array:23 [
  "pii" => "S0870255123004651"
  "issn" => "08702551"
  "doi" => "10.1016/j.repc.2023.10.007"
  "estado" => "S300"
  "fechaPublicacion" => "2024-05-01"
  "aid" => "2274"
  "copyrightAnyo" => "2023"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "cor"
  "cita" => "Rev Port Cardiol. 2024;43:297"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S0870255123004638"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2023.09.004"
    "estado" => "S300"
    "fechaPublicacion" => "2024-05-01"
    "aid" => "2272"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "cor"
    "cita" => "Rev Port Cardiol. 2024;43:299-300"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "High prevalence of cardiovascular disease and risk factors among type 2 diabetes patients followed in a hospital setting in Portugal"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "299"
          "paginaFinal" => "300"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Alta preval&#234;ncia de doen&#231;as cardiovasculares e fatores de risco entre pacientes com diabetes tipo 2 acompanhados em ambiente hospitalar em Portugal"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Kashish Zehra Manjee, Danish Hassan"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Kashish"
              "apellidos" => "Zehra Manjee"
            ]
            1 => array:2 [
              "nombre" => "Danish"
              "apellidos" => "Hassan"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255123004638?idApp=UINPBA00004E"
    "url" => "/08702551/0000004300000005/v1_202404230444/S0870255123004638/v1_202404230444/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S0870255123004560"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2023.08.004"
    "estado" => "S300"
    "fechaPublicacion" => "2024-05-01"
    "aid" => "2267"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "cor"
    "cita" => "Rev Port Cardiol. 2024;43:295-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "The risk of local anesthetic systemic toxicity is increased in patients with critically low weight and muscle mass"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "295"
          "paginaFinal" => "296"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "O risco de toxicidade sist&#233;mica dos anest&#233;sicos locais &#233; mais elevado em doentes com peso e massa muscular extremamente baixos"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Russell K&#46; McAllister, Michael P&#46; Hofkamp, Emily H&#46; Garmon"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Russell K&#46;"
              "apellidos" => "McAllister"
            ]
            1 => array:2 [
              "nombre" => "Michael P&#46;"
              "apellidos" => "Hofkamp"
            ]
            2 => array:2 [
              "nombre" => "Emily H&#46;"
              "apellidos" => "Garmon"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255123004560?idApp=UINPBA00004E"
    "url" => "/08702551/0000004300000005/v1_202404230444/S0870255123004560/v1_202404230444/en/main.assets"
  ]
  "asociados" => array:1 [
    0 => array:18 [
      "pii" => "S0870255123004560"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2023.08.004"
      "estado" => "S300"
      "fechaPublicacion" => "2024-05-01"
      "aid" => "2267"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "cor"
      "cita" => "Rev Port Cardiol. 2024;43:295-6"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:1 [
        "total" => 0
      ]
      "en" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
        "titulo" => "The risk of local anesthetic systemic toxicity is increased in patients with critically low weight and muscle mass"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "295"
            "paginaFinal" => "296"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "O risco de toxicidade sist&#233;mica dos anest&#233;sicos locais &#233; mais elevado em doentes com peso e massa muscular extremamente baixos"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Russell K&#46; McAllister, Michael P&#46; Hofkamp, Emily H&#46; Garmon"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "Russell K&#46;"
                "apellidos" => "McAllister"
              ]
              1 => array:2 [
                "nombre" => "Michael P&#46;"
                "apellidos" => "Hofkamp"
              ]
              2 => array:2 [
                "nombre" => "Emily H&#46;"
                "apellidos" => "Garmon"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255123004560?idApp=UINPBA00004E"
      "url" => "/08702551/0000004300000005/v1_202404230444/S0870255123004560/v1_202404230444/en/main.assets"
    ]
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "Reply to the Letter to the Editor &#8220;The risk of local anesthetic systemic toxicity is increased in patients with critically low weight and muscle mass&#8221;"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:1 [
        "paginaInicial" => "297"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Marisa Nunes Silva"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "Marisa"
            "apellidos" => "Nunes Silva"
            "email" => array:1 [
              0 => "marisarns@hotmail.com"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servi&#231;o de Anestesiologia&#44; Centro Hospitalar Lisboa Central&#44; Hospital de Santa Marta&#44; Lisboa&#44; Portugal"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Resposta &#224; Carta ao Editor - O risco de toxicidade sist&#233;mica dos anest&#233;sicos locais &#233; mais elevado em doentes com peso e massa muscular extremamente baixos"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The authors have reflected on all the points highlighted by McAllister et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Regarding low body weight being one of the key risk factors for complications of local anesthetics &#40;LA&#41;&#44; we agree&#44; as we clearly stated in the discussion section of our case report<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> &#8211; &#8220;The most critical aspect of LA is appropriate dosing&#46; The lowest effective dose should be used and patient weight and comorbidities need to be considered when calculating the dose&#46;&#8221; The risks of LA are well known within anesthesiologists&#8217; clinical practice&#44; and we are aware of the need to identify high-risk patients&#44; as LA are commonly used in our practice in a variety of routes of administration&#46; This topic is frequently covered in anesthesiology journals&#44; especially by regional anesthesia societies&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#8211;5</span></a> However&#44; these journals are not usually of interest to other medical and surgical specialties and we consider that local anesthetic systemic toxicity &#40;LAST&#41; is potentially overlooked by other practitioners&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Our main aim in publishing this case report was to raise awareness of the risks of administering lidocaine&#44; a commonly used drug in all medical and surgical specialties&#44; in which physicians may not be as aware of the risk factors and the possibility of LAST&#46; Lidocaine is widely used and is frequently considered to be extremely safe&#59; however&#44; many practitioners may fail to identify high-risk patients and may misdiagnose the early symptoms of LAST&#46; This is what occurred in the case presented&#58; the first suspected diagnosis was anaphylaxis&#44; as LAST is rarely in the minds of those who frequently use local anesthetics&#46; We presented the case especially because the subcutaneous route was used&#44; a frequent practice in outpatient settings&#44; as it is commonly considered an innocuous route of administration&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Overall&#44; we are in line with McAllister et al&#46;&#8217;s reflections and completely agree with their conclusion that prevention is key&#44; by considering weight&#44; route of administration and comorbidities in order to identify high-risk patients&#46; However&#44; we are also aware that choosing the correct dosage when performing outpatient procedures on such high-risk patients is challenging for medical practitioners&#46; Thus&#44; we would like to highlight the need to refer these patients to the care of an anesthesiologist&#44; so that other possibilities beyond local anesthetic infiltration can be weighed to ensure a safe&#44; effective and comfortable procedure for both patient and practitioner&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:2 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Conflicts of interest"
        ]
        1 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The risk of local anesthetic systemic toxicity is increased in patients with critically low weight and muscle mass"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;K&#46; McAllister"
                            1 => "M&#46;P&#46; Hofkamp"
                            2 => "E&#46;H&#46; Garmon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2023"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lidocaine-induced central nervous system toxicity during implantable cardioverter defibrillator placement &#8211; a case report and literature review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Nunes Silva"
                            1 => "A&#46; Ferro"
                            2 => "I&#46; Fragata"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2023"
                        "volumen" => "42"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity&#58; executive summary 2017"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;M&#46; Neal"
                            1 => "M&#46;J&#46; Barrington"
                            2 => "M&#46;R&#46; Fettiplace"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/AAP.0000000000000720"
                      "Revista" => array:6 [
                        "tituloSerie" => "Reg Anesth Pain Med"
                        "fecha" => "2018"
                        "volumen" => "43"
                        "paginaInicial" => "113"
                        "paginaFinal" => "123"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29356773"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Local anaesthetic systemic toxicity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46;C&#46; Linsey"
                            1 => "J&#46; Picard"
                            2 => "G&#46;L&#46; Weinberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Br J Anaesth"
                        "fecha" => "2015"
                        "volumen" => "15"
                        "paginaInicial" => "136"
                        "paginaFinal" => "142"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Local anesthetic systemic toxicity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Dillane"
                            1 => "B&#46;T&#46; Finucane"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s12630-010-9275-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Can J Anesth"
                        "fecha" => "2010"
                        "volumen" => "57"
                        "paginaInicial" => "368"
                        "paginaFinal" => "380"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20151342"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/08702551/0000004300000005/v1_202404230444/S0870255123004651/v1_202404230444/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "93369"
    "tipo" => "SECCION"
    "pt" => array:2 [
      "titulo" => "Letters to the Editor"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "pt"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08702551/0000004300000005/v1_202404230444/S0870255123004651/v1_202404230444/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255123004651?idApp=UINPBA00004E"
]
Partilhar
Informação da revista
Vol. 43. Núm. 5.
Páginas 297 (maio 2024)
Partilhar
Partilhar
Baixar PDF
Mais opções do artigo
Vol. 43. Núm. 5.
Páginas 297 (maio 2024)
Letter to the Editor
Acesso de texto completo
Reply to the Letter to the Editor “The risk of local anesthetic systemic toxicity is increased in patients with critically low weight and muscle mass”
Resposta à Carta ao Editor - O risco de toxicidade sistémica dos anestésicos locais é mais elevado em doentes com peso e massa muscular extremamente baixos
Visitas
916
Marisa Nunes Silva
Serviço de Anestesiologia, Centro Hospitalar Lisboa Central, Hospital de Santa Marta, Lisboa, Portugal
Conteúdo relacionado
Russell K. McAllister, Michael P. Hofkamp, Emily H. Garmon
Este item recebeu
Informação do artigo
Texto Completo
Bibliografia
Baixar PDF
Estatísticas
Texto Completo

The authors have reflected on all the points highlighted by McAllister et al.1 Regarding low body weight being one of the key risk factors for complications of local anesthetics (LA), we agree, as we clearly stated in the discussion section of our case report2 – “The most critical aspect of LA is appropriate dosing. The lowest effective dose should be used and patient weight and comorbidities need to be considered when calculating the dose.” The risks of LA are well known within anesthesiologists’ clinical practice, and we are aware of the need to identify high-risk patients, as LA are commonly used in our practice in a variety of routes of administration. This topic is frequently covered in anesthesiology journals, especially by regional anesthesia societies.3–5 However, these journals are not usually of interest to other medical and surgical specialties and we consider that local anesthetic systemic toxicity (LAST) is potentially overlooked by other practitioners.

Our main aim in publishing this case report was to raise awareness of the risks of administering lidocaine, a commonly used drug in all medical and surgical specialties, in which physicians may not be as aware of the risk factors and the possibility of LAST. Lidocaine is widely used and is frequently considered to be extremely safe; however, many practitioners may fail to identify high-risk patients and may misdiagnose the early symptoms of LAST. This is what occurred in the case presented: the first suspected diagnosis was anaphylaxis, as LAST is rarely in the minds of those who frequently use local anesthetics. We presented the case especially because the subcutaneous route was used, a frequent practice in outpatient settings, as it is commonly considered an innocuous route of administration.

Overall, we are in line with McAllister et al.’s reflections and completely agree with their conclusion that prevention is key, by considering weight, route of administration and comorbidities in order to identify high-risk patients. However, we are also aware that choosing the correct dosage when performing outpatient procedures on such high-risk patients is challenging for medical practitioners. Thus, we would like to highlight the need to refer these patients to the care of an anesthesiologist, so that other possibilities beyond local anesthetic infiltration can be weighed to ensure a safe, effective and comfortable procedure for both patient and practitioner.

Conflicts of interest

The authors have no conflicts of interest to declare.

References
[1]
R.K. McAllister, M.P. Hofkamp, E.H. Garmon.
The risk of local anesthetic systemic toxicity is increased in patients with critically low weight and muscle mass.
Rev Port Cardiol, (2023),
[2]
M. Nunes Silva, A. Ferro, I. Fragata.
Lidocaine-induced central nervous system toxicity during implantable cardioverter defibrillator placement – a case report and literature review.
Rev Port Cardiol, 42 (2023),
[3]
J.M. Neal, M.J. Barrington, M.R. Fettiplace, et al.
The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: executive summary 2017.
Reg Anesth Pain Med, 43 (2018), pp. 113-123
[4]
E.C. Linsey, J. Picard, G.L. Weinberg.
Local anaesthetic systemic toxicity.
Br J Anaesth, 15 (2015), pp. 136-142
[5]
D. Dillane, B.T. Finucane.
Local anesthetic systemic toxicity.
Can J Anesth, 57 (2010), pp. 368-380
Baixar PDF
Idiomas
Revista Portuguesa de Cardiologia
Opções de artigo
Ferramentas
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

Ao assinalar que é «Profissional de Saúde», declara conhecer e aceitar que a responsável pelo tratamento dos dados pessoais dos utilizadores da página de internet da Revista Portuguesa de Cardiologia (RPC), é esta entidade, com sede no Campo Grande, n.º 28, 13.º, 1700-093 Lisboa, com os telefones 217 970 685 e 217 817 630, fax 217 931 095 e com o endereço de correio eletrónico revista@spc.pt. Declaro para todos os fins, que assumo inteira responsabilidade pela veracidade e exatidão da afirmação aqui fornecida.