Analysis of Local Anesthetic Intoxication during Epidural Anesthesia for Pediatric Patients

Abstract

  We often use both general and epidural anesthesia for pediatric surgery in abdominal or lower extremities for intraoperative and postoperative analgesia. But local anesthetic intoxication (LAI) tends to be overlooked under general anesthesia. We retrospectively reviewed LAI induced by epidural anesthesia for pediatric patients during the last decade. Neurological signs and symptoms of LAI induced by mepivacaine were observed in 17 cases (0.002%) in the operating room and the general wards. They were treated with oxygen inhalation, mask ventilation and administration of anticonvulsants. They recovered rapidly without neurological damage after treatment. It was suggested that the main cause was not the intravascular injection but the accumulation of mepivacaine due to its excessive or long-term administration. Anesthetists should administer an appropriate dose of local anesthetic in order to avoid LAI during epidural anesthesia for pediatric patients.