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Local anesthetic systemic toxicity: Continuing Professional Development
Kariem El-Boghdadly1, Ki Jinn Chin2
1Department of Anesthesia, Toronto Western Hospital, 399 Bathurst Street, McL 2-405, Toronto, ON, M5T 2S8, Canada.
Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|February 3, 2016
Summary
Local anesthetic systemic toxicity (LAST) is a dangerous complication of regional anesthesia. Understanding its causes, prevention strategies, and management is crucial for anesthesiologists to ensure patient safety.
Area of Science:
- Anesthesiology
- Pharmacology
- Patient Safety
Background:
- Regional anesthesia is experiencing a resurgence with new techniques and ultrasound guidance.
- Local anesthetic systemic toxicity (LAST) is a significant complication requiring updated knowledge.
- Continuing Professional Development (CPD) is essential for practitioners.
Purpose of the Study:
- To provide an understanding of the current knowledge on local anesthetic systemic toxicity (LAST).
- To equip practitioners with effective prevention and management strategies for LAST.
- To enhance the safe application of regional anesthesia techniques.
Main Methods:
- Review of multifactorial causes of LAST, including patient factors, drug doses, pharmacokinetics, and anesthetic techniques.
- Description of the biphasic clinical course (CNS excitation then inhibition) and cardiovascular compromise.
- Identification of prevention strategies: careful drug selection/dosing, aspiration, dose fractionation, intravascular markers, and ultrasound guidance.
Main Results:
- LAST presents with variable and sometimes atypical central nervous system and cardiovascular effects.
- Cardiovascular compromise includes dysrhythmias, myocardial depression, and reduced vascular resistance.
- Effective management involves oxygenation, ventilation, seizure control, circulatory support, and intravenous lipid emulsion therapy.
Conclusions:
- Local anesthetic systemic toxicity (LAST) is a potentially fatal condition with diverse manifestations.
- Anesthesiologists must possess comprehensive knowledge of LAST risks, prevention, and management.
- Understanding and applying these principles is vital for safe patient care in regional anesthesia.
