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©The Author(s) 2022.
World J Orthop. Jan 18, 2022; 13(1): 11-35
Published online Jan 18, 2022. doi: 10.5312/wjo.v13.i1.11
Published online Jan 18, 2022. doi: 10.5312/wjo.v13.i1.11
Table 4 Clinical presentation and management of local anesthetic systemic toxicity
Local anesthetic systemic toxicity (LAST) |
Clinical presentation of LAST |
1 Dizziness, drowsiness, tinnitus, perioral numbness |
2 Muscle twitching and tremors |
3 Seizures |
4 CNS depression, coma |
5 Hypertension, tachycardia |
6 Myocardial depression, ventricular arrhythmias, conduction delays |
7 EKG changes: Prolonged PR, QRS; T-wave changes |
8 Cardiovascular collapse |
Management of LAST |
1 Call for help |
2 Call for LAST rescue kit |
3 Consider early lipid emulsion administration |
(1) Under 70 kg: Bolus 1.5 mL/kg over 2-3 min, Infuse 0.25 mL/kg/min. Repeat bolus or double the infusion rate if the patient remains unstable |
(2) Over 70 kg: Bolus approximately 100 mL over 2-3 min, infuse approximately 250 mL over 15-20 min. Repeat bolus or double the infusion rate if the patient remains unstable |
(3) If the patient is stable, continue lipid emulsion ≥ 15 min after hemodynamic stability. Maximum lipid dose: 12 mL/kg |
4 Seizure |
(1) Airway management |
(2) Benzodiazepine |
(3) Consider low dose propofol |
5 Arrhythmia or cardiovascular Instability |
(1) Epinephrine: Administered at lower dose than ACLS dosing, start with ≤ 1 mcg/kg |
(2) Avoid local anesthetics, beta-blockers, vasopressin, calcium channel blockers |
(3) Consider alerting cardiopulmonary bypass team |
6 Close monitoring |
Once stable, continue close monitoring: 2 h after seizure, 4-6 h after cardiovascular instability, and as clinically appropriate after cardiac arrest |
- Citation: Kamel I, Ahmed MF, Sethi A. Regional anesthesia for orthopedic procedures: What orthopedic surgeons need to know. World J Orthop 2022; 13(1): 11-35
- URL: https://www.wjgnet.com/2218-5836/full/v13/i1/11.htm
- DOI: https://dx.doi.org/10.5312/wjo.v13.i1.11