Case Report: Bupivacaine Toxicity with Dorsal Penile Block for Circumcision

Portland , OR, USA.
American family physician (Impact Factor: 2.18). 08/2012; 86(3):222.
Source: PubMed
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    • "La prévalence est difficilement estimable car les circoncisions sont très souvent réalisées hors d'un milieu hospitalier par des médecins ou d'autres intervenants. Les cas d'intoxication aux anesthésiques locaux décrits au cours de circoncisions réalisées sous anesthésie locale ou locorégionale sont rares [3] [4] [5], notamment hors du milieu hospitalier. Les signes cliniques neurologiques (troubles sensitifs , crises convulsives, troubles de la conscience, coma) précèdent classiquement les signes cardiaques (troubles du rythme et de la conduction, altération de la fonction ventriculaire , arrêt cardiorespiratoire) et surviennent entre 5 et 30 minutes après l'injection. "
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    ABSTRACT: Local anesthetic intoxication is an uncommon complication of regional anesthesia. We report the case of a 4-month-old infant who presented with generalized tonic-clonic seizure complicated by cardiac arrest secondary to a severe intoxication to local anesthesia. These complications were observed after a bilateral dorsal penile nerve block with lidocaine for circumcision in a non-hospital setting. This report emphasizes the potential risk of local anesthetic systemic toxicity in such circumstances and describes its treatment. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
    Full-text · Article · Nov 2014 · Archives de Pédiatrie
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    ABSTRACT: Local anesthetics continue to be used to achieve anesthesia and analgesia via a wide range of routes of administration. This review of relevant 2010 publications covers adverse reactions after brachial plexus anesthesia, caudal, epidural, and spinal (intrathecal) anesthesia, dental anesthesia, infiltration anesthesia, ocular anesthesia, paravertebral anesthesia, and transversus abdominis plane block; there is also a special review on tumescent anesthesia. Some adverse reactions to local anesthetics are specific to certain routes of administration, while others are specific to certain compounds, such as benzocaine, bupivacaine and levobupivacaine, lidocaine, mepivacaine, prilocaine and EMLA (prilocaine + lidocaine), and ropivacaine. Typical adverse reactions related to the route of administration continue to be unintentional spread of the local anesthetic into the intrathecal space, uptake into the systemic circulation, or chondrolysis after intra-articular infusion. Typical adverse reactions related to certain individual compounds are methemoglobinemia after the use of benzocaine and prilocaine and cardiotoxicity with bupivacaine. The successful use of lipid solutions to treat systemic toxicity of local anesthetics continues to be reported. True allergic reactions to local anesthetics are rare.
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    ABSTRACT: Pediatric patients often undergo anesthesia for ambulatory procedures. This article discusses several common preoperative dilemmas, including whether to postpone anesthesia when a child has an upper respiratory infection, whether to test young women for pregnancy, which children require overnight admission for apnea monitoring, and the effectiveness of nonpharmacological techniques for reducing anxiety. Medication issues covered include the risks of anesthetic agents in children with undiagnosed weakness, the use of remifentanil for tracheal intubation, and perioperative dosing of rectal acetaminophen. The relative merits of caudal and dorsal penile nerve block for pain after circumcision are also discussed.
    No preview · Article · Jun 2014 · Anesthesiology Clinics


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