Overdose : מינון יתר

4.9 Overdose
Acute systemic toxicity
Bupivacaine can cause acute toxic effects on the central nervous and cardiovascular systems if given at high doses, particularly if administered intravascularly. However, the dose used in spinal anaesthesia is low and thus the risk of overdose is unlikely. However, when administered concomitantly with other local anaesthetic agents, systemic toxic effects may occur since the toxic effects are additive.

Treatment
In the event of total spinal blockade, ensure adequate ventilation (clear airways, oxygen, if necessary intubation and controlled ventilation). In the event of a fall in blood pressure/bradycardia, administer a vasopressor, preferably with an inotropic effect.

If signs of acute systemic toxicity occur, the administration of local anaesthetic agents should be stopped immediately. Treatment must be given to maintain good ventilation, oxygen supply and circulation.

Always give oxygen. If necessary, perform intubation and controlled ventilation (possibly with hyperventilation). In the event of convulsions, give diazepam. In the event of bradycardia, give atropine. In the event of circulatory shock, give intravenous fluids, dobutamine and if necessary noradrenaline (initially 0.05 µg/kg/min, increased if needed by 0.05 µg/kg/min every 10 minutes), guided by haemodynamic monitoring in more severe cases. Ephedrine can also be tried. In the event of circulatory arrest, resuscitation measures may be indicated for several hours. Treat any acidosis.