Local Anesthetic Systemic Toxicity 2010

Regional Anesthesia and Pain Medicine:
March/April 2010 - Volume 35 - Issue 2 - pp 152-193
doi: 10.1097/AAP.0b013e3181d22fcd

ASRA Practice Advisory on Local Anesthetic Systemic Toxicity

Neal, Joseph M.; Bernards, Christopher M.; Butterworth, John F. IV; Di Gregorio, Guido; Drasner, Kenneth; Hejtmanek, Michael R.; Mulroy, Michael F.; Rosenquist, Richard W.; Weinberg, Guy L.

Local anesthetics are widely and commonly used throughout medical and dental practice. Although it is rare for patients to manifest serious adverse effects or experience complications secondary to local anesthetic administration, adverse events do occur. These range from the mild symptoms that may follow systemic absorption of local anesthetic from a correctly sited and appropriately dosed regional anesthetic procedure to major central nervous system (CNS) and/or cardiac toxicity (most often from unintentional intravascular injection) that can result in disability or death. A variety of factors influence the likelihood and severity of local anesthetic systemic toxicity (LAST), including individual patient risk factors, concurrent medications, location and technique of block, specific local anesthetic compound, total local anesthetic dose (the product of concentration x volume), timeliness of detection, and adequacy of treatment. Read more...