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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

* Reduce individual epinephrine boluses to ≤ 1 mcg/kg

* Avoid vasopressin, calcium channel blocks, beta blockers, or other local anesthetics


  • Stop injecting local anesthetic
  • Get help
    • Consider lipid emulsion therapy at the first sign of a serious LAST event
    • Call for the LAST Rescue Kit
    • Alert the nearest cardiopulmonary bypass team — resuscitation may be prolonged
  • Airway management
    • Ventilate with 100% oxygen / avoid hyperventilation / advanced airway device if necessary
  • Control seizures
    • Benzodiazepines preferred
    • Avoid large doses of propofol, especially in hemodynamically unstable patients
  • Treat hypotension and bradycardia — If pulseless, start CPR
  • Continue monitoring
    • At least 4-6 hours after a cardiovascular event
    • Or, at least 2 hours after a limited CNS event
  • Do not exceed 12 mL/kg lipid emulsion (particularly important in the small adult or child)
    • Much smaller doses are typically needed for LAST treatment

Download the full printable checklist here.

Review the full article here.