{"id":8786,"date":"2019-02-04T04:23:25","date_gmt":"2019-02-04T03:23:25","guid":{"rendered":"http:\/\/news-papers.eu\/?p=8786"},"modified":"2019-01-02T18:05:03","modified_gmt":"2019-01-02T17:05:03","slug":"8786-2","status":"publish","type":"post","link":"http:\/\/news-papers.eu\/?p=8786","title":{"rendered":"Lokal Anesthetic Systemic Toxicity (LAST)"},"content":{"rendered":"<p><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"8790\" data-permalink=\"http:\/\/news-papers.eu\/?attachment_id=8790\" data-orig-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/02\/Gift.png?fit=1280%2C1127\" data-orig-size=\"1280,1127\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Gift\" data-image-description=\"\" data-image-caption=\"\" data-medium-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/02\/Gift.png?fit=300%2C264\" data-large-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/02\/Gift.png?fit=1024%2C902\" class=\"size-medium wp-image-8790 alignright\" src=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/02\/Gift.png?resize=300%2C264\" alt=\"\" width=\"300\" height=\"264\" srcset=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/02\/Gift.png?resize=300%2C264 300w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/02\/Gift.png?resize=768%2C676 768w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/02\/Gift.png?resize=1024%2C902 1024w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/02\/Gift.png?resize=750%2C660 750w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/02\/Gift.png?w=1280 1280w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/>Ein Beitrag von Dr. Wolfgang Keul, Schweiz zu Lokalan\u00e4thesitika-Intoxikation (<strong>L<\/strong>okal <strong>A<\/strong>nesthetic <strong>S<\/strong>ystemic <strong>T<\/strong>oxicity (LAST):<\/p>\n<blockquote><p><strong>Neal JM, et al.\u00a0The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity Executive Summary 2017. Regional Anesthesia and Pain Medicine 2018; 43: 113-123<\/strong><\/p><\/blockquote>\n<p><strong>Kurzzusammenfassung &#8211; Lokalan\u00e4sthesitika (LA) -\u00dcberdosierung<\/strong><\/p>\n<p><strong>Symptome:\u00a0<\/strong><\/p>\n<ul>\n<li><strong>Neurologisch:\u00a0<\/strong>ZNS Erregung (Unruhe, H\u00f6rminderung, metallischer Geschmack ) &gt;&gt; Krampfanf\u00e4lle &gt;&gt; Bewusstlosigkeit und Atemstillstand.<\/li>\n<li><strong>Kardiovaskul\u00e4r:\u00a0<\/strong>Hypertension, Tachycardie,\u00a0 ventricul\u00e4re\u00a0Arrhythmien &gt;&gt; Bradycardie, Hypotonie, AV- Block, Asystolie.<\/li>\n<\/ul>\n<p>Neurologische und kardiovaskul\u00e4re Symptome k\u00f6nnen gemeinsam oder isoliert, sofort nach Injektion oder verz\u00f6gert (bis &gt; 60min) auftreten!<\/p>\n<p><strong>Therapie:<\/strong><\/p>\n<ol>\n<li style=\"text-align: justify;\"><strong>Atemwegsmanagement:\u00a0<\/strong>Bei Atemst\u00f6rung fr\u00fchzeitige <strong>Intubation und ad\u00e4quate Ventilation,\u00a0<\/strong>um Azidose und intrazellul\u00e4re Anreicherung der LA-Molek\u00fcle zu vermindern.<\/li>\n<li><strong>Lipidemulsion 20%\u00a0<\/strong><strong>sofort nach Symptombeginn:<\/strong><\/li>\n<\/ol>\n<table style=\"height: 474px;\" width=\"650\">\n<tbody>\n<tr>\n<td width=\"114\"><\/td>\n<td width=\"149\"><strong>&lt;70kg<\/strong><\/td>\n<td width=\"167\"><strong>&gt;70kg<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"114\"><strong>Initialbolus<\/strong><\/td>\n<td width=\"149\">1,5 ml\/kg \u00fcber 2-3 min<\/td>\n<td width=\"167\">100 ml \u00fcber 2-3 min<\/td>\n<\/tr>\n<tr>\n<td width=\"114\"><strong>Folgeinfusion<\/strong><\/td>\n<td width=\"149\">0,25 ml\/kg\/min<\/td>\n<td width=\"167\">200-250 ml \u00fcber 15-20min<\/td>\n<\/tr>\n<tr>\n<td width=\"114\"><strong>Dosissteigerung<\/strong><\/td>\n<td colspan=\"2\" width=\"316\">Falls keine Stabilsierung: Bolus wiederholen oder<br \/>\nInfusion auf 0,5 ml\/kg\/min steigern<\/td>\n<\/tr>\n<tr>\n<td width=\"114\"><strong>Infusionssdauer<\/strong><\/td>\n<td colspan=\"2\" width=\"316\">Bis mindestens 10 min nach Stabilisierung<\/td>\n<\/tr>\n<tr>\n<td width=\"114\"><strong>Maximaldosis<\/strong><\/td>\n<td colspan=\"2\" width=\"316\">12 ml\/kg<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ol start=\"3\">\n<li>Bei\u00a0<strong>Krampfanf\u00e4llen: <\/strong>Benzodiazepin\u00a0Boli, ggf. Relaxation, um Azidose zu vermindern Anm: Das Abklingen der Krampfanf\u00e4lle kann auch nach Relaxation mit der EEG Kurve des BIS monitorisiert werden).<\/li>\n<li>Bei\u00a0<strong>ventrikul\u00e4ren Arrhythmien:\u00a0<\/strong>Amiodaron Boli<\/li>\n<li>Bei\u00a0<strong>Kreislaufstillstand:\u00a0<\/strong>Standardreanimation, aber mit kleinen Dosen Adrenalin (&lt;1 ug\/kg) beginnen<\/li>\n<li>Bei\u00a0<strong>Erfolglosigkeit der Reanimation: <\/strong>Herz-Lungen-Maschine anschliessen (fr\u00fchzeitig planen)<\/li>\n<\/ol>\n<p>Weiter Informationen finden Sie bei:<\/p>\n<blockquote>\n<p style=\"text-align: justify;\"><strong>Zink W et al.,\u00a0Klinische Anwendung und Toxizit\u00e4t von Lokalan\u00e4sthetika.\u00a0An\u00e4sth Intensivmed 2018;59:716-728 (<a href=\"https:\/\/www.ai-online.info\/aionline\/;jsessionid=4A40E3CB0B4EF82F6885E6A4FA9C8B09?wicket:interface=:1:1:::\" target=\"_blank\" rel=\"noopener\">PDF<\/a>)<\/strong><\/p>\n<\/blockquote>\n<h6 style=\"text-align: justify;\">F\u00fcr Angaben \u00fcber Dosierungsanweisungen und\u00a0Applikationsformen kann keine\u00a0Gew\u00e4hr \u00fcbernommen werden. Jeder Benutzer ist\u00a0angehalten, durch sorgf\u00e4ltige Pr\u00fcfung der Beipackzettel\u00a0der verwendeten Pr\u00e4parate und gegebenenfalls\u00a0nach Konsultation eines Spezialisten festzustellen,\u00a0ob die in diesem Blog gegebenen Empfehlung f\u00fcr Dosierungen\u00a0oder die Beachtung von Kontraindikationen gegen\u00fcber\u00a0der Angabe in diesem Blog\u00a0abweicht. Eine\u00a0solche Pr\u00fcfung ist besonders wichtig bei selten verwendeten\u00a0Pr\u00e4paraten oder solchen, die neu auf den\u00a0Markt gebracht worden sind. Jede Dosierung oder\u00a0Applikation erfolgt auf eigene Gefahr des Benutzers. Wir\u00a0appellieren an jeden Benutzer\u00a0etwa auffallende Ungenauigkeiten uns\u00a0mitzuteilen.<\/h6>\n","protected":false},"excerpt":{"rendered":"<p>Ein Beitrag von Dr. Wolfgang Keul, Schweiz zu Lokalan\u00e4thesitika-Intoxikation (Lokal Anesthetic Systemic Toxicity (LAST): Neal JM, et al.\u00a0The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":8790,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"__cvm_playback_settings":[],"__cvm_video_id":"","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[14],"tags":[191,1581],"class_list":["post-8786","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-intoxikationen","tag-intoxikation","tag-lokalanaesthestika"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/02\/Gift.png?fit=1280%2C1127","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p7fR2g-2hI","jetpack-related-posts":[{"id":10744,"url":"http:\/\/news-papers.eu\/?p=10744","url_meta":{"origin":8786,"position":0},"title":"R\u00fcckblick auf news-papers.eu (Teil 2)","author":"Michael Bernhard","date":"Januar 2, 2020","format":false,"excerpt":"Gestern haben wir Euch den ersten Teil unseres Jahresr\u00fcckblicks pr\u00e4sentiert. 2019 war ein wissenschaftlich interessantes und spannendes Jahr, deshalb haben wir einen R\u00fcckblick der vergangenen Beitr\u00e4ge auf NEWS-PAPERS.EU\u00a0zusammengestellt und wegen der F\u00fclle auf zwei Posts verteilt. 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Was aber machen bei einer 60 kg Patienten mit 8 g Paracetamol? Die Antwort liefert ToxDocs in einer zweiteiligen Serie: Paracetamol Intoxikation Teil 1 Paracetamol Intoxikation Teil 2 Viel Spass\u2026","rel":"","context":"In &quot;Intoxikationen&quot;","block_context":{"text":"Intoxikationen","link":"http:\/\/news-papers.eu\/?cat=14"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/03\/Tabletten.png?fit=873%2C577&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/03\/Tabletten.png?fit=873%2C577&resize=350%2C200 1x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/03\/Tabletten.png?fit=873%2C577&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/03\/Tabletten.png?fit=873%2C577&resize=700%2C400 2x"},"classes":[]},{"id":3559,"url":"http:\/\/news-papers.eu\/?p=3559","url_meta":{"origin":8786,"position":2},"title":"Intoxikation mit Kalziumkanalblocker bei #dasFOAM und #FOAMina","author":"Michael Bernhard","date":"Januar 14, 2017","format":false,"excerpt":"Die Kollegen von #dasFOAM und #FOAMina haben interessante Beitr\u00e4ge zur Intoxikation mit Calciumkanalblockern gepostet. 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J Cardiothorac Vasc Anesth 2016. In press. Epidemiologie: das\u2026","rel":"","context":"In &quot;Gef\u00e4\u00dfnotfall&quot;","block_context":{"text":"Gef\u00e4\u00dfnotfall","link":"http:\/\/news-papers.eu\/?cat=706"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/01\/Bildschirmfoto-2016-12-06-um-08.15.20.png?fit=1191%2C892&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/01\/Bildschirmfoto-2016-12-06-um-08.15.20.png?fit=1191%2C892&resize=350%2C200 1x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/01\/Bildschirmfoto-2016-12-06-um-08.15.20.png?fit=1191%2C892&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/01\/Bildschirmfoto-2016-12-06-um-08.15.20.png?fit=1191%2C892&resize=700%2C400 2x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/01\/Bildschirmfoto-2016-12-06-um-08.15.20.png?fit=1191%2C892&resize=1050%2C600 3x"},"classes":[]},{"id":4784,"url":"http:\/\/news-papers.eu\/?p=4784","url_meta":{"origin":8786,"position":4},"title":"Unklare Vigilanzst\u00f6rung &#8211; Was tun ?","author":"Michael Bernhard","date":"Juli 17, 2017","format":false,"excerpt":"Im Canadian Journal of Emergency Medicine publizierten Laurence Carlier\u00a0aus Belgien einen sehr interssanten Fall, der hier kurz zusammengefasst werden soll: Carlier L et al., Gamma-hydroxybutyrate (GHB), an unusual cause\u00a0of high anion gap metabolic acidosis. 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