All articles

Checklist for Treatment of Local Anesthetic Systemic Toxicity

Download the full printable checklist, or see an overview below.

The Pharmacologic Treatment of Local Anesthetic Systemic Toxicity (LAST) is Different from Other Cardiac Arrest Scenarios

  • Get Help
  • Initial Focus
    • Airway management: ventilate with 100% oxygen
    • Seizure suppression: benzodiazepines are preferred; AVOID propofol in patients having signs of cardiovascular instability
    • Alert the nearest facility having cardiopulmonary bypass capability
  • Management of Cardiac Arrhythmias
    • Basic and Advanced Cardiac Life Support (ACLS) will require adjustment of medications and perhaps prolonged effort
    • AVOID vasopressin, calcium channel blockers, beta blockers, or local anesthetic
    • REDUCE individual epinephrine doses to <1 mcg/kg
  • Lipid Emulsion (20%) Therapy (values in parenthesis are for 70kg patient)
    • Bolus 1.5 mL/kg (lean body mass) intravenously over 1 minute (~100mL)
    • Continuous infusion 0.25 mL/kg/min (~18 mL/min; adjust by roller clamp)
    • Repeat bolus once or twice for persistent cardiovascular collapse
    • Double the infusion rate to 0.5 mL/kg/min if blood pressure remains low
    • Continue infusion for at least 10 minutes after attaining circulatory stability
    • Recommended upper limit: Approximately 10 mL/kg lipid emulsion over the first 30 minutes
  • Post LAST events at 

Download the full printable checklist