Table of contents
Local anesthetic systemic toxicity
What's new
Added 2023 AHA and 2018 ASRA guidelines for the management of local anesthetic systemic toxicity.
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of local anesthetic systemic toxicity are prepared by our editorial team based on guidelines from the American Heart Association (AHA 2023) and the American Society of Regional Anesthesia and Pain Medicine (ASRA 2018).
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Screening and diagnosis
Clinical presentation: as per ASRA 2018 guidelines, recognize that classic descriptions of LAST depict a progression of subjective symptoms of CNS excitement (agitation, auditory changes, metallic taste, or abrupt onset of psychiatric symptoms), followed by seizures, then CNS depression (drowsiness, coma, or respiratory arrest), and near the end of this continuum, initial signs of cardiac toxicity (hypertension, tachycardia, or ventricular arrhythmias) are supplanted by cardiac depression (bradycardia, conduction block, asystole, decreased contractility, and hypotension).
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Respiratory support
Medical management
General principles: as per ASRA 2018 guidelines, use written or electronic checklists as cognitive aids in the management of LAST.
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More topics in this section
Lipid emulsion therapy
Management of seizures
Management of cardiac arrest