Share |

Local Anesthesia Systemic Toxicity (LAST) Treated as Anaphylaxis

Case report

Abstrak

Ketoksikan sistemik bius setempat (LAST) dan anafilaksis adalah kesan sampingan lignocaine yang boleh membawa maut. Namun, kedua-duanya mempunyai tanda-tanda dan rawatan yang berbeza. Kami melaporkan satu kes seorang perempuan berumur 35 tahun datang ke Jabatan Kecemasan (ED) dengan gejala keletihan, mengantuk, dan susah bernafas dengan rasa bendasing dan rasa logam di dalam tekak. Gejala tersebut bermula 15 minit selepas pesakit mendapatkan suntikan di bahagian bahu kanan dengan 250 mg lignocaine bercampur dengan Triamcinolone di Klinik Orthopedik. Pesakit telah dibawa ke kawasan resusitasi dan telah dirawat sebagai anafilaksis. Semasa pemeriksaan lanjut, tekanan darah tidak pernah rendah, tiada tanda-tanda salur pernafasan terjejas, tiada gejala gastrousus, dan tiada penglibatan mukosa yang menjurus kepada diagnosis LAST berbanding anafilaksis. Walau bagaimanapun, pesakit telah beransur-ansur pulih dan dibenarkan pulang selepas pemerhatian di ED selama enam jam. Ini merupakan laporan kes yang pertama yang menunjukkan LAST dirawat dengan berkesan sebagai anafilaksis.

Abstract

Local anesthesia systemic toxicity (LAST) and anaphylaxis are the life-threatening adverse effects of lignocaine.  Both have different presentations and treatments. We report a case of 35-year-old female who came to our Emergency Department (ED) with symptoms of lethargy, drowsiness, and difficulty breathing with foreign body sensation and a metallic taste in the throat which started 15 minutes after a right shoulder injection with 250 mg of lignocaine mixed with Triamcinolone in the Orthopedic Clinic. She was pushed to the resuscitation bay and was treated as anaphylaxis. Upon further evaluation, the blood pressure was never hypotensive, no sign of compromised airway, no gastrointestinal symptom, and no mucosal involvement which directs to the diagnosis of LAST rather than anaphylaxis. Surprisingly, she was gradually improving and was discharged home after six hours of observation in the ED. This is the first case report that LAST had been effectively treated as anaphylaxis.