1.21 Local Anaesthetic Toxicity

Question 1

DDx after LA top up

Answer 1

1. LAST

2 .Cardiac:
Arrest
Arr
CVA
Post Hypo

3. Resp
   - PTX tension
   - PE
   - Hypoxia hyper carb
4. Other
   Hypovolaemia second to RTA
   Vasovagal
   drugs opiate

Question 2

Signs of LAST

Answer 2

CNS:
Peri-oral tinging
Reduced LOC
Coma
Seizures

CVS
arrhythmia
- VF / VT / Asystole

Question 3

LAST Management

Immediate

Answer 3

Stop injecting LA
Call help

Secure airway if approp

Ventilation w/ 100%O2

Confirm IV access
Manage seizures w/ standard hypnot / bzd
propofol / thio

Attach cardiac monitoring - rhythm

Commence CPR prn
Rx Arrh - ACLS

Lengthy resus may be required

CPB / ECMO?

Question 4

LAST

Specific emulsion Tx

Answer 4

CPR continued through

Blood sample
before and after admin
and hourly interval
measure LA / TG level

IV bolus
Intralipid 20%
1.5ml/kg over 1 min

Start IV infusion
intralipid 20%
15ml/kg/hour

If adequacy C not restored
or deteriorates after 5 min

Repeat bolus x2
@5min intervals
Max of 3 boluses

Increase infusion rate to 30ml/kg/hour over 10min
if adequate circulation not restored

Continue infusion until stable C
max cumulative dose 12ml/kg

Question 5

Intralipid dose

Answer 5

IV bolus
Intralipid 20%
1.5ml/kg over 1 min

Start IV infusion
intralipid 20%
15ml/kg/hour

Question 6

Follow up

Answer 6

Care in HDU / ICU

Monitor pancreatitis
reg med r/v
serum amylase / lipase level x2/7
Report case