Toxicity and Systemic Effects of Local Anesthetic Agents

  • B. G. Covino
Part of the Handbook of Experimental Pharmacology book series (HEP, volume 81)


The primary pharmacological action of local anesthetic agents is the inhibition of the excitation conduction process in peripheral nerves. However, the ability of these agents to stabilize membranes is not limited to peripheral nerves. Any excitable membranes such as exist in heart, brain, neuromuscular junction will be altered by local anesthetic agents if they achieve a sufficient tissue concentration. Regional anesthesia which is properly performed usually does not result in blood levels of local anesthetics which are sufficient to cause systemic effects. However, the accidental intravascular injection or the use of an excessive extravascular amount of local anesthetics can result in blood and tissue levels which will cause profound systemic effects. Most of the systemic effects of local anesthetic agents are considered to be undesirable and toxic in nature. However, some actions have proven to be of therapeutic value. For example, the effect of lidocaine on cardiac membranes is responsible for the efficacy of this agent in the treatment of ventricular dysrhythmias (Rosen et al. 1975). The effect of various local anesthetics on membrane structures in the brain have also proven to be of therapeutic value in the treatment of epilepsy (Bernard and Bohn1965). In general, the primary systemic effects of local anesthetic agents are manifest in the central nervous system and the cardiovascular system.


Pulmonary Vascular Resistance Local Anesthetic Agent Convulsive Activity Anesthetic Potency Negative Inotropic Action 
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© Springer-Verlag Berlin Heidelberg 1987

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  • B. G. Covino

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