Clorotekal Disease Interactions

Lumbar and caudal epidural anesthesia should be used with extreme caution in persons with neurological disease, spinal deformities, septicemia, and severe hypertension.

Local anesthetics such as chloroprocaine should be used with caution in patients with impaired cardiovascular function since they may be less able to compensate for functional changes associated with the prolongation of A-V conduction produced by these drugs.

Local anesthetic injections containing a vasoconstrictor should be used cautiously and in carefully circumscribed quantities in areas of the body supplied by end arteries or having otherwise compromised blood supply. Patients with peripheral vascular disease and those with hypertensive vascular disease may exhibit exaggerated vasoconstrictor response. Ischemic injury or necrosis may result. Caution is advised.

Local anesthetics such as chloroprocaine, should be used with caution in patients with hypotension or heart block.

Since ester-type local anesthetics like chloroprocaine are hydrolyzed by plasma cholinesterase produced by the liver, chloroprocaine should be used cautiously in patients with hepatic disease.

Cases of methemoglobinemia have been reported in association with local anesthetic use such as chloroprocaine. Although all patients are at risk for methemoglobinemia, patients with glucose- 6-phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, infants under 6 months of age, and concurrent exposure to oxidizing agents or their metabolites are more susceptible to developing clinical manifestations of the condition. If local anesthetics must be used in these patients, close monitoring for symptoms and signs of methemoglobinemia is recommended.

Chloroprocaine and its metabolites are known to be substantially excreted by the kidney, and the risk of toxic reactions may be greater in patients with impaired renal function. The elderly and patients with decreased renal function, might need cautious dose selection and renal function monitoring.