What should I do with a drug overdose caused by procaine?

*For medical professionals only

Clinical decision-making can be simpler

Overdose[1]

Drug overdose reactions caused by local anesthetics are usually associated with high blood concentrations that occur during the use of local anesthetics, or accidental subarachnoid injections.

Recent clinical data show that patients with convulsions caused by local anesthetic overdose can rapidly develop hypoxia, carbon dioxide retention, and acidosis within one minute of the onset of convulsions.

If left untreated, convulsive symptoms of hypoxia, carbon dioxide retention, and acidosis, coupled with myocardial inhibition due to the direct action of local anesthetics, can lead to fatal adverse reactions such as arrhythmias, bradycardia, cardiac arrest, ventricular fibrillation, or cardiac arrest, and respiratory system abnormalities, including apnea.

Accidental subarachnoid injection of local anesthetics can cause hypoventilation or apnea, and can lead to cardiac arrest if respiratory support is not established in time.

Treatment scheme[1]

Prophylaxis should be considered first, and after procaine administration, the patient's vital signs should be continuously monitored to confirm the patient's state of consciousness in time after each local anesthetic injection. If the patient's condition changes, oxygen should be supplied in time.

For systemic toxicity, hypoventilation, or apnea caused by accidental subarachnoid injection, the first step should be to immediately establish or maintain airway patency and provide positive pressure oxygen through a mask to prevent convulsions.

If necessary, convulsions can be controlled with medications.

Intravenous bolus of 50 mg to 100 mg of succinylcholine can paralyze the patient and maintain ventilation without inhibiting the central nervous system or cardiovascular system.

Intravenous bolus of 5 mg to 10 mg of diazepam or 50 mg to 100 mg of sodium thiopental may promote ventilation and counteract central nervous system stimulation, but these drugs also inhibit central nervous system, respiratory, and cardiac function, worsen post-attack depression, and may be at risk of apnea.

Intravenous barbiturates, anticonvulsants, or muscle relaxants are given, but only by someone familiar with their use.

Immediately after the taking of ventilation measures, the adequacy of the patient's circulation should be assessed. Supportive care with circulatory inhibition may require intravenous fluids and, depending on the clinical situation, vasopressors (ephedrine, epinephrine) to enhance myocardial contractility.

If oxygen is not effective through a mask or if prolonged respiratory support is required, patients can be endotracheal intubated using drugs and techniques familiar to clinicians.

In the event of cardiac arrest, standard CPR measures should be taken to extend the duration of CPR if necessary. It has been reported that after a long period of resuscitation, the patient's heartbeat recovered.

bibliography:

[1] Product Information: NOVOCAIN-procaine hydrochloride injection, solution, Hospira, Inc.April 16, 2007.

Source: Clinical Pharmacy Channel of the Medical Community

Editor-in-charge: Zheng Huaju

Proofreader: Zang Hengjia

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