Local Anesthetic Systemic Toxicity Treatment

Local anesthetic systemic toxicity is a systemic adverse reaction to the administration of a local anesthetic. Children are at particular risk for local anesthetic systemic toxicity given their smaller body weight. In cases of cardiac arrest from local anesthetic systemic toxicity, prolonged chest compressions or extracardiac membrane oxygenation may be indicated because cardiac toxicity may last for several hours. Under general anesthesia, some of the early central nervous system signs of local anesthetic systemic toxicity, such as altered consciousness and seizures, may be masked, and the first indicator of local anesthetic systemic toxicity may be hemodynamic instability or cardiac arrest. Nevertheless, in a multicenter database of more than 100,000 consecutive pediatric regional anesthetics, local anesthetic systemic toxicity did not occur more often in pediatric patients undergoing regional anesthesia under general anesthesia compared with patients undergoing regional anesthesia awake or under sedation, and was overall very rare (2.2/10,000 and 15.2/10,000, respectively). In cases of cardiac arrest from local anesthetic systemic toxicity, prolonged chest compressions or extracardiac membrane oxygenation (ECMO) may be required because toxicity may last for several hours or more. Aggressive resuscitation and early administration of intralipid are the most important steps.

Behcet’s disease and severe inflammatory reaction to 23-valent pneumococcal polysaccharide vaccine: a case report and review of literature

Current European League Against Rheumatism guidelines strongly recommend considering the use of polysaccharide pneumococcal vaccine in all patients with autoimmune inflammatory rheumatic diseases. However, a previously published case series reports of reactions to 23-valent pneumococcal polysaccharide vaccine in patients with Behcet’s disease. The purpose of this report is to present a similar case of a systemic adverse reaction in a patient with Behcet’s disease to 23-valent pneumococcal polysaccharide vaccine.

In Vivo Evaluation of Biodegradability and Biocompatibility of Fe30Mn Alloy

Objectives This study aims to evaluate the biodegradability and biocompatibility of an alloy of iron and manganese (Fe30Mn) in a bone model in vivo. Methods Resorption of a Fe30Mn wire was compared with traditional permanent 316L stainless steel (SS) wire after bilateral transcondylar femoral implantation in 12 rats. Evaluation of biodegradation over 6 months was performed using radiography, post-mortem histology and microscopic implant surface analysis. Results Corrosion and resorption of the novel iron-manganese implant with formation of an iron oxide corrosion layer was noted on all post-mortem histological sections and macroscopic specimens (corrosion fraction of 0.84 and 0 for Fe30Mn and 316L SS, respectively). Increased bone ongrowth was observed at the wire-bone interface (bone ongrowth fraction of 0.61 and 0.34 for Fe30Mn and 316L SS, respectively). Occasionally, poorly stained newly formed bone and necrotic bone in contact with corrosion was seen. In bone marrow, Fe30Mn alloy was scored as a mild local irritant compared with 316L SS (biocompatibility score of 8.8 and 5.3, respectively). There was no evidence of systemic adverse reaction. Clinical Significance Resorbable iron-manganese alloys may offer a promising alternative to permanent metallic implants. Further in vivo studies to control implant resorption at a rate suitable for fracture healing and to confirm the biocompatibility and biosafety of the resorbable Fe30Mn metallic implant are necessary prior to use in clinical settings.