Overdose : מינון יתר

4.9.     Overdose
Acute systemic toxicity
When given at a high dose and particularly when administered intravascularly, bupivacaine can cause acute toxic effects of a central nervous system or cardiovascular character.
However, the dose used in spinal anaesthesia is low, and thus the risk of overdose is unlikely. Systemic toxic effects may arise, however, when administered concurrently with other local anaesthetics due to the additive nature of the toxic effects.

Treatment
Adequate ventilation (free airways, oxygen, and intubation and controlled respiration if required) must be ensured in the case of total spinal blockade. In the case of a fall in blood pressure or bradycardia, administer a vasopressor, preferably with inotropic effect.

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

Oxygen must always be administered. Where required, intubation and controlled ventilation (possibly with hyperventilation). In the case of cramps: diazepam. In the case of bradycardia: atropine. In the case of circulatory failure: intravenous fluids, dobutamine and possibly noradrenaline (initially 0.05 µg/kg/min, to be increased when required by 0.05 µg/kg/min every 10 minutes); in severe cases under guidance of haemodynamic monitoring. Ephedrine can also be tested. In case of circulatory arrest, resuscitation measures over several hours may be warranted. Treat any acidosis.