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ASRA PRACTICE ADVISORY ON LOCAL ANESTHETIC SYSTEMIC TOXICITY
Local Anesthetic Systemic Toxicity: A Historical Perspective
  1. Kenneth Drasner, MD
  1. From the University of California, San Francisco, CA.
  1. Address correspondence to: Kenneth Drasner, MD, University of California, San Francisco, San Francisco General Hospital, Room 3C-38, San Francisco, CA 94110 (e-mail: kdrasner{at}anesthesia.ucsf.edu).

Abstract

The most feared complication associated with the administration of local anesthetics is the profound and potentially lethal effect that these agents can have on cardiac conduction and function. This review traces the evolution of local anesthetic systemic toxicity beginning with the early deaths associated with the introduction of cocaine into clinical practice. The development of bupivacaine is discussed, with particular emphasis on the delayed recognition and acceptance of its inherent cardiotoxicity. Finally, the origins of lipid resuscitation are reviewed with respect to their theoretical foundation, as well as the confluence of events and experimental investigations that delivered this therapy into clinical practice.

https://doi.org/10.1097/AAP.0b013e3181d2306c

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    Footnotes

    • Presented in part as a component of the ASRA Taskforce on Local Anesthetic Systemic Toxicity at the ASRA Annual Meeting, May 2008, Cancun, Mexico.