| アブストラクト | PURPOSE: To characterize clinical profile of pediatric local anesthetic (LA) systemic toxicity (LAST) and to identify determinants of life-threatening outcomes. METHODS: Spontaneous reports notified to the French Pharmacovigilance Network were retrieved and followed by a case-by-case review, according to the following criteria: LA as suspected drug, age < 18 years, adverse drug reactions related to nervous system, cardiac, respiratory, psychiatric or general disorders. Multivariate logistic regression analysis was performed to identify factors leading to life-threatening reaction (i.e. continuous seizures or cardiorespiratory arrest). RESULTS: Among 512 cases retrieved, 64 LAST cases were included (neonates 11%, infants 30%, children 36%, adolescents 23%) mainly involving lidocaine (47%), lidocaine + prilocaine (22%) and ropivacaine (14%). Toxicity profiles were neurological (58%), cardiac (11%) or mixed (20%) and 7 patients (11%) developed methemoglobinemia. LAST was life-threatening for 23 patients (36%) and 2 patients died. Doses were above recommendations in 26 patients (41%) and were not different between life-threatening and non-life-threatening cases. The context of use (general and orthopedic surgery, p = 0.006) and the type of LA agent (lidocaine, p = 0.016) were independently associated with a life-threatening outcome. CONCLUSION: In this national retrospective analysis, LAST in children appear to be a rare event. Neurological and cardiac signs were the most frequently reported reactions. LAST in children can be life-threatening, even at therapeutic doses. Although a fatal outcome may anecdotally occur, the vast majority of patients recovered after appropriate medical care. |
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| ジャーナル名 | BMC pediatrics |
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| 投稿日 | 2023/6/25 |
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| 投稿者 | Schweitzer-Chaput, Arnaud; Callot, Delphine; Bouazza, Naim; Lesage, Fabrice; Oualha, Mehdi; Paret, Nathalie; Boyer-Gervoise, Marie; Treluyer, Jean-Marc; Chouchana, Laurent |
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| 組織名 | Centre Regional de Pharmacovigilance, Service de Pharmacologie, Hopital Cochin,;AP-HP, Paris, France.;Pharmacologie Et Evaluation Des Therapeutiques Chez L'enfant Et La Femme Enceinte;(EA 7323), Universite de Paris, Paris, France.;Unite de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, Paris, France.;Service de Reanimation Pediatrique, Hopital Necker, Paris, France.;Centre Antipoison, Hospices Civils De Lyon, Lyon, France.;Centre Regional de Pharmacovigilance, Service de Pharmacologie Clinique,;Assistance Publique Hopitaux de Marseille, Marseille, France.;AP-HP, Paris, France. laurent.chouchana@aphp.fr.;(EA 7323), Universite de Paris, Paris, France. laurent.chouchana@aphp.fr. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/37355586/ |
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