Marcain Spinal Heavy Overdosage

Acute systemic toxicity: Marcain Spinal Heavy used as recommended is not likely to cause blood levels high enough to cause systemic toxicity. However, if other local anaesthetics are concomitantly administered, toxic effects are additive and may cause systemic toxic reactions.
Treatment of acute systemic toxicity: If signs of acute systemic toxicity or total spinal block appear, injection of the local anaesthetic should be stopped immediately and cardiovascular and neurological symptoms (convulsions, CNS depression) must be treated adequately.
If circulatory arrest should occur, immediate cardiopulmonary resuscitation should be instituted. Optimal oxygenation and ventilation and circulatory support as well as treatment of acidosis are of vital importance.
If cardiovascular depression is evident (hypotension, bradycardia), ephedrine 5-10 mg i.v. should be given and this dose should be repeated, if necessary, after 2-3 minutes. Children should be given ephedrine doses commensurate with their age and weight.
If convulsions due to systemic toxicity occurs, the objective of treatment is to maintain oxygenation, stop the convulsions and support the circulation. Oxygen must be given and ventilation assisted, when necessary (mask and bag or tracheal intubation). An anticonvulsant should be given i.v. if the convulsions do not stop spontaneously in 15-20 seconds. Thiopentone sodium 1-3 mg/kg i.v. will abort the convulsions rapidly. Alternatively diazepam 0.1 mg/kg i.v. may be used, although its action will be slow. Prolonged convulsions may jeopardize the patient's ventilation and oxygenation. If so, injection of a muscle relaxant (e.g. succinylcholine 1 mg/kg) will rapidly stop the convulsions so that ventilation and oxygenation can be controlled. Endotracheal intubation must be considered in such situations.