J Dent Anesth Pain Med.  2019 Aug;19(4):181-189. 10.17245/jdapm.2019.19.4.181.

Lipid emulsion therapy of local anesthetic systemic toxicity due to dental anesthesia

• Rhee SH
• Park SH
• Ryoo SH
• Karm MH

• KMID: 2456009
• DOI: http://doi.org/10.17245/jdapm.2019.19.4.181

Abstract

Local anesthetic systemic toxicity (LAST) refers to the complication affecting the central nervous system (CNS) and cardiovascular system (CVS) due to the overdose of local anesthesia. Its reported prevalence is 0.27/1000, and the representative symptoms range from dizziness to unconsciousness in the CNS and from arrhythmias to cardiac arrest in the CVS. Predisposing factors of LAST include extremes of age, pregnancy, renal disease, cardiac disease, hepatic dysfunction, and drug-associated factors. To prevent the LAST, it is necessary to recognize the risk factors for each patient, choose a safe drug and dose of local anesthesia, use vasoconstrictor , confirm aspiration and use incremental injection techniques. According to the treatment guidelines for LAST, immediate application of lipid emulsion plays an important role. Although lipid emulsion is commonly used for parenteral nutrition, it has recently been widely used as a non-specific antidote for various types of drug toxicity, such as LAST treatment. According to the recently published guidelines, 20% lipid emulsion is to be intravenously injected at 1.5 mL/kg. After bolus injection, 15 mL/kg/h of lipid emulsion is to be continuously injected for LAST. However, caution must be observed for >1000 mL of injection, which is the maximum dose. We reviewed the incidence, mechanism, prevention, and treatment guidelines, and a serious complication of LAST occurring due to dental anesthesia. Furthermore, we introduced lipid emulsion that has recently been in the spotlight as the therapeutic strategy for LAST.

Keyword

Dental Anesthesia; Lipid Emulsions; Local Anesthetic Systemic Toxicity

MeSH Terms

Anesthesia, Dental*
Anesthesia, Local
Arrhythmias, Cardiac
Cardiovascular System
Causality
Central Nervous System
Dizziness
Drug-Related Side Effects and Adverse Reactions
Heart Arrest
Heart Diseases
Humans
Incidence
Parenteral Nutrition
Pregnancy
Prevalence
Risk Factors
Unconsciousness

Figure

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  Fig. 1 Systemic presentation of local anesthetic systemic toxicity (CVS: Cardiovascular system; CNS: Central nervous system)

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  Fig. 2 Safety guidelines by the Association of Anaesthetists of Great Britain and Ireland, 2010 (IV: Intravenous)

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