II. Definitions

  1. LAST
    1. Local Anesthetic Systemic Toxicity

III. Mechanism

  1. Vascular injection of large dose of local anesthetic

IV. Adverse Effects: Lidocaine

  1. Neurologic
    1. Tinnitus
    2. Dizziness
    3. Circumoral or Tongue numbness
    4. Confusion
    5. Seizure
  2. Cardiovascular
    1. Bradycardia
    2. Hypotension
    3. Ventricular arrhythmia (including VT/VF)
    4. AV Block
    5. Palpitations

V. Adverse Effects: Bupivicaine

  1. High risk of serious arrhythmia or Cardiac Arrest if injected intravascularly
  2. Much more toxic systemically than Lidocaine
    1. Highly lipophilic
    2. High Sodium channel affinity

VI. Management

  1. ABC Management
  2. Seizure Management
    1. See Status Epilepticus
    2. Benzodiazepines are preferred first-line agents
    3. Avoid Propofol (due to hemodynamic instability)
  3. Arrhythmia Management
    1. See ABC Management (follow ACLS protocols)
    2. Avoid vasopressin, Calcium Channel Blockers, Beta Blockers
    3. Decrease Epinephrine dose to 1 mcg/kg
  4. Intralipid 20% emulsion
    1. Bolus 1.5 mg/kg (Lean Body Mass) IV over 2 minutes
      1. May repeat 1-2x for refractory cardiovascular collapse
    2. Continuous infusion 0.25 ml/kg/min for at least 10 min after circulatory stability
      1. May increase to 0.50 ml/kg/min if persistent Hypotension
    3. See Intravenous Lipid Emulsion
    4. Primarily for lipophilic drug toxicity (esp. bupivicaine)

VII. References

  1. Acker, Koval and Leeper (2017) Crit Dec Emerg Med 31(4): 3-13
  2. Burch (2011) Am J Health Syst Pharm 68(2):125-9 +PMID:21200058 [PubMed]

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Ontology: Local anesthetic agent poisoning (C0473977)

Concepts Injury or Poisoning (T037)
ICD10 T41.3 , T41.3X1
SnomedCT 212652002, 111764002
English Local anaesth.poisoning NOS, Local anaesthetic poisoning, Local anaesthetic poisoning NOS, Local anaesthetics, Local anesthetic agent poisoning, Local anesthetic poisoning, Local anesthetic poisoning NOS, Local anesthetics, Poisoning by local anaesthetics, Poisoning by local anesthetics, local anesthetic toxicity, local anesthetic toxicity (diagnosis), toxicity from local anesthetics, Poisoning by local anesthetics NOS, Local anesthetic poisoning NOS (disorder), Local anaesthetic agent poisoning, Poisoning by local anaesthetic, Poisoning by local anesthetic (disorder), Poisoning by local anesthetic
German Vergiftung: Lokalanaesthetika
Korean 국소성 마취제에 의한 중독
Spanish intoxicación por anestésico local, SAI, intoxicación por anestésico local, SAI (trastorno), intoxicación por agente anestésico local, intoxicación por anestésico local (trastorno), intoxicación por anestésico local
Dutch Lokale anaesthetica