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Alexandre J, Humbert X, Sassier M, Cesbron A, Le Naourès C, Pottier V, Puddu PE, Milliez P, Coquerel A, Fedrizzi S. Cardiac arrests associated with low plasma and tissue levels of local anaesthetics. Therapie 2023; 78:S81-S84. [PMID: 27839711 DOI: 10.2515/therapie/2015056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 07/24/2015] [Indexed: 11/20/2022]
Affiliation(s)
- Joachim Alexandre
- CHU de Caen, Department of Pharmacology, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 9, France; Université de Caen Basse-Normandie, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14032 Caen, France; Université de Caen Basse-Normandie, Medical School, 14032 Caen, France
| | - Xavier Humbert
- CHU de Caen, Department of General Medicine, 14033 Caen, France
| | - Marion Sassier
- CHU de Caen, Department of Pharmacology, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 9, France
| | - Alexandre Cesbron
- CHU de Caen, Department of Pharmacology, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 9, France
| | | | | | - Paolo-Emilio Puddu
- Department of Cardiovascular Sciences, Sapienza University, 00185 Roma, Italy
| | - Paul Milliez
- Université de Caen Basse-Normandie, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14032 Caen, France; Université de Caen Basse-Normandie, Medical School, 14032 Caen, France; CHU de Caen, Department of Cardiology, 14033 Caen, France
| | - Antoine Coquerel
- CHU de Caen, Department of Pharmacology, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 9, France; Université de Caen Basse-Normandie, Medical School, 14032 Caen, France; Université de Caen Basse-Normandie, Inserm U 1075, COMETE, 14032 Caen, France.
| | - Sophie Fedrizzi
- CHU de Caen, Department of Pharmacology, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 9, France
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Orfanidis A, Gika H, Theodoridis G, Chatziioannou AC, Raikos N. Analysis, Stability and Distribution of Pharmaceuticals and Drugs of Abuse over a Period of One Year in Formalin-Fixed Liver and Formalin Solutions. J Anal Toxicol 2023; 47:182-190. [PMID: 35957494 DOI: 10.1093/jat/bkac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/01/2022] [Accepted: 01/12/2023] [Indexed: 11/12/2022] Open
Abstract
The present study reports a thorough research on the stability of drugs of abuse and pharmaceuticals over a time period of 12 months. Fixed-liver tissues and formalin solutions where the tissues were preserved were analyzed using an ultra high performance liquid chromatography--tandem mass spectrometry method that has been developed and validated for this purpose. The method monitors 84 drugs in a 13-minute run. The concentrations of the drugs found were compared with their concentrations determined in the fresh liver tissues in a previous study. In the study, 14 cases with forensic interest were included with the main objective of the analysis and the study of the stability and the distribution of drugs of abuse and pharmaceuticals in the human liver and the formalin solution during preservation. The results showed that the number of detected compounds in the first month was significantly lower than the compounds found in fresh tissues. The effect of formalin was catalytic, and few substances could be detected. Specifically, out of the 86 positive detections of the monitored substances in the fresh tissues (in which 25 different substances were found), only 32 (37%) remained detectable 3 months after, 20 (23%) 6 months after and 15 (17%) 12 months after.
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Affiliation(s)
- Amvrosios Orfanidis
- School of Medicine, Laboratory of Forensic Medicine and Toxicology, Aristotle University of Thessaloniki, University Campus, Thessaloniki 54124, Greece
- Bioanalysis and Omics Lab, Centre for Interdisciplinary Research and Innovation, CIRI-AUTH B1.4, Aristotle University of Thessaloniki, Thermi road, Thessaloniki 57001, Greece
| | - Helen Gika
- School of Medicine, Laboratory of Forensic Medicine and Toxicology, Aristotle University of Thessaloniki, University Campus, Thessaloniki 54124, Greece
- Bioanalysis and Omics Lab, Centre for Interdisciplinary Research and Innovation, CIRI-AUTH B1.4, Aristotle University of Thessaloniki, Thermi road, Thessaloniki 57001, Greece
| | - Georgios Theodoridis
- Department of Chemistry, Laboratory of Analytical Chemistry, Aristotle University of Thessaloniki, University Campus, Thessaloniki 54124, Greece
- Bioanalysis and Omics Lab, Centre for Interdisciplinary Research and Innovation, CIRI-AUTH B1.4, Aristotle University of Thessaloniki, Thermi road, Thessaloniki 57001, Greece
| | | | - Nikolaos Raikos
- School of Medicine, Laboratory of Forensic Medicine and Toxicology, Aristotle University of Thessaloniki, University Campus, Thessaloniki 54124, Greece
- Bioanalysis and Omics Lab, Centre for Interdisciplinary Research and Innovation, CIRI-AUTH B1.4, Aristotle University of Thessaloniki, Thermi road, Thessaloniki 57001, Greece
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Bahar E, Yoon H. Lidocaine: A Local Anesthetic, Its Adverse Effects and Management. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:782. [PMID: 34440986 PMCID: PMC8399637 DOI: 10.3390/medicina57080782] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 01/12/2023]
Abstract
The most widely used medications in dentistry are local anesthetics (LA), especially lidocaine, and the number of recorded adverse allergic responses, particularly of hazardous responses, is quite low. However, allergic reactions can range from moderate to life-threatening, requiring rapid diagnosis and treatment. This article serves as a review to provide information on LA, their adverse reactions, causes, and management.
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Affiliation(s)
| | - Hyonok Yoon
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Gyeongsang National University, Jinju 52828, Korea;
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Santos GFS, Ferreira LO, Gerrits Mattos B, Fidelis EJ, de Souza AS, Batista PS, Manoel CAF, Cabral DAC, Jóia de Mello V, Favacho Lopes DC, Hamoy M. Electrocorticographic description of the effects of anticonvulsant drugs used to treat lidocaine-induced seizures. Brain Behav 2021; 11:e01940. [PMID: 33369278 PMCID: PMC7882171 DOI: 10.1002/brb3.1940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Local anesthetics are widely used in clinical practice. While toxicity is rare, these drugs can cause potentially lethal seizures. OBJECTIVE In the present study, we investigated the electrocorticographic (ECoG) and electromyographic patterns of seizures induced by acute lidocaine (LA) toxicity and treated with anticonvulsant drugs. The study used adult male Wistar rats to describe of the seizure-related behavior of LA and investigated the treatment with anticonvulsant drugs. RESULTS The use of LA resulted in clear changes in the ECoG pattern, which presented characteristics of Status epilepticus, with increased intensity in all brainwaves. The decomposition of the cerebral waves showed an increase in the beta and gamma waves that may be related to tonic-clonic seizure. Although the treatment with anticonvulsants drugs reduces the power of brainwaves at frequencies between 1 and 40 Hz compared to the LA group, but only diazepam (DZP) was able to decrease the intensity of oscillations. The muscle contraction power also indicated a difference in the effectiveness of the three treatments. CONCLUSION The sum of the evidence indicates that LA causes status epilepticus and that DZP is the most effective treatment for the control of these seizures, by restoring the systemic values to levels close to those recorded in the control group.
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Affiliation(s)
- George Francisco S Santos
- Laboratory of the Pharmacology and Toxicology of Natural Products, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | - Luan Oliveira Ferreira
- Laboratory of Experimental Neuropathology, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Brazil
| | - Bruna Gerrits Mattos
- Laboratory of Experimental Neuropathology, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Brazil
| | - Eliniete J Fidelis
- Laboratory of the Pharmacology and Toxicology of Natural Products, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | - Alisson S de Souza
- Laboratory of the Pharmacology and Toxicology of Natural Products, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | - Paula S Batista
- Laboratory of the Pharmacology and Toxicology of Natural Products, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | - Cecilia A F Manoel
- Laboratory of the Pharmacology and Toxicology of Natural Products, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | - Diego Arthur C Cabral
- Laboratory of the Pharmacology and Toxicology of Natural Products, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | - Vanessa Jóia de Mello
- Laboratory of the Pharmacology and Toxicology of Natural Products, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | - Dielly Catrina Favacho Lopes
- Laboratory of Experimental Neuropathology, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Brazil
| | - Moisés Hamoy
- Laboratory of the Pharmacology and Toxicology of Natural Products, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
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Li YK, Lee FT, Lau FL. A Lady with Confusion and Seizure after Ingestion of Lidocaine for Dyspepsia. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790901600109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a 29-year-old lady who developed confusion, agitation and seizure after the ingestion of a self-mixture of 3 grams of lidocaine with antacid for treatment of dyspepsia. She developed two episodes of seizure requiring diazepam, propofol and intubation. There was no significant cardiac toxicity and she was discharged on day 3. This is the first reported adult case of seizure in the literature after intentional ingestion of lidocaine for treatment of dyspepsia. The use of local anaesthetic in gastrointestinal cocktail for dyspepsia and its safety are highlighted. Advances in the management of local anaesthetic overdose are also discussed.
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Affiliation(s)
| | - FT Lee
- United Christian Hospital, Accident & Emergency Department, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong
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Aminiahidashti H, Laali A, Nosrati N, Jahani F. Recurrent seizures after lidocaine ingestion. J Adv Pharm Technol Res 2015; 6:35-7. [PMID: 25709968 PMCID: PMC4330610 DOI: 10.4103/2231-4040.150370] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lidocaine has a concentration-dependent effect on seizures. Concentrations above 15 μg/mL frequently result in seizures in laboratory animals and human. We report a case of central nervous system (CNS) lidocaine toxicity and recurrent seizure after erroneous ingestion of lidocaine solution. A 4-year-old boy presented to the Emergency Department of Imam Hospital of Sari in December 2013 due to tonic-clonic generalized seizures approximately 30 min ago. 3 h before seizure, his mother gave him 2 spoons (amount 20-25 cc) lidocaine hydrochloride 2% solution instead of pediatric gripe by mistake. Seizure with generalized tonic-clonic occurred 3 times in home. Neurological examination was essentially unremarkable except for the depressed level of consciousness. Personal and medical history was unremarkable. There was no evidence of intracranial ischemic or hemorrhagic lesions in computed tomography scan. There were no further seizures, the condition of the patient remained stable, and he was discharged 2 days after admission. The use of viscous lidocaine may result in cardiovascular and CNS toxicity, particularly in children. Conservative management is the best option for treatment of lidocaine induced seizure.
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Affiliation(s)
| | - Abolghasem Laali
- Department of Emergency, Mazandaran University of Medical Sciences, Sari, Iran
| | - Nazanin Nosrati
- Department of Emergency, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Jahani
- Department of Emergency, Mazandaran University of Medical Sciences, Sari, Iran
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Oertel R, Arenz N, Zeitz SG, Pietsch J. Investigations into distribution of lidocaine in human autopsy material. Biomed Chromatogr 2015; 29:1290-6. [DOI: 10.1002/bmc.3419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 10/22/2014] [Accepted: 11/28/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Reinhard Oertel
- Institute of Clinical Pharmacology; TU Dresden; Dresden Germany
| | - Norman Arenz
- Institute of Clinical Pharmacology; TU Dresden; Dresden Germany
| | | | - Jörg Pietsch
- Institute of Legal Medicine; TU Dresden; Dresden Germany
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Lidocaine intoxication in axillary block: similar pharmaceutical form, different concentration. North Clin Istanb 2015; 1:178-181. [PMID: 28058328 PMCID: PMC5175040 DOI: 10.14744/nci.2014.46320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 11/14/2014] [Indexed: 11/30/2022] Open
Abstract
Local anesthetic intoxication is a medical emergency with high mortality. These drugs have not spesific antidotes, quick differential diagnosis and supportive treatment required in the case of exposure to toxic doses. We report the complications and anesthetic management of a patient who was scheduled for right carpal tunnel syndrome surgery under regional anesthesia, but mistakenly received injection of 140 mg procaine added to 10% 10 mL lidocaine (10 mL=1000mg) instead of 2% lidocaine (10mL=200 mg) as part of an axillary plexus blockade.
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Nikolaou P, Papoutsis I, Dona A, Spiliopoulou C, Athanaselis S. Toxicological analysis of formalin-fixed or embalmed tissues: A review. Forensic Sci Int 2013; 233:312-9. [DOI: 10.1016/j.forsciint.2013.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 09/19/2013] [Accepted: 10/05/2013] [Indexed: 11/15/2022]
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Takayasu T. Toxicological Analyses of Medications and Chemicals in Formalin-Fixed Tissues and Formalin Solutions: A Review. J Anal Toxicol 2013; 37:615-21. [DOI: 10.1093/jat/bkt055] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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A case of sudden death after gingival injection of a therapeutic dose of lidocaine: distribution of lidocaine in whole blood and various tissues. Forensic Toxicol 2008. [DOI: 10.1007/s11419-008-0047-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Martínez MA, Ballesteros S, Segura LJ, García M. Reporting a fatality during tumescent liposuction. Forensic Sci Int 2008; 178:e11-6. [PMID: 18343065 DOI: 10.1016/j.forsciint.2008.01.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Revised: 12/10/2007] [Accepted: 01/30/2008] [Indexed: 10/22/2022]
Abstract
Deaths of patients during elective surgery have drawn attention to the danger of anesthesia. Tumescent local anesthesia is subcutaneous infiltration of large volumes of dilute lidocaine with epinephrine to produce vasoconstriction while delivering anesthesia over large areas without lidocaine toxicity. This report documents the case of a 38-year-old woman who attended an outpatient clinic to undergo liposuction of the abdomen and bilateral hips and thighs. According to one witness, around 30 min after anesthesia administration, the victim suffered an episode of tonic-clonic convulsion. When the emergency medical services arrived the patient was in asystole. She died in spite of attempted cardiopulmonary resuscitation. The patient had no significant past medical history including no history of allergies or any known complications with anesthesia. A complete autopsy was performed and possible causes of death such as myocardial infarction, aspiration of food or foreign body, and pulmonary embolism were discarded. Anaphylactic shock was considered a possible but unlikely explanation for the fatality. Toxicological analyses revealed the presence of lidocaine and mepivacaine in heart blood, at concentrations of 4.9 and 16.2mg/L, respectively. All drugs involved in the case were detected using gas chromatography with nitrogen-phosphorus detector and confirmed using gas chromatography-mass spectrometry full scan mode after solid-phase extraction using Chem-Elut columns. An additional high-performance liquid chromatography coupled to diode-array detection screening also obtained the same results. Based on the autopsy findings, case history, and toxicology results, the forensic pathologists ruled that the cause of death was an overdose of local anesthetic agents. The Court of Law ruled the death as an involuntary homicide due to gross negligence.
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Affiliation(s)
- María A Martínez
- Instituto Nacional de Toxicología y Ciencias Forenses, Ministerio de Justicia, C/Luis Cabrera 9, 28002 Madrid, Spain.
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Centini F, Fiore C, Riezzo I, Rossi G, Fineschi V. Suicide due to oral ingestion of lidocaine: a case report and review of the literature. Forensic Sci Int 2007; 171:57-62. [PMID: 16787726 DOI: 10.1016/j.forsciint.2006.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Revised: 05/02/2006] [Accepted: 05/04/2006] [Indexed: 10/24/2022]
Abstract
The Authors describe a rare case of suicide in a 31-year-old woman, due to oral ingestion of lidocaine; the histological and toxicological findings are discussed to provide useful information to the present experience with this particular modality of death. Histological examination revealed generalized stasis. In the myocardium we observed segmentation of the myocardial cells and/or widening of intercalated discs and associated group of hypercontracted myocardial cells with "square" nuclei in line with hyperdistended ones. Non-eosinophilic bands of hypercontracted sarcomeres alternating with stretched, often apparently separated sarcomeres, small foci of paradiscal contraction band necrosis, and perivascular fibrosis were observed too. Lidocaine was detected in the subject's urine through immunoenzymatic screening. Toxicological analysis by solid-liquid extraction and gas chromatography-mass spectrometry (GC-MS) analysis, was carried out to identify and quantify the individual substances present in the biological fluids and organs. Lidocaine concentrations were as follows: blood 31 microg/mL, gastric content 2.5 g, liver 10 microg/g, kidney 12 microg/g, brain 9 microg/g, spleen 24 microg/g, lung 84 microg/g, heart 9 microg/g, urine 9 microg/mL, and bile 6 microg/mL. No other drugs or alcohol were detected. When blood lidocaine reaches toxic levels, serious toxic symptoms associated with the central nervous system and cardiac system are noted. The overdose of lidocaine produces death from ventricular fibrillation or cardiac arrest. In this case, according to macroscopic and microscopic findings, the cause of death was most likely cardiac and possibly related to ventricular fibrillation.
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Affiliation(s)
- F Centini
- Forensic Toxicology Unit, University of Siena, Italy
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