GasGasGas - Anaesthetic Science for Anaesthesia! LAST: Local Anaesthetic Systemic Toxicity Management for Anaesthetists/Emergency Docs
Aug 14, 2025
Explore the critical topic of local anaesthetic systemic toxicity (LAST) and its implications in regional anaesthesia. Learn about the risks from different injection sites, toxic dose limits, and emergency management protocols. Discover the significance of immediate actions during LAST, including resuscitation priorities and lipid emulsion treatment. Delve into changing patterns of LAST incidence, mitigating strategies, and the importance of dose adjustments for high-risk patients. This episode emphasizes vigilance and clear communication for safe anaesthetic practices.
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Systemic Targets Of Local Anaesthetics
- Local anaesthetics are chiefly sodium channel blockers and affect CNS and myocardium as well as peripheral nerves.
- Amide agents (bupivacaine, ropivacaine, lidocaine) pose greater systemic toxicity risk than esters due to hepatic clearance.
Immediate Steps For A Suspected LAST
- Stop the surgeon, declare an emergency, give 100% oxygen and call for help immediately when LAST is suspected.
- Delegate retrieval of the AAGBI quick reference and required kits so you can focus on immediate resuscitation tasks.
Resuscitation And Intralipid Regimen
- During LAST cardiac arrest, secure airway, ventilate with 100% oxygen, treat seizures with benzodiazepines and avoid propofol.
- Give a 1.5 mL·kg−1 Intralipid bolus over 1 minute, then an infusion at 15 mL·kg−1·hr−1 and prepare repeat boluses if needed.