Local Anaesthetic Toxicity Flashcards
What are the classic signs and symptoms of local anaesthetic toxicity?
- Tingling in lips and tongue
- Metallic taste
- Dysphoria
- Blurred vision
- Tinnitus
- Restlessness
- Confusion
- Loss of consciousness
- Seizures
- Hypotension
- Cardiovascular collapse
What would be some common differential diagnoses for LA toxicity?
- Vasovagal episode
- Anxiety
- Anaphylaxis
- Total spinal
- Epilepsy
Outline an immediate management strategy for local anaesthetic toxicity
- Cease administration of local anaesthetic
- Call for help
- ABC approach
- Intubate if dec LOC
- Hyperventilate if possible as acidosis increases cardiotoxicity of local anaesthetics
- Manage hypotension with pressors and IV fluids
- Give atropine for bradycardia
- If presents in cardiac arrest - commence CPR and give Intralipid
- Manage tachyarrythmias with Amiodarone and Intralipid
What is the dose for IV 20% lipid emulsion?
1.5mL/kg over 1 min as a bolus
Commence infusion at 15mLs/kg/hr
Repeat bolus after 5 mins if CVS stability has not been achieved
Maximum of 3 boluses (including initial)
If still not stable after 3 boluses - increase infusion rate to 30mLs/kg/hr
DO NOT exceed maxiumum cumulative dose of 12mLs/kg
What options are available for management of seizures associated with LA toxicity?
As per management of refractory seizures in epilepsy - IV Midazolam 5mg IV, Propofol 50mg increments, Thiopentone 50mg increments
