Toxicidade de anestésicos locais na prática clínica

Abstract

Local anesthetics (LAs) are essential for most invasive procedures. This study aimed to evaluate the various systemic problems due to the indistinct use of LAs. Were used following sources: electronic databases such as PUBMED, MEDLINE, LILACS and BBO, articles in books and periodicals published between the years 2005 to 2012. The descriptors were used: local anesthetics, toxicity, adverse effects and systemic complications. Among the most frequent systemic complications, the effects have been reported in the central nervous system (CNS) and cardiovascular (CVS). Toxic levels of LAs in the CNS is the clinical manifestation of primary generalized tonic-clonic seizures, and result in widespread depression of both systems. CVS-level, the LAs can cause bradycardia and hypotension. Opposing the LAs, sympathomimetic vasoconstictor generate excitatory effects, which intensify in joining the endogenous catecholamines. Can occur even hypersensitivity reactions or hematologic. True anaphylaxis occur mainly in LAs ester type. Furthermore, methylparaben and sodium bisulfite included in the cartridge of LAs are often generated sensitization. The most common hematological abnormality is methemoglobinemia. According to literature, the LAs are safe drugs, but it is necessary expertise in anesthetic technique, dose titration and knowledge about the care needed for their use.