8/9/2023 0 Comments Midazolam antidote![]() ![]() Delayed-onset LAST may be harder to diagnose because it's not obviously temporally linked to anesthetic administration and clinically it may evolve in a more gradual fashion.ii) Due to accumulation following a continuous infusion of local or systemic medication (e.g., intravenous lidocaine infusion).This may occur several hours after administration. i) Due to gradual systemic absorption, following a single administration of local anesthetic. ![]() LAST can occur within minutes of local anesthetic administration (due to inadvertent intravenous administration).At a large center which performs lots of nerve blocks, LAST is an event which will occasionally occur.Overall, nerve blocks are a very safe procedure (often safer than the use of systemic analgesics).( 33426662) This creates an interesting duality: LAST has an incidence of roughly one per thousand nerve blocks.Large-volume, subcutaneous administration (e.g., to facilitate liposuction).Mucosal administration (e.g., bronchoscopy or awake intubation).Bupivacaine has greater risks than ropivacaine or lidocaine.Placement of catheter for prolonged anesthetic infusion.High-volume blocks, with doses approaching the maximal safe dose range (see table below).Mitochondrial diseases, carnitine deficiency.Pregnancy (hyperdynamic circulation may accelerate systemic absorption following nerve blocks reduced concentration of alpha-1 acid glycoprotein leads to higher free drug levels).Low muscle mass (e.g., older age, cachexia).Renal dysfunction: Uremia and acidosis may increase free drug levels, exacerbating toxicity.Cardiac dysfunction: Reduced cardiac reserve function may render LAST more dangerous (e.g., patients with severe chronic systolic heart failure or underlying conduction disease).Clearance rate is most relevant if the agent is slowly absorbed, administered in multiple doses, or provided as a continuous infusion. Hepatic dysfunction: Most anesthetics are hepatically cleared. ![]()
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