Lokal Anestezik Sistemik Toksisitesi
Synopsis
Although local anesthetics are safe medications widely used in surgical and anesthesia practice, high doses or improper administration can lead to local anesthetic systemic toxicity (LAST), a rare but life-threatening critical condition. Chemically classified into amino esters and amino amides, amide derivatives, which are slowly metabolized in the liver, carry a higher risk of systemic toxicity. Clinical manifestations of LAST primarily affect the central nervous system (CNS) and cardiovascular system (CVS). Early CNS symptoms include metallic taste, tinnitus, perioral numbness, and lightheadedness, whereas progressing toxicity can result in agitation, convulsions, delirium, coma, and respiratory arrest. CVS manifestations initially present with hypertension and tachycardia due to sympathetic activation, followed by conduction disorders, arrhythmias, myocardial dysfunction, and cardiac arrest. Additionally, agents such as prilocaine, articaine, and benzocaine increase the risk of methemoglobinemia. Extremes of age, pregnancy, systemic diseases, and highly vascular injection sites are major risk factors for LAST. Prevention relies heavily on ultrasound guidance, using the lowest effective dose, frequent aspiration, and test dosing with epinephrine. In toxicity management, immediate cessation of LA administration, 100% oxygen support, seizure control with benzodiazepines, and early administration of intravenous 20% lipid emulsion therapy to support resuscitation are of vital importance.
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