local anesthetic poisoning
Introduction
Introduction to local anesthetic poisoning Local anesthetics include procaine, cocaine, lidocaine, marcaine, carbocaine, prilocaine, etc. The nervous system acts as an inhibitor, but when it is poisoned, it can cause central nervous system excitation, cardiac inhibition, vasodilation, etc., and symptoms appear. In recent years, when pregnant women give birth, they often use some kind of local anesthetic analgesia. These drugs can be absorbed by the mother to pass the placenta and cause neonatal poisoning. If the cause is used for fistula block or peri-cervical anesthesia, careless Injecting local anesthetics into the fetus can cause serious poisoning symptoms in newborn babies. In the liver of newborn babies, kidney development is not yet mature, and the metabolism and excretion functions of these drugs are very poor. basic knowledge Sickness ratio: 0.002%-0.004% Susceptible people: old, young, infirm Mode of infection: non-infectious Complications: syncope, dehydration
Cause
Cause of local anesthetic poisoning
In the delivery of pregnant women, the above-mentioned local anesthetic is often used for analgesia. These drugs can be absorbed by the mother to pass the placenta and cause neonatal poisoning. When the cause is used for fistula block or peri-cervical anesthesia, the local anesthetic is inadvertently used. Injection into the fetus can cause severe poisoning symptoms in newborn babies. The liver and kidney development of newborn babies are not yet mature, and the metabolism and excretion functions of these drugs are very poor.
Prevention
Local anesthetic poisoning prevention
In addition to due to variety, drug resistance, allergic reactions, are related to dosage, so elderly, young, infirm, should be cautious, try to apply small doses first, and then continue to apply the full amount after no serious reaction; It should also be observed whether there is an allergic reaction to rash, urticaria, facial edema, and lip edema after administration. The duration of medication should not be too long, and a local pain. The symptoms of pruritus are relieved and should be discontinued. If administered systemically, its effects not only affect the central nervous system, but also the function of the heart, skeletal muscles and smooth muscles. It can cause poisoning and death when overdose.
Complication
Local anesthetic poisoning complications Complications
Adverse reactions of local anesthetics
(1) Toxic reaction
Toxic reactions are called when the concentration of local anesthetic in the blood reaches or exceeds various excitations or inhibits clinical symptoms of the central nervous system. According to different clinical manifestations, the toxic reactions can be divided into two categories, namely, excitatory and inhibitory.
The clinical manifestations of mild excitability are stressful, multilingual, and may be accompanied by mild heart rate. Those with a higher degree may complain of shortness of breath or even suffocation, but there is no significant change in respiratory rate and depth.
(2) Hypersensitivity response
Low-dose local anesthetics, that is, those with toxic reactions, are called hypersensitivity reactions. Its characteristics are that the dose and symptoms are extremely disproportionate, and the clinical manifestations are more acute. In addition to the symptoms and signs of general toxic reactions, syncope, respiratory depression and circulatory collapse can also occur suddenly. Hypersensitivity reactions are often associated with the patient's pathophysiological status and the effects of the surrounding environment, such as dehydration, acid-base imbalance, infection and hyperthermia are all factors that contribute to high-sensitivity reactions.
(3) Idiosyncratic response
A very small dose of local anesthetic is a serious toxic reaction, called the idiosyncratic reaction, clinical manifestations of convulsions, wheezing, panic sensation and even collapse.
(4) Allergic reactions are also called allergic reactions.
It means that the patient has used some kind of local anesthetic in the past without adverse reactions, and when the drug is used again, it has a serious reaction.
Symptom
Symptoms of local anesthetic poisoning Common symptoms Dizziness, coma, shock, eyelids, head reflexes, disappearance, slow muscle tone, reduced power, light reflection, disappearance
Toxic reactions are called when the concentration of local anesthetic in the blood reaches or exceeds various excitations or inhibits clinical symptoms of the central nervous system. According to different clinical manifestations, the toxic reactions can be divided into two categories, namely, excitatory and inhibitory. The clinical manifestations of mild excitability are stressful, multilingual, and may be accompanied by mild heart rate. Those with a higher degree may complain of shortness of breath or even suffocation, but there is no significant change in respiratory rate and depth.
When local anesthetic poisoning occurs during childbirth, the child develops dizziness, vomiting, convulsions, convulsions, coma, shock, etc., and even death. Promethazine poisoning can cause methemoglobinemia.
The main clinical manifestations of local anesthetic poisoning in newborn babies are respiratory weakness or asphyxia, bradycardia, and decreased muscle tone; common convulsions, dilated pupils, slow or disappeared light response, and disappeared eye-head reflexes. The above symptoms are generally after birth 6 Within 12 hours, some newborns can occur immediately after birth. Most of the seizures are strong and straight, and a few are clonic-strength.
In addition, newborns due to hypoxemia caused by encephalopathy, often after 12 to 24 hours of birth, similar symptoms, so if the mother has a history of injection of local anesthetics, and newborns in the early postnatal period, pupil dilation, light reflection Disappeared, eye-head reflex disappeared, etc., and there are still the above signs after resuscitation, which is highly suggestive of local anesthetic poisoning. Sometimes, puncture marks are found in the scalp of the sick baby, and a small amount of liquid medicine can be sucked in the part.
Examine
Local anesthetic poisoning test
The main clinical manifestations of local anesthetic poisoning in newborn babies are respiratory weakness or asphyxia, bradycardia, and decreased muscle tone; common convulsions, dilated pupils, slow or disappeared light response, and disappeared eye-head reflexes. The above symptoms are generally after birth 6 Within 12 hours, some newborns can occur immediately after birth. Most of the seizures are strong and straight, and a few are clonic-strength.
In addition, newborns due to hypoxemia caused by encephalopathy, often after 12 to 24 hours of birth, similar symptoms, so if the mother has a history of injection of local anesthetics, and newborns in the early postnatal period, pupil dilation, light reflection Disappeared, eye-head reflex disappeared, etc., and there are still the above signs after resuscitation, which is highly suggestive of local anesthetic poisoning. Sometimes, puncture marks are found in the scalp of the sick baby, and a small amount of liquid medicine can be sucked in the part.
Diagnosis
Diagnosis and identification of local anesthetic poisoning
diagnosis
Diagnosis can be based on symptoms and medication history.
Differential diagnosis
The essence of ether poisoning ether is mainly used for surgical anesthesia in clinic. It is an ancient and safe and effective general anesthetic. Its acute poisoning is mainly caused by excessive inhalation. The clinical manifestations of clinically seen a large amount of ether inhalation cause paralysis. Because it is not taken seriously, it does not find that the breathing has a shallow speed, shallow slowness, sobbing or sighing changes, not paying attention to exhalation and inhalation, which have a more frequent pause and a rhythm of respiratory arrest such as rhythm disorder. Due to the high concentration of time, timely detection and effective measures can be taken, which can lead to serious consequences.
Thiopental poisoning thiopental sodium, also known as sodium pentothiopyrazine, pan permeable, is a short-acting barbiturate type of bar, clinically used for short-term surgery, usually used 1%-25% solution, one dose is 0,5g is 1.0g/time, thiopental is strong alkaline, intravenous injection if the liquid leaks out of the blood vessel or the outer skin, easy to organize necrosis, vein The injection should be slow to avoid central inhibition leading to apnea, severe anemia for severe acidosis, heart disease, hypokalemia, shock, bronchial asthma, apnea, severe anemia, severe anemia, heart disease, hypotension, shock Patients with bronchial asthma should be used with caution or avoidance to avoid poisoning.
Cocaine poisoning cocaine, also known as cocaine, this drug was originally proposed from the coca leaves, is an alkaloid, later synthetic, is an ester of amino acids and aromatic acids, clinically mainly used for surface anesthetics, for Eye, nasopharyngeal surgery, in addition, there are procaine, dicaine, lidocaine and cacaine, the chemical structure is similar to cocaine.
