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Complex of action directed on the prevention of local anesthetic toxicity regional anesthesia in dogs
In article clinical signs of spinal injection are investigated by a method of median access that gives the chance correctly differentiate necessary for input local anesthetic space and to execute anaesthesia of the necessary department of a backbone.
Features of influence on organism cardiotoxicity actions of lidocaine and bupivacaine are described. So occurrence of clinical signs was preceded by changes on the electrocardiogram. The analysis of changes of an electrocardiogram characterised features of a current cardiotoxicity local anesthetic. At spinal application of lidocaine it was observed: AV-conductivity delay (lengthening of interval P–Q), paroxysmal tachycardia (reduction of intervals R–R, deformation of tooth P), AV-blockade of II degree (lengthening of complex QRS, periodic loss of complex QRST).
Bupivacaine showed strong cardiotoxicity action, namely: infringement atrioventricular conductivity (reduction of interval P–Q that is connected with a syndrome of premature excitation ventricular), ventricular paroxysmal tachycardia (reduction of interval R–R, deformation and expansion of complex QRS with discordant an arrangement of segment RS–T and tooth T), sinoatrial blockade (periodic loss of separate warm cycles: teeth P and complexes QRST), and then full AV-blockade (tooth P is not connected with complex QRST). The above-stated changes quite often led to fibrillation ventricular hearts (various on amplitude, the form and the duration, wide waves passing each other behind fluctuations).
Describe harbingers and clinical signs of local anesthetic toxicity which noticed behind indicators of the resuscitative-surgical monitor: expansion, lengthening or losses of complex QRST, changes of intervals P–Q, R–R, P–T, deformation of tooth P.
Monitoring of clinical indicators of a life-support systems condition is carried out at reanimation. So changes on the monitor were quite often accompanied by simultaneous changes in the central nervous system: nistagm, anxiety, vocalisation, reduction of obverse muscles, time lengthening perfusion fabrics (haemodynamics infringement). Breath became frequent, superficial with possible apnoe or even a full stop.
Local anesthetic toxicity the last possibly caused by high concentration in blood that is caused by a casual intravenous injection, overdose, or fast absorption in strong vascularized fabrics (soft and arachnoid covers the dense vascular grid of a web cover, presence "venous textures – rings" at level of each vertebra) is local nontight for medicinal substances.
The presented algorithm of carrying out of actions of the consequences of an intoxication directed on prevention local anesthetic at performance of techniques regional anesthesia with epidural, spinal (subdural, subarachnoid) and casual intravascular introduction of the last. The specified safe doses amide local anesthetic.
It is investigated that addition to the standard scheme reanimation (oxygen therapy the humidified oxygen mix, necessarily artificial lung ventilators with the help a bear of Ambu, introduction every 5 minutes 0,1% of a solution of adrenaline of a hydrochloride in a dose of weight of a body of 0,01 mg/kg (at heart fibrillation), intravenous introduction of 0,1% of a solution of atropine of sulphate in a dose of weight of a body of 0,05 mg/kg (at a bradycardia), at occurrence hypovolemia – infusion by a physical solution) with the introduction of lipid rescue therapy (20% a solution intralipid in the maximum dose of 2 g/kg, thus on one bolus introduction no more than 0,3 g/kg of weight of a body at injection through intravenous infusion cannula is decided in jugular vein) and reduction of the general dose local anesthetic (2% a lidocaine solution in a dose of 5 mg/kg or 0,5% bupivacaine in a dose of weight of a body of 2,3 mg/kg) has not broken work of cardiovascular system, has led to loading decrease on system of breath and avoidance of excitation of the central nervous system, it was reflected in reduction of duration of spasms. In groups where applied fatty lipid emulsion (intralipid) it was possible to prevent cardiotoxicity influence aforementioned local anesthetic. Thus, level cardiotoxicity bupivacaine has considerably decreased that is possibly caused by the best lipophilic anesthetic longer action – bupivacaine.
The specified optimum points spinal injection at performance regional anesthesia. So at simultaneous epidural and subdural introduction local anesthetic in lumbar sacral region of the spine, namely between vertebras L4–L5 and L7–S1 it was necessary to reach the minimum loading on life-support systems of an organism of a dog.
The further researches in this direction will allow to optimise reanimation at occurrence of an intoxication owing to local anesthetic overdose.
Key words: bupivacaine, lidocaine, intralipid, an intoxication, reanimation.
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