Methodical recommendations of the ministry of health of the Russian Federation on systemic toxicity of local anesthetic

Methodological recommendations of the Ministry of health of the Russian Federation “Systemic toxicity of local anesthetics” were prepared by the all-Russian public organization “Federation of anesthesiologists and resuscitators”. Systemic toxicity of local anesthetics is a rare but dangerous complication of regional anesthesia. These recommendations provide updated indicators of the prevalence of this complication, the preventive value of ultrasound navigation, and the evolution of the clinical picture. The results of the analysis of new reports indicate a trend towards delayed manifestation of symptoms after regional anesthesia. The type of local anesthetic, dosage, volume, injection site, and concomitant diseases of the patient affect the rate of absorption from the injection site and the toxicity of local anesthetics. The article presents new information about the mechanisms of lipid resuscitation, summarizes the latest scientific data on the mechanisms of neutralization of local anesthetics in blood plasma by introducing fat emulsions, including the effect of rapid redistribution, direct inotropic effect and postconditioning. Guidelines for the prevention, recognition and treatment of systemic toxicity of local anesthetics have been updated in accordance with new data.