![]() However, the euphoria, subsequent addiction, and cases of mortality from the clinical use of the natural ester cocaine created a drive to the development of the less toxic newer amino esters. Halsted and Hall took more invasive steps by directly injecting cocaine into oral cavity nerves in order to produce anesthesia for removal of a wisdom tooth. Chance discovery in 1884 by Freud while using cocaine to wean a morphine addict lead Koller to use cocaine successfully in ophthalmic surgery as a topical anesthetic. Medical use of local anesthetic agents began some years after the isolation of cocaine from Peruvian coca in the 1860s. Local anesthetics (LAs) can be defined as drugs that reversibly block transmission of a nerve impulse, without affecting consciousness. In this paper we intend to discuss the pharmacology and pathophysiology of local anesthetics and toxicity, and the rationale for lipid emulsion therapy. All who use local anesthetics in their practice should have an appreciation of patients at high risk of toxicity, early symptoms and signs of toxicity, preventative measures when using local anesthetics, and the initial management of systemic toxicity with intravenous lipid emulsion. Despite this, awareness amongst practitioners appears to be lacking. Over the last decade, there has been convincing evidence of intravenous lipid emulsions as a rescue in local anesthetic-cardiotoxicity, and anesthetic organisations, over the globe have developed guidelines on the use of this drug. ![]() Local anesthetics are the most frequently used drugs amongst anesthetists and although uncommon, local anaesthetic systemic toxicity accounts for a high proportion of mortality, with local anaesthetic-induced cardiac arrest particularly resistant to standard resuscitation methods. The commonly used amide local anesthetics have varying adverse effects on the myocardium, and beyond a certain dose all are capable of causing death. The accidental overdose of local anesthetics may prove fatal. ![]()
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