Local anesthetic toxicity and lipid resuscitation in pregnancy
Local anesthetic toxicity and lipid resuscitation in pregnancy
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DOI：
10.1097/aco.0b013e32834654df
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发表时间：
2011-06-11
影响因子：
2.5
通讯作者：
Weinberg, Guy
中科院分区：
文献类型：
--
作者：
Bern, Sarah;Weinberg, Guy
综述目的脂肪乳已成为局麻药引起的心脏骤停的有效治疗方法，但其在产科患者中的治疗应用目前需要定义。这篇综述讨论了临床报告，相关的实验室研究，和未来的发展方向，一个最佳的协议，脂质复苏在pregnancy.Recent findingsSeveral mechanisms已经假定占明显增强的敏感性，局部麻醉全身毒性在怀孕期间。1例妊娠患者脂质复苏的病例报告显示了有利的结局，并支持脂质治疗的安全性。目前的指南和病例报告提出，在最早的毒性迹象大丸脂质可能会防止心血管calles.SummaryAs产科人口变得更老，更肥胖，新的技术和战略，可以协助控制孕产妇死亡和继发于麻醉并发症的主要发病率。脂质复苏似乎是一种有效的治疗亲脂性药物引起的毒性，并可能是有用的治疗妊娠患者的全身毒性。产科护理提供者应了解脂质复苏，并考虑按照美国区域麻醉和疼痛医学学会指南的描述使用。
Purpose of reviewLipid emulsion has emerged as an effective treatment of local anesthetic-induced cardiac arrest, but its therapeutic application for the obstetric patient requires definition at present. This review discusses clinical reports, relevant laboratory studies, and future directions for the development of an optimal protocol for lipid resuscitation in pregnancy.Recent findingsSeveral mechanisms have been postulated to account for the apparent enhanced sensitivity to local anesthetic systemic toxicity during pregnancy. One case report of lipid resuscitation in the pregnant patient demonstrates favorable outcomes and supports the safety of lipid therapy. Current guidelines and case reports propose that a large bolus of lipid at the earliest signs of toxicity may prevent cardiovascular collapse.SummaryAs the obstetric demographic becomes older and more obese, new technologies and strategies can assist in controlling maternal death and major morbidity secondary to anesthesia complications. Lipid resuscitation appears to be an effective treatment for toxicity induced by lipophilic medications and may be useful in treating systemic toxicity in the pregnant patient. Obstetric care providers should be aware of lipid resuscitation and consider its use as described by American Society of Regional Anesthesia and Pain Medicine guidelines.