Ua lawe anei ʻoe i kahi lāʻau hoʻomaʻemaʻe kūloko e unuhi i kahi niho, e humuhumu i kahi ʻeha, a i ʻole e hana i kahi ʻoki liʻiliʻi? A laila manaʻo ʻoe he mae wale ʻoe a ʻaʻohe mea i hana ʻia? He mea kupanaha paha ia, akā he mea nui loa kēia lāʻau hoʻomaʻemaʻe i ka lāʻau lapaʻau. Eia naʻe, he mea kakaikahi loa, ʻo ia hoʻi, he mea kakaikahi loa, hiki i kēia lāʻau hoʻomaʻemaʻe ke hana i kahi pilikia liʻiliʻi no ko mākou kino. ʻO ia ka mea a mākou e kapa nei he Local Anesthetic Systemic Toxicity , a i ʻole LAST . Mai hopohopo, he mea kakaikahi loa kēia. Akā he mea maikaʻi ke ʻike iki e pili ana i kēia.
No laila he aha ka LAST (Local Anesthetic Systemic Toxicity)?
I ka ʻōlelo maʻalahi, ʻo ka LAST ka hopena i ka wā e ʻai ʻia ai kahi lāʻau lapaʻau, aia ia ma nā ʻōnaehana o ko mākou kino, ʻoiai ka Central Nervous System (CNS), ʻo ia ka lolo a me ke kaula kuamoʻo, a me ka Cardiovascular System, ʻo ia ka puʻuwai a me nā kīʻaha koko.
E noʻonoʻo pehea e hana ai nā lāʻau ʻeha. Ke ālai nei lākou i nā aʻalolo (nā aʻalolo peripheral) i kekahi ʻāpana o ko mākou kino. A laila e pau kēlā mau aʻalolo i ka hoʻouna ʻana i nā manaʻo e like me ka ʻeha a me ka hoʻopā ʻana i ka lolo. ʻO ia ke kumu e manaʻo ai mākou e like me ke ʻāʻī ʻana ma ia wahi. Loaʻa kēia mau lāʻau ʻeha ma ke ʻano o nā injections, gels, a me nā sprays.
No laila, hiki mai ka LAST i loko o nā minuke o ka lawe ʻana i ka mea hoʻopau ʻeha. Akā ʻo ka mea maikaʻi loa, aia kahi lāʻau no kēia. Inā ʻike kāu kauka i kēia mau hōʻailona, e hana koke lākou.
He aha nā hōʻailona o LAST? Pehea mākou e ʻike ai?
ʻO ka hopena nui o ka LAST i ko mākou ʻōnaehana nerve waena (CNS). ʻO nā hōʻailona mua paha:
Nā hōʻailona e pili ana i ka ʻōnaehana nerve waena (CNS):
- Nā ʻūlū: ʻO kēia ka hōʻailona maʻamau. Aia nā ʻūlū koke a me ka nalowale o ka ʻike.
- Ka huhū a huikau paha: He manaʻo o ka hiki ʻole ke noho mālie, hiki ʻole ke noʻonoʻo pono, a me ka maopopo ʻole i ka mea e hana nei.
- Nā loli pepeiao: Ke kani mau nei i nā pepeiao (Tinnitus) .
- ʻO ka maeʻele a puni kou waha: ʻO ka maeʻele a puni kou waha, e like me ka wā e hoʻokomo ai ke kauka niho i ka lāʻau lapaʻau.
- ʻOno metala i loko o kou waha: He ʻono ia me he ʻāpana hao lā i loko o kou waha.
- ʻŌlelo paheʻe (Dysarthria): Lilo nā huaʻōlelo i paʻakikī ke ʻōlelo maopopo.
- Hallucinations: Ke ʻike ʻana a lohe ʻana paha i nā mea i ʻike ʻole ʻia ma laila.
- Nā ʻano ʻē o ka neʻe ʻana o ka maka: Neʻe nā maka me ke kāohi ʻole, me he mea lā e neʻe ana mai kekahi ʻaoʻao a i kekahi ʻaoʻao.
Nā hōʻailona e pili ana i ka ʻōnaehana Cardiovascular:
Hiki i ke kūlana HOPE LOA ke hoʻopilikia i ko kākou puʻuwai. A laila hiki ke ʻike ʻia nā hōʻailona e like me kēia:
- Ke koko haʻahaʻa:Ke emi nei ke kaomi.
- Nā loli i ka helu o ka puʻuwai: Hiki ke lohi loa ka helu o ka puʻuwai (Bradycardia) , wikiwiki loa (Tachycardia) , a i ʻole nā kuʻina puʻuwai kūpono ʻole (Arrhythmias) .
- Pōkole o ka hanu (Dyspnea): Paʻakikī ka hanu ʻana, ka wheezing.
- Hopu ka puʻuwai: Ka pau koke ʻana o ka hana uila o ka puʻuwai. Hiki ke hana ʻia kēia ma muli o ka nalowale piha ʻana o ka hana uila i loko o ka puʻuwai (asystole) , a i ʻole ma muli o ke kuʻi wikiwiki ʻana o nā ʻāpana o ka puʻuwai a me ke ʻano ʻole (ventricular fibrillation) .
Mea nui: Inā ʻaʻole e mālama koke ʻia, hiki iā LAST ke alakaʻi i ka hopu ʻana o ka hanu a i ʻole ka coma .
ʻIke pinepine ʻia kēia mau hōʻailona i loko o ʻelima mau minuke o ka lawe ʻana i ka lāʻau ʻeha. I kekahi manawa hiki i kēia mau hōʻailona ke hoʻomaka mālie loa a piʻi mālie, a i ʻole hiki ke lilo koke i mea koʻikoʻi. ʻO ia ke kumu e nānā pono ai nā kauka iā ʻoe ma hope o ka hāʻawi ʻana iā ʻoe i ka lāʻau ʻeha, ʻoiai inā he kiʻekiʻe kou pilikia no ka hoʻomohala ʻana i ka LAST.
No ke aha e hiki hope loa ai kēia? He aha nā kumu?
ʻO ke kumu nui o LAST ka hoʻokomo ʻia ʻana o kahi lāʻau ʻeha i loko o ke kīʻaha koko. E noʻonoʻo e pili ana i ia mea, ua manaʻo ʻia e hoʻokomo ʻia ka lāʻau ʻeha ma kahi kokoke i kahi aʻalolo. Akā i kekahi manawa inā komo ia i loko o ke kīʻaha koko, hiki i ka lāʻau ke laha koke i loko o ke kino a hoʻoulu i kēia maʻi.
Ua hōʻike ʻia ʻo ka pilikia o LAST e kū mai ana i ka wā e hana ana i nā poloka aʻalolo e hoʻomānoino ai i nā lālā ma kahi o 20%. Eia naʻe, ʻaʻole kēia wale nō:
- Ua hoʻomohala ʻia ʻo LAST ma ke ʻano he lāʻau lapaʻau topical i hoʻopili ʻia i ka ʻili ma ke ʻano he gel .
- Ua hoʻokumu ʻia hoʻi ʻo LAST e nā lāʻau lapaʻau e hoʻonāukiuki i nā membrane mucous o ka waha, ka puʻu, a me nā ala ea .
ʻO ke ʻano kēia hiki ke hana LAST me ka nānā ʻole i ke ʻano o kāu hoʻohana ʻana i ka lāʻau. Eia nō naʻe, hoʻonui kekahi mau kumu i kēia pilikia.
ʻO wai ka mea i ʻoi aku ka pilikia o ka hoʻomohala ʻana i ka LAST? (Nā kumu pilikia)
Hiki i kekahi mau mea e pili ana i kou kūlana olakino ke hoʻonui i kou pilikia o ka loaʻa ʻana o LAST.
Nā mea pilikia e pili ana i kou olakino:
- ʻO ka acidosis metabolic: Ke loli ke kaulike kemika i loko o ke kino a piʻi ka acidity.
- Haʻahaʻa ka pae oxygen i loko o ke kino (Hypoxia): Ke emi ka nui o ka oxygen i loko o ke koko.
- Maʻi puʻuwai i loaʻa mua: ʻOi aku ka poʻe me nā kūlana e like me ka ischemia , arrhythmias , nā ʻano hana conduction , a me ka haʻahaʻa ejection fraction .
- Nā kānaka ma luna o 65 mau makahiki:Eia kekahi, ʻoi aku ka nui o ka pilikia o nā pēpē ma lalo o 4 mahina i ka loaʻa ʻana o LAST.
- Maʻi akepaʻa a maʻi puʻupaʻa paha: Hiki i ka poʻe me kēia mau kūlana ke ulu i ka wā LAST no ka mea ua lōʻihi ka manawa e haʻalele ai ka lāʻau i ke kino.
- Ka hāpai ʻana.
- Nā maʻi mitochondrial: ʻO kēia nā maʻi e hoʻopilikia i nā ʻāpana hana ikehu o kā mākou mau cell i kapa ʻia ʻo mitochondria.
Nā mea pilikia e pili ana i ka lāʻau lapaʻau Hiri:
ʻOi aku ka nui o ka hopena o kekahi mau lāʻau anesthetics, e like me ka bupivacaine , i ka LAST ma mua o nā mea ʻē aʻe. Eia kekahi, piʻi ka pilikia ke hāʻawi ʻia nā lāʻau anesthetics i nā nui kiʻekiʻe .
Nā mea pilikia e pili ana i ke ʻano lāʻau lapaʻau waha:
Hiki i kekahi mau ʻano o ka hāʻawi ʻana i nā lāʻau ʻeha ke hoʻonui i ka pilikia o LAST. Ua ʻike ʻia kahi noiʻi o 125 mau hihia o LAST:
- ʻO nā ʻano hana komo ʻana he mau ʻano ia e hoʻokomo ʻia ai ka lāʻau lapaʻau ma lalo o ka ʻili. ʻO kēia ka mea e pili ana i 20% o nā hihia LAST.
- Hāʻawi ʻia nā poloka neuraxial waena, e like me nā poloka epidural a me caudal, i ka iwi kuamoʻo. He 15% o nā hihia i hōʻike ʻia lākou.
- Ua hōʻike ʻia ma kahi o 13% ma muli o ka hoʻokomo mau ʻana o nā lāʻau ʻeha, e like me ka saline .
ʻO ka mea hope loa, ʻoi aku ka nui o ka LAST e hiki mai ana ke hoʻokomo ʻia nā anesthetics i loko o nā wahi me ke koko kiʻekiʻe . No ka laʻana, ʻoi aku ka nui o ka hōʻike ʻana o nā hihia LAST i ka wā e hana ʻia ai nā poloka aʻalolo penile .
Pehea e ʻike ai nā kauka i ka LAST? (Diagnosis)
Hoʻoholo nā kauka i ka LAST ma muli o kāu mau hōʻailona . No ka mea, he pilikia ka LAST e pono ai ka mālama koke ʻana, ʻaʻole hiki ke hoʻopaneʻe ʻia ka hōʻailona. He mea kākaʻikahi loa, hiki i kāu kauka ke kauoha i kahi EKG (electrocardiogram) e kōkua i ka hōʻoia ʻana i kēia.
He aha nā lāʻau lapaʻau no LAST?
He pilikia olakino ka ʻona ʻōnaehana hoʻomaʻemaʻe kūloko. No laila, e hoʻomaka koke nā kauka i ka mālama ʻana. Eia nā lāʻau lapaʻau maʻamau:
- Ka mālama ʻana i ke ala ea: Hāʻawi koke ʻia ka lāʻau lapaʻau oxygen e mālama i kou hanu ʻana, a hāʻawi ʻia ka ea inā pono.
- Ka pale ʻana a i ʻole ka mālama ʻana i ka hopu ʻana: Pili kēia i ka hāʻawi ʻana i nā lāʻau lapaʻau e like me benzodiazepines .
- ʻO ka hoʻokomo ʻana o ka lipid emulsion i loko o ke aʻa: He lāʻau lapaʻau kūikawā kēia i hāʻawi ʻia i loko o kahi aʻa . Hana ia ma ka omo ʻana i nā lāʻau ʻeha mai ke koko a me nā ʻiʻo. Hoʻemi kēia i ka nui o nā lāʻau ʻeha e hiki ai i ka lolo a me ka puʻuwai.
- CPR (Hoʻōla ʻana i ka puʻuwai):Inā hoʻopilikia ka LAST i ka hana o ka puʻuwai, hana nā kauka i ka CPR a hoʻohana i nā ʻano hana ʻē aʻe e hoʻopaʻa ai i ka puʻuwai.
Ma hope o ka lāʻau lapaʻau, e mālama ʻia ʻoe ma lalo o ka nānā ʻana o ke kauka no ʻeono hola ma ka liʻiliʻi e ʻike ai inā ua holomua ka lāʻau lapaʻau a inā he mau pilikia ʻē aʻe.
He aha ka mea e hiki mai ana i kahi mea nona ka LAST? (Prognosis)
ʻO ka poʻe i ʻike ʻia a mālama ʻia i ka wā mua, ʻoi aku ka maikaʻi o ka hopena. Hiki i ka lāʻau lapaʻau ke hoʻohuli nui i ke kūlana o LAST.
Eia nō naʻe, inā ʻaʻole mālama koke ʻia ka LAST koʻikoʻi, hiki iā ia ke alakaʻi i ka coma a i ʻole ka make. Eia naʻe, he mea kākaʻikahi loa kēia. No ka laʻana, e like me ka ʻikepili mai nā kikowaena kaohi lāʻau make ma ʻAmelika Hui Pū ʻIa, ʻehā wale nō make mai nā lāʻau ʻeha i ka makahiki 2016.
Hiki ke pale ʻia ka LAST?
ʻAʻole hiki ke pale ʻia ka LAST i nā manawa a pau, akā hoʻohana nā kauka i kekahi mau ʻano a me nā alakaʻi e hōʻemi i kēia pilikia.
Eia kekahi laʻana, e hoʻohana kāu kauka i ka lāʻau lapaʻau ʻeha haʻahaʻa loa e pono ai . Eia kekahi, i kekahi manawa e hoʻohana lākou i ke kiʻi ultrasound e hāʻawi i ka injection, i mea e hōʻoia ai ʻaʻole ia e komo hewa i loko o kahi kīʻaha koko.
Inā he mau kumu pilikia kou no ka hoʻomohala ʻana iā LAST, e noʻonoʻo pono kāu kauka i ka lāʻau ʻeha palekana loa, ka nui, a me ke ala o ka hoʻokele ʻana nāu.
Ke hele ʻoe e kiʻi i kahi lāʻau ʻeha, ʻaʻole paha ʻoe e noʻonoʻo nui e pili ana iā LAST. Ke hopohopo nui nei paha ʻoe inā e ʻeha ka inikini a inā paha e manaʻo ʻoe he mae loa. He mea maʻamau kēlā, no ka mea, he mea kakaikahi loa ʻo LAST. Akā e hoʻomanaʻo, e mālama pono kāu kauka iā ʻoe ma hope o ka hāʻawi ʻana iā ʻoe i kahi lāʻau ʻeha. Inā loaʻa iā ʻoe nā hōʻailona o LAST, e hana koke lākou.
ʻO ka mea hope loa, leka lawe i ka home:
Inā he mau nīnau kāu, hopohopo, a kānalua paha e pili ana i kāu lāʻau anesthetic, mai kānalua e nīnau i kāu kauka. Aia lākou ma laila e kōkua iā ʻoe. ʻAʻohe mea e makaʻu ai ka Local Anesthetic Systemic Toxicity (LAST) , no ka mea, he mea kakaikahi loa ia a he mau lāʻau lapaʻau maikaʻi. ʻO ka mea nui loa, ʻo ia ka makaʻala i kēia a kamaʻilio ākea me kāu kauka. A laila hiki iā ʻoe ke alo i kekahi lāʻau lapaʻau me ka maluhia o ka noʻonoʻo.
ʻO ka ʻawahia o ka ʻōnaehana anesthetic kūloko, LAST, ka ʻawahia o ka anesthetic, nā hopena ʻaoʻao anesthetic, ʻōnaehana nerve, ʻōnaehana cardiovascular, nā hōʻailona, ka lāʻau lapaʻau
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