Language
English
Publication Date
9-1-2024
Journal
Cureus
DOI
10.7759/cureus.69215
PMID
39398741
PMCID
PMC11469792
PubMedCentral® Posted Date
9-11-2024
PubMedCentral® Full Text Version
Post-print
Abstract
Introduction: Local anesthetic systemic toxicity (LAST) is a rare complication of regional anesthesia. Pregnancy is a risk factor due to gestational physiologic changes. Labor and disorders of pregnancy can mask or delay symptoms of LAST, slowing appropriate intervention. This study examines LAST within a larger cohort and identifies features that help distinguish LAST in pregnant women from LAST in nonpregnant patients.
Methods: The TriNetX database was used to compare pregnant and nonpregnant patients with LAST from 2013 to 2023. Cohorts were matched on age, race, obesity status, diabetes, metabolic disorders, local anesthetic type, and cardiovascular, liver, kidney, and respiratory disease. Outcomes included prodromal symptoms of LAST and symptoms of cardiac and central nervous system excitation and depression.
Results: Matching occurred for 276 pregnant and 276 nonpregnant patients. Pregnant cohorts had a significantly higher risk of cardiac depression (risk ratio (RR)=1.96 (95% confidence interval (CI): 1.44-2.66), p< 0.01) and significantly lower risk of cardiac excitation (RR=0.38 (95% CI: 0.22-0.63), p< 0.01), prodromal symptoms (RR=0.17 (95% CI: 0.09-0.33), p< 0.01), central nervous system excitation (RR=0.44 (95% CI: 0.21-0.90), p=0.02), and central nervous system depression (RR=0.24 (95% CI: 0.13-0.48), p< 0.01) than nonpregnant cohorts.
Conclusion
Pregnant patients with LAST were more likely to exhibit cardiac depression and less likely to manifest prodromal symptoms, cardiac excitation, and central nervous system excitation and depression than nonpregnant patients. Physiological changes during pregnancy and prompt detection and treatment may explain these differences. These findings highlight the variable nature of LAST and how pregnancy may influence its clinical presentation.
Keywords
cardiovascular toxicity, local analgesia, local anesthetic systemic toxicity (last), neurotoxicity, obstetric anesthesia, peripartum period, pregnancy risk, pregnant females
Published Open-Access
yes
Recommended Citation
De Valle, Micah K; Adkison, Michael; Maredia, Ruhi; et al., "Local Anesthetic Systemic Toxicity in Pregnancy: A Retrospective Cohort Analysis" (2024). Faculty and Staff Publications. 3830.
https://digitalcommons.library.tmc.edu/baylor_docs/3830