EM SAQs · Local anaesthesia & topical agents
Maximum dose calculation and LAST rescue
ACEM-style SAQ on LA arithmetic from a given local maximum and lipid bolus for LAST.
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Dose calculation (given local maximum). 80 × 7 = 560 mg. 1% = 10 mg/mL → 56 mL. State aloud before drawing up; aspirate every aliquot. Lidocaine milligram ceilings are not in the fetched ASRA abstracts — the 7 mg/kg figure here is the stem’s departmental number.[1]
LAST management. Neal 2018: presentations have shifted toward delayed LAST with ultrasound, infiltration and infusions. Stop injection; 100% oxygen; benzodiazepine for seizures; lipid-emulsion bolus 1.5 mL/kg (Karaoglu recommended bolus; ~120 mL in this 80 kg adult). Infusion millilitre-per-minute recipes are not in the fetched ASRA abstracts — follow the printed 2020 checklist. Fettiplace: lipid shuttle plus cardiotonic/postconditioning. Do not treat LAST with more lidocaine.[2][3][4]
References4ShowHide
- [1]Neal JM, Neal EJ, Weinberg GL. American Society of Regional Anesthesia and Pain Medicine Local Anesthetic Systemic Toxicity checklist: 2020 version Reg Anesth Pain Med, 2021.PMID 33148630
- [2]Neal JM, Barrington MJ, Fettiplace MR, Gitman M, Memtsoudis SG, Mörwald EE, Rubin DS, Weinberg G. The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: Executive Summary 2017 Reg Anesth Pain Med, 2018.PMID 29356773
- [3]Karaoglu RO, Toprak Karaoglu A, Kumas Solak S, Sevdi MS, Demirgan S. Awareness and preparedness for local anesthetic systemic toxicity among surgical clinicians: a multi-center cross-sectional survey study BMC Anesthesiol, 2026.PMID 42399827
- [4]Fettiplace MR, Weinberg G. The Mechanisms Underlying Lipid Resuscitation Therapy Reg Anesth Pain Med, 2018.PMID 29356774