustained recovery is achieved • Exclude pancreatitis by regular clinical review, including daily amylase or lipase assays for two days Follow-up • Report cases as follows: in the United Kingdom to the National Patient Safety Agency (via www.npsa.nhs.uk) in the Republic of Ireland to the Irish Medicines Board (via www.imb.ie) If Lipid has been given, please also report its use to the international registry at www.lipidregistry.org. Details may also be posted at www.lipidrescue.org your nearest bag of lipid emulsion is kept This guideline is not a standard of medical care. The ultimate judgement with regard to a particular clinical procedure or treatment plan must be made by the clinician in the light of the clinical data presented and the diagnostic and treatment options available. © The Association of Anaesthetists of Great Britain & Ireland 2010
  • 2. ImmedIately Give an initial intravenous bolus Start an intravenous infusion of 20% injection of 20% lipid emulsion and lipid emulsion at 15 ml.kg –1.h –1 1.5 ml.kg –1 over 1 min after 5 mIn Give a maximum of two repeat Continue infusion at same rate, but: boluses (same dose) if: Double the rate to 30 ml.kg –1.h –1 at • cardiovascular stability has not any time after 5 min, if: been restored or • cardiovascular stability has not been • an adequate circulation and restored or deteriorates • an adequate circulation deteriorates Leave 5 min between boluses Continue infusion until stable and A maximum of three boluses can be adequate circulation restored or given (including the initial bolus) maximum dose of lipid emulsion given Do not exceed a maximum cumulative dose of 12 ml.kg–1 An approximate dose regimen for a 70-kg patient would be as follows: ImmedIately Give an initial intravenous bolus Start an intravenous infusion of 20% injection of 20% lipid emulsion and lipid emulsion at 1000 ml.h –1 100 ml over 1 min after 5 mIn Continue infusion at same rate Give a maximum of two repeat and but double rate to 2000 ml.h –1 if boluses of 100 ml indicated at any time Do not exceed a maximum cumulative dose of 840 ml This AAGBI Safety Guideline was produced by a Working Party that comprised: Grant Cave, Will Harrop-Griffiths (Chair), Martyn Harvey, Tim Meek, John Picard, Tim Short and Guy Weinberg. this Safety Guideline is endorsed by the australian and new Zealand college of anaesthetists (anZca). © The Association of Anaesthetists of Great Britain & Ireland 2010