Introduction Local Anesthetic Systemic Toxicity (LAST) is a rare complication of regional anesthesia. Pregnancy is a risk factor due to gestational physiologic changes. Labor and disorders of pregnancy can mask or delay symptoms of LAST, slowing appropriate intervention. This study examines LAST within a larger cohort and identifies features that help distinguish LAST in pregnancy from nonpregnant patients. Methods The TriNetX database was used to compare pregnant and nonpregnant patients with LAST from 2013 to 2023. Cohorts were matched on age, race, obesity status, diabetes, metabolic disorders, local anesthetic type, and cardiovascular, liver, kidney, and respiratory disease. Outcomes included prodromal symptoms of LAST and symptoms of cardiac and central nervous system excitation and depression. Results Matching occurred for 276 pregnant and 276 nonpregnant patients. Pregnant cohorts had a significantly higher risk of cardiac depression (RR, 1.96 [95% CI 1.44 - 2.66], p<0.01) and significantly lower risk of cardiac excitation (RR, 0.38 [95% CI 0.22-0.63], p<0.01), prodromal symptoms (RR, 0.17 [95% CI 0.09 - 0.33], p<0.01), central nervous system excitation (RR, 0.44 [95% CI 0.21-0.90], p=0.02), and central nervous system depression (RR, 0.24 [95% CI 0.13-0.48], p<0.01) than nonpregnant cohorts. Conclusion Pregnant patients with LAST were more likely to exhibit cardiac depression and less likely to manifest prodromal symptoms, cardiac excitation, and central nervous system excitation and depression than nonpregnant patients. Physiological changes during pregnancy and prompt detection and treatment may explain these differences. These findings highlight the variable nature of LAST and how pregnancy may influence its clinical presentation.

中文翻译：

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妊娠期局部麻醉药全身毒性：回顾性队列分析

简介 局部麻醉全身毒性 (LAST) 是局部麻醉的罕见并发症。由于妊娠生理变化，怀孕是一个危险因素。分娩和妊娠障碍可能会掩盖或延迟 LAST 症状，从而减慢适当的干预措施。这项研究在更大的队列中检查了 LAST，并确定了有助于区分妊娠患者和非妊娠患者 LAST 的特征。方法 使用 TriNetX 数据库比较 2013 年至 2023 年接受 LAST 治疗的怀孕和非怀孕患者。队列在年龄、种族、肥胖状况、糖尿病、代谢紊乱、局部麻醉类型以及心血管、肝脏、肾脏和呼吸系统疾病方面进行匹配。结果包括 LAST 的前驱症状以及心脏和中枢神经系统兴奋和抑郁的症状。结果 276 名怀孕患者和 276 名非怀孕患者进行了匹配。怀孕队列的心脏抑郁风险显着较高（RR，1.96 [95% CI 1.44 - 2.66]，p<0.01），心脏兴奋风险显着较低（RR，0.38 [95% CI 0.22-0.63]，p <0.01） ）、前驱症状（RR，0.17 [95% CI 0.09 - 0.33]，p<0.01）、中枢神经系统兴奋（RR，0.44 [95% CI 0.21-0.90]，p=0.02）和中枢神经系统抑制（ RR，0.24 [95% CI 0.13-0.48]，p<0.01）比非妊娠队列。结论 与非妊娠患者相比，LAST 妊娠患者更容易出现心脏抑郁，而较少出现前驱症状、心脏兴奋、中枢神经系统兴奋和抑郁。怀孕期间的生理变化以及及时检测和治疗可以解释这些差异。这些发现强调了 LAST 的可变性质以及妊娠如何影响其临床表现。