Home

Account ⋅ Sign Out

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)....
Show more

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).
B
Show 3 more
Create free account

Respiratory support

Airway management: as per ASRA 2018 guidelines, Ensure prompt and effective airway management to prevent hypoxia, hypercapnia, and acidosis in patients with signs and symptoms of LAST.
B
Create free account

Medical management

General principles: as per ASRA 2018 guidelines, Use written or electronic checklists as cognitive aids in the management of LAST.
A
Create free account

More topics in this section

  • Lipid emulsion therapy

  • Management of seizures

  • Management of cardiac arrest

Inpatient care

Clinical monitoring
As per ASRA 2018 guidelines:
Obtain monitoring for at least 4-6 hours in patients with a significant cardiovascular event.
B
Obtain monitor for at least 2 hours in patients with an event limited to quickly resolving central nervous symptoms.
B
Create free account

Therapeutic procedures

Extracorporeal life support: as per AHA 2023 guidelines, Consider initiating extracorporeal life support, such as venoarterial ECMO, for the management of refractory cardiogenic shock in patients with LAST.
C
Create free account

Preventative measures

Prevention: as per ASRA 2018 guidelines, Use ultrasound guidance to reduce the risk of LAST in patients undergoing peripheral nerve block.
B
Show 7 more
Create free account