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Checklist for Treatment of Local Anesthetic Systemic Toxicity

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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.