LAST (Local Anesthetic Systemic Toxicity)

Question 1

List some symptoms of LAST.

Local Anesthetic Systemic Toxicity

Answer 1

Analgesia, lightheadedness, tinnitis, tongue/circumoral numbness, tingling of mouth, funny/metallic taste, SZ, LOC, respiratory arrest, cardiovascular arrest.

Question 2

Explain the lipid rescue for LAST.

Answer 2

In addition to CPR -
1. bolus 20% intralipids 0.25ml/kg/min
2. circulate lipids w/ CPR
3. repeat bolus q3-5 mins UP TO 3ml/kg total dose until ROSC.
4. ⬆ infusion to 0.5ml/kg/min if BP declines - continue infusion until hemodynamically stable.

*MAX DOSE: 8ml/kg

If you dont have 20% lipids immediately handy - give what you have until you obtain the 20%.