Potential risks when using anesthetics

Nowadays, the use of anesthetics is very common, from procedures performed at medical facilities outside the hospital such as tooth extraction, minor wound surgery... to procedures and minor surgeries performed at the hospital. such as: catheter placement, lumbar puncture, plastic and cosmetic surgery.

Anesthetic poisoning can occur and cause serious consequences that threaten the patient's life if not treated promptly.

In particular, in the context that performing anesthesia techniques before these procedures tends to be performed by doctors who are not specialized in anesthesiology and resuscitation, anesthetic poisoning can occur. and causes serious consequences that threaten the patient's life if not treated promptly.

Recently, the Emergency Department, Central Military Hospital 108 admitted a 66-year-old male patient to the emergency room with symptoms of dizziness, vertigo, and shaking limbs after tooth extraction, during the procedure. Tooth extraction process uses 2 tubes of Lidocaine 2% local anesthesia; Vital signs and basic test indicators were all within normal limits.

The patient was diagnosed with Lidocaine poisoning after tooth extraction. The patient immediately received an intravenous infusion of 20% lipid emulsion and closely monitored the state of consciousness and hemodynamics.

After 15 minutes of taking the medicine, the clinical symptoms that made the patient uncomfortable completely disappeared. The patient was transferred to the Allergy Department, Central Military Hospital 108 for continued monitoring and treatment.

In the above case, the patient was fortunate to receive emergency treatment properly and promptly, thus avoiding unfortunate consequences. However, anesthetic poisoning is always potentially dangerous (anesthetic poisoning, anesthetic anaphylaxis, fear syndrome).

The differential diagnosis of the above hypotheses is often based on accompanying symptoms such as the patient's panic and excessive anxiety before the procedure (fear syndrome); Patients have difficulty breathing, wheezing, rash, itching, nausea, abdominal pain (anaphylaxis to the drug); The rest is poisoning.

Of the three hypotheses above, poisoning is the most common, while anaphylaxis is the rarest. Therefore, when encountering a clinical situation like the above, we should treat it in the direction of drug poisoning combined with basic emergency resuscitation measures, which will most likely save the patient's life.

Anesthetic poisoning, if not treated promptly, will have serious consequences, even death. Therefore, understanding the early signs and timely emergency measures for patients with anesthetic poisoning is very important, helping to reduce the risk of illness and death.

To prevent anesthetic poisoning, according to doctors from the Emergency Department, Central Military Hospital 10, those at high risk of anesthetic poisoning are children under 6 months old; Patients with small physical condition; old age, weakness; heart failure, myocardial ischemia; liver failure.

The American Society of Regional Anesthesia and Pain Management recommends that patients with neurological or cardiovascular changes while using anesthetics, no matter the small dose or method of anesthesia, should be considered anesthetic poisoning first. and treated according to the protocol.

Central nervous system such as stimulation (restlessness, anxiety, screaming, muscle twitching, convulsions); depression (drowsiness, coma, or apnea); Non-specific symptoms (metallic taste in the mouth, numbness around the mouth, double vision, tinnitus, dizziness). With the cardiovascular system: In the early stages, there may be increased blood pressure, rapid pulse, ventricular arrhythmia...

Later stages: Patients may have progressive hypotension; conduction block, bradycardia, asystole; Ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation, torsades de pointes, asystole).

Clinical symptoms of poisoning may appear slowly after 30 minutes or later. Regular communication with the patient is necessary to detect early signs of poisoning.

Patients need to understand the early signs of anesthetic poisoning so that when it occurs, they can go to the nearest medical facility for emergency treatment promptly.

And at medical facilities, there should always be an anesthetic poisoning emergency kit just like an anaphylaxis emergency kit. Lipid emulsion is the first-line agent at the first and obvious manifestation of anesthetic toxicity from any anesthetic and adrenaline doses ≤ 1mcg/kg are more effective in advanced CPR in patients Cardiac arrest or hypotension due to anesthetic poisoning.