Treatment of local anesthetic systemic toxicity (LAST)

Severe, systemic local anesthetic toxicity is arguably the most feared complication of regional anesthesia. A combination of old and new therapies is recommended to reduce the morbidity and mortality of symptomatic local anesthetic overdose. Prevention remains the criterion standard for improving patient safety during regional anesthesia. However, when local anesthetic toxicity occurs, considering the diagnosis is the doctor's first step to successful treatment. Preparing a plan of action ahead of time and having the necessary tools readily at hand will likewise contribute to saving the patient's life. Airway management, oxygenation, ventilation, and good basic life support are the sine qua non of successful resuscitation. Seizure suppression is key, and we recommend communicating with a perfusion team for possible cardiopulmonary bypass. Lipid infusion should be considered early, and the treating physician should be familiar with the method. We also recommend avoiding vasopressin and using epinephrine only in small doses. Vigilance, preparedness, and quick action will improve outcomes of this dreaded complication.