LAST Mechanisms and Clinical Presentation

Charles Berde, MD, PhD, is the Sara Page Mayo Chair in Pediatric Pain Medicine and a Professor of Anaesthesia at Harvard Medical School. As a co-founder of the Pain Treatment Center at Boston Children's Hospital, he has spent decades at the forefront of pediatric analgesic pharmacology and the development of novel local anesthetics. His extensive translational research focuses on local anesthetic mechanisms and prolonged-duration formulations, making him a preeminent authority on the physiological impacts and safety profiles of these agents in neonates and children. A recipient of the Myron Yaster Lifetime Achievement Award from the Society for Pediatric Anesthesia, Dr. Berde brings unparalleled expertise to the discussion of managing and preventing local anesthetic systemic toxicity (LAST) within the high-stakes environments of the PICU and pediatric operating rooms.

Guest Conflicts of Interest (COI)

• Algavita Bio: Collaborator/Developer of novel, prolonged-duration local anesthetics.
• Quiver Bioscience: Unpaid Scientific Advisor and co-PI on an NINDS-HEAL grant focused on rare disease pain treatments.
• Latigo Biotherapeutics: Scientific Advisor and recipient of past research support for novel analgesics development.
• Algos: Scientific Advisor for non-opioid analgesics development.

Learning Objective: By the end of this podcast, listeners should be able to discuss an evidence-based and expert-guided approach to the management of local anesthetic systemic toxicity (LAST) in children.

References:

Patient and Doctor Reconcile for Greater Good

Berde CB. Toxicity of local anesthetics in infants and children. J Pediatr. 1993 May;122(5 Pt 2):S14-20. doi: 10.1016/s0022-3476(11)80004-1.

McMahon K, Paster J, Baker KA. Local anesthetic systemic toxicity in the pediatric patient. Am J Emerg Med. 2022 Apr;54:325.e3-325.e6. doi: 10.1016/j.ajem.2021.10.021. Epub 2021 Oct 25. 

Lavonas et al. 2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning: An Update to the AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2023 Oct 17;148(16):e149-e184. doi: 10.1161/CIR.0000000000001161. Epub 2023 Sep 18. 

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Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected].  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!