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1、REGIONALANESTHESIAANDACUTEPAINSPECIALARTICLETheThirdAmericanSocietyofRegionalAnesthesiaandPainMedicinePracticeAdvisoryonLocalAnestheticSystemicToxicityExecutiveSummary2017JosephM.Neal,MD,*MichaelJ.Barrington,MBBS,FANZCA,PhD,†MichaelR.Fettiplace,MD,PhD,‡§MarinaGitman,MD,
2、§StavrosG.Memtsoudis,MD,PhD,
3、
4、EvaE.Mörwald,MD,
5、
6、DanielS.Rubin,MD,**andGuyWeinberg,MD§††practiceadvisory,“avarietyoffactorsinfluencethelikelihoodAbstract:TheAmericanSocietyofRegionalAnesthesiaandPainMed-andseverityofLAST,includingindividualpatientriskfactors,icine'sThird
7、PracticeAdvisoryonlocalanestheticsystemictoxicityisanconcurrentmedications,locationandtechniqueofblock,specificinterimupdatefromits2010advisory.Theadvisoryfocusesonnewinfor-localanestheticcompound,totallocalanestheticdose(theproductmationregardingthemechanismsoflipidres
8、uscitation,updatedfrequencyofconcentrationxvolume),timelinessofdetection,andadequacyestimates,thepreventativeroleofultrasoundguidance,changestocase1oftreatment.”TheoverallrarityofLASTandthefactthatepi-presentationpatterns,andlimitedinformationrelatedtolocalinfiltrations
9、odescanoccurdespitepropertechniquearguestronglyforedu-anesthesiaandliposomalbupivacaine.Inadditiontoemerginginformation,cationandpreparednessamongallprofessionalswhoadministertheadvisoryupdatesrecommendationspertainingtoprevention,recognition,localanestheticstotheirpati
10、ents.andtreatmentoflocalanestheticsystemictoxicity.TheAmericanSocietyofRegionalAnesthesiaandPainMed-icine(ASRA)conveneditsfirstConferenceonLocalAnestheticWhat’sNewinThisUpdate?ThisinterimupdatesummarizesrecentToxicityin2001coincidingwithinitialclinicalexperienceaftersci
11、entificfindingsthathaveenhancedourunderstandingofthemechanismsreleaseofthelevo-enantiomersropivacaineandl-bupivacaine,thatleadtolipidemulsionreversalofLAST,includingrapidpartitioning,di-plusemerginglaboratoryobservationsontheeffectivenessofrectinotropy,andpost-condition
12、ing.Sincethepreviouspracticeadvisory,lipidemulsionasanantidoteforLAST.In2008,asecondadvi-epidemiologicaldataha
