General Knowledge
This is what L.A.S.T. stands for
Local Anesthetic Systemic Toxicity
The MAJORITY of event occur in this timeframe
w/in 5 minutes of injection
These sx’s often follow CNS sx’s
CV
Initial management is focused on this
Airway mgmt
This is the dose of the initial IL bolus
1.5 mL/kg
The majority of victims are this gender
Female
Symptoms are divided into these 2 groups
CV and CNS
However, this later sign is a CNS sx
seizures
Seizures are treated with these
Benzodiazepines
The bolus should be repeated this often
Every 3-5 minutes
The most common cause of LAST
Inadvertant injection into vasculature
Initial signs are usually from this group
CNS
These CV sx’s are the first signs of cardiac toxicity
Hypotension and bradycardia
This colloid is the mainstay of LAST treatment
Intralipids 20%
The maximum dose of IL
8-10 mL/kg
The most common regional technique asso. w/ LAST
Epidural (33%)
This might lead to a delay of recognition of initial signs of LAST
Sedation (for regional block)
Hypotension is treated with this
IV NS infusion
This ACLS drug should be i’d to <1 mcg/kg
Epinephrine
The infusion rate of the IL infusion
0.25 mL/kg/min
The majority of events are related to this drug
Bupivicaine
Five examples of early CNS sx’s
Agitation, confusion, dizziness, tinnitus, perioral munbness, metallic taste, drowsiness
Five examples of CV sx’s
HTN, dyspnea, ST changes, asystole, tachycardia, V-tach, V-fib
These 4 drugs should be AVOIDED during treatment
Vasopressin, CCB, bB, locals
This should be instituted for patients not responding to IL treatment
Cardiopulmonary bypass