Signs/Symptoms
The time frame after a one-time injection of Local Anesthetic within which symptoms of LAST are most likely to appear.
What is within minutes and up to 1 hour?
NOTE: with continuous local anesthetic infusions, LAST symptoms may be very delayed.
LAST is predominantly encountered during which type of anesthetic procedures where large doses of local anesthetic may be administered.
What are regional nerve blocks?
What are Epidurals?
What are Penile and Pudendal blocks?
What IV solution is effective in reversing local anesthetic toxicity?
What is 20% lipid emulsion?
LAST resuscitation calls for reduced doses of this primary ACLS medication due to potential worsening of arrhythmias and poor antidote effect
What is epinephrine?
** start with < 1 mcg/kg
The length of time a patient with "neurological symptoms" of LAST should be monitored.
What is a minimum of two hours?
These evidence-based practices can help lower the incidence of a LAST complication.
What is Ultrasound-guidance for regional anesthesia?
What is using saline to improve needle tip visualization?
What is adding epinephrine to anesthetic to provoke tachycardia if needle tip is intravascular?
First-line treatment of seizures that result from neurotoxic doses of local anesthetic
What are benzodiazepines?
(i.e. lorazepam, midazolam, diazepam, and clonazepam)
Which ACLS standard antiarrthymic is contraindicated for someone experiencing LAST induced arrhythmias?
What is lidocaine?
What are two early "neurologic symptoms" of LAST
What is tongue or circumoral numbness?
What is a metallic taste?
What is tinnitus?
What is dizziness?
A bedside calculation that can be used to reduce the incidence of LAST
What is calculating the weight-based "hourly maximum lock-out dose" for an epidural infusion for a particular patient?
Immediate first action to take if LAST symptoms are recognized
What is stop the injection or the continuous epidural infusion?
These common ACLS medications should be avoided in the resuscitation of LAST
What are beta blockers?
What are calcium channel blockers?
What is vasopressin?
What are other local anesthetics?
Two early signs of cardiotoxicity in LAST
What is hypertension and tachycardia?
Patient-level risk factors for LAST
What is ...?
Age extremes (<16 or >60 years old)
Low muscle mass (i.e. newborns, infants, frailty, malnutrition)
Female gender or Pregnancy
Cardiac disease (arrhythmias, ischemia, low EF, CHF)
Metabolic disease (DM, carnitine deficiency, mitochondrial disease, liver or kidney disease)
Effective airway management in LAST resuscitation is crucial to prevent these respiratory conditions that exacerbate LAST
What is hypoxia, hypoventilation, and acidosis?
For a < 70 kg patient who is experiencing severe LAST symptoms with cardiovascular collapse, this initial IV bolus dose of 20% lipid emulsion is recommended
What is ~1.5 mL/kg of 20% lipid emulsion given over 2-3 minutes?
Following symptoms of "cardiovascular toxicity" related to LAST, the patient should be observed at least this long after recovery
What is monitor for a minimum of 6 hours after resolution of any cardiovascular instability, or 12 hours after resolution of severe cardiotoxic symptoms?
These actions reduce the risk of accidental intravascular injection of a local anesthetic during regional anesthesia.
What is aspiration every 3 ml of local anesthetic injected?
What is using saline to improve needle tip visualization?
What is adding epinephrine to the local anesthetic to trigger tachycardia if needle tip is intravascular?
Ventilation with 100% oxygen is recommended when treating LAST.
What methods can be used to deliver 100% oxygen?
What is a nonrebreather at 10-15 L/min?
What is an ambu bag attached to high flow O2 source?
What is intubation and mechanical ventilation?
If cardiovascular instability continues after administering an initial IV bolus dose of 20% lipid emulsion for LAST, it is recommended to start a continuous infusion of 20% lipids at this rate.
What is 0.25 mL/kg/min?
This rate can be doubled if cardiovascular instability persists