Anaes SAQs · Local anaesthetic pharmacology
Local anaesthetic systemic toxicity — recognition and management
The LAST SAQ — the prodrome (perioral tingling, tinnitus), seizures, cardiovascular collapse (especially bupivacaine's refractory arrest), the lipid emulsion protocol (1.5 mL/kg bolus + infusion), and the modified ACLS. Anchored to the ASRA 2020 checklist.
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ANZCAFRCAABAEDAIC
Prompt
Describe the clinical features of local anaesthetic systemic toxicity (LAST), the sequence of CNS and cardiovascular signs, and the immediate management including the role of lipid emulsion.
Question
Describe the clinical features of local anaesthetic systemic toxicity (LAST), the sequence of CNS and cardiovascular signs, and the immediate management including the role of lipid emulsion.
References3ShowHide
- [1]Neal JM, Neal EJ, Weinberg GL. American Society of Regional Anesthesia and Pain Medicine Local Anesthetic Systemic Toxicity checklist: 2020 version. Regional Anesthesia and Pain Medicine, 2021.PMID 33148630
- [2]Fettiplace MR, Weinberg G. The Mechanisms Underlying Lipid Resuscitation Therapy. Regional Anesthesia and Pain Medicine, 2018.PMID 29356774
- [3]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.