Local Anesthetic Toxicity Medication

Updated: Aug 17, 2017
  • Author: Raffi Kapitanyan, MD; Chief Editor: David Vearrier, MD, MPH  more...
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Medication

Medication Summary

The goals of pharmacologic therapy in patients with neurologic toxicity from local anesthetic agents are to terminate the neuromuscular and cerebral manifestations.

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Anticonvulsants, Barbiturates

Class Summary

These agents terminate seizures.

Pentobarbital (Nembutal)

A short-acting barbiturate with sedative, hypnotic, and anticonvulsant properties, pentobarbital can produce all levels of CNS mood alteration.

Phenobarbital (Luminal)

Phenobarbital interferes with the transmission of impulses from the thalamus to the cerebral cortex. In the emergent setting, phenobarbital is typically used when benzodiazepines fail to abort status epilepticus.

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Anxiolytics, Benzodiazepines

Class Summary

These agents terminate seizures. By binding to a specific receptor site, these agents appear to potentiate the effects of gamma-aminobenzoic acid (GABA) and to facilitate inhibitory GABA neurotransmission and other inhibitory neurotransmitters.

Diazepam (Valium, Diastat, Diastat AcuDial)

Diazepam depresses all levels of the CNS (eg, limbic and reticular formation), possibly by increasing the activity of GABA. Diazepam diminishes or terminates seizures. Individualize dosage and increase cautiously to avoid adverse effects.

Midazolam

Midazolam depresses all levels of the CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA. It diminishes or terminates seizures. Midazolam is shorter acting and more potent than diazepam. Individualize dosage and increase cautiously to avoid adverse effects.

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Neuromuscular Blockers, Depolarizing

Class Summary

These agents terminate the neuromuscular manifestations of seizures.

Succinylcholine (Anectine, Quelicin)

Succinylcholine causes paralysis of airway and respiratory muscles; apnea ensues. Establishing and maintaining an airway and ventilation are mandatory prerequisites.

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