This handout is for local anesthetic systemic toxicity (last). Your care team identified this based on: cns excitation (perioral numbness, tinnitus, metallic taste, agitation, seizure) after local anesthetic block (asra 2020).
Other reasons your team may use this plan: cardiovascular collapse (dysrhythmia, hypotension, arrest) after local anesthetic injection or infusion (asra 2020); local anesthetic dose at or above maximum (bupivacaine >2 mg/kg, ropivacaine >3 mg/kg, lidocaine >7 mg/kg with epi) (asra 2020); inadvertent iv / intravascular la injection during regional block (asra 2020).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| stop_local_anesthetic_injection | STOP all LA infusion / injection | IV | immediate | Halt ongoing exposure (ASRA 2020) |
| oxygen_100_percent_airway_support | 100% FiO2 via BVM; intubate if airway compromise / persistent seizure | inhaled | continuous | Hypoxia and acidosis worsen LA cardiotoxicity (ASRA 2020) |
| call_for_help_and_lipid_emulsion | Activate LAST cart; request 20% lipid emulsion to bedside | team_call | once | LAST cart at every site administering LA (ASRA 2020) |
Plan: Local Anesthetic Systemic Toxicity — ASRA 2020 checklist: STOP injection, airway/O2, benzodiazepine for seizure, 20% lipid emulsion, low-dose epinephrine, amiodarone
Call 911 or go to the nearest emergency room right away if you have:
Report event to LipidRescue registry; investigate dose/technique cause; consider plain ropivacaine over bupivacaine for high-dose blocks; counsel patient (ASRA 2020)
Guideline: ASRA 2020 Local Anesthetic Systemic Toxicity Checklist (Neal, Neal, Weinberg — Reg Anesth Pain Med 2020) — current ASRA practice advisory; complemented by Weinberg 1998 (Anesthesiology — lipid emulsion rat model) and Rosenblatt 2006 (Anesthesiology — first successful human lipid rescue case)