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- Pharmacology/Anesthesiology
- Lipid Emulsion in the Successful Resuscitation of Local Anesthetic Toxicity after Ankle Block
- Sang Hee Park, Sang Hyun Kwak, Kyung Yeon Yoo, Hyun Jung Lee, Keun Bae Yook, Seok Jai Kim
- Korean J Crit Care Med. 2014;29(3):234-236. Published online August 31, 2014
- DOI: https://doi.org/10.4266/kjccm.2014.29.3.234
- 6,422 View
- 96 Download
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Abstract
PDF - Unexpected occurrence of local anesthetic toxicity is not rare and can cause fatal complications that do not respond to any known drug of intervention. Recently, the successful use of lipid emulsion for local anesthetic toxicity has been reported and recommended as a rescue method for cardiac or neurologic complications. We report a case of seizure attack and respiratory arrest successfully recovered with the use of intravenous lipid emulsion. Clinicians must be aware of the beneficial role of lipid emulsion in cases of local anesthetic toxicity.
Original Articles
- Endobronchial Insufflation of Air Supports Ventilation in Apneic Dogs
- Ji Han Rhyu, Sun Gyoo Park
- Korean J Crit Care Med. 1998;13(2):198-204.
- 1,426 View
- 4 Download
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Abstract
PDF
- BACKGOUND: Mass casualties from organophosphorus inhalation die from respiratory depression. Gas supplies and equipment are limited for mechanical ventilation of multiple subjects in emergency situation. Endobronchial insufflation of air (EIA) can be simply performed with air compressor and catheter. The author tried to examine the usefulness of EIA in five apneic dogs induced by tetrodotoxin (TTX) infusion.
METHOD
Five anesthetized dogs were intubated with endotracheal tube and endobronchial insufflation catheter and instrumented with arterial catheter and ventilated with controlled mechanical ventilation (CMV) while 12 microgram/kg TTX was infused intravenous over 90 minutes to produce apnea. EIA of 1 microliter/kg/min was delivered through a 35 cm long, 0.8 cm ID catheter with a forked end placed astride the carina. During conventional ventilation, arterial blood gases and pH were measured (base line, BL). The data were measured after confirmation of apnea for 1 minute (time=0, control value), and then measured serially for 4 hours of EIA.
RESULT
All animals survived and were alert and neurologically normal within 24 hours. The changes of arterial oxygen tension (PaO2) were no significant difference between control value and 10, 20, 30 minute (p<0.05), and arterial carbon dioxide tension (PaCO2) were significant increase in control value compared to base line (p<0.05), and pH were no significant difference in all values (p<0.05). Spontaneous respiratory efforts slowly returned after 45 minute of EIA and resulted in the improvement of gas exchange.
CONCLUSION
EIA recognized as a sort of ventilatory technique is useful only when other equipments could not be available. The EIA catheter can be placed by cricothyroidotomy. EIA is very helpful in supporting ventilation, and it also helps the apneic dogs stay in normal condition.
- The Effects of Repeated Toluene Exposure on Amino Acid Neurotransmitters in the Rat Brain
- Hae Kyu Kim, Seung Kyung Baeck, Sie Jeong Ryu, Inn Se Kim
- Korean J Crit Care Med. 1998;13(1):33-42.
- 1,529 View
- 10 Download
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Abstract
PDF
- Introduction: It was aimed to investigate the effect of chronic toluene exposure on amino acid neurotransmitters in the rat brain, corpus striatum.
METHODS
Twenty four male Sprague-Dawley rats were divided into one of three groups, control, acute, and chronic. Each groups was for the microdialysis to estimate the changes of amino acid neurotransmitters, aspartate, glutamate, and citrulline before, during, and after 3,000 ppm toluene exposure for 2 hours.
RESULTS
The results were as follows; 1) Aspartate and glutamate concentration were generally decreased in the toluene inhalation groups compared with the control group and more significantly decreased in chronic inhalation group than other groups. 2) Citrulline that expressed the activity of nitric oxide synthase and taurine as an inhibitory amino acid showed no significant differences between all groups. Based on these results, it is suggested that the decreasing excitatory amino acids, aspartate and glutamate, are partly contributed to the toxic mechanisms of toluene in rat brain.
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