Local Anesthetic Toxicity in the Geriatric Population

Area of Science:

• Anesthesiology
• Pharmacology
• Geriatric Medicine

Background:

• Local anesthetic systemic toxicity (LAST) remains a concern despite advancements in anesthetic formulations and monitoring techniques.
• The elderly population presents unique challenges and increased susceptibility to LAST.
• Understanding the specific risk factors and clinical manifestations in geriatric patients is essential.

Purpose of the Study:

• To provide a comprehensive overview of local anesthetic systemic toxicity.
• To highlight the specific risks, presentation, and management of LAST in the geriatric population.
• To emphasize prevention strategies and the importance of physician education.

Main Methods:

• Systematic literature review using MEDLINE, Scopus, and Google Scholar.
• Inclusion of original research, registries, case reports, and review articles.
• Search terms included various local anesthetics and toxicity-related keywords.

Main Results:

• LAST continues to occur despite improved anesthetic agents and ultrasound guidance.
• Elderly patients are at a disproportionately higher risk of toxicity due to comorbidities and decreased muscle mass.
• Inadvertent overdosing is a contributing factor in some cases of LAST among older adults.

Conclusions:

• Older patients require special consideration regarding systemic disease and muscle wasting when using local anesthetics.
• Enhanced physician and staff education on recognizing and managing LAST is vital for improving safety in geriatric patients.
• Optimizing regional anesthesia and multimodal analgesia in the elderly necessitates a thorough understanding of LAST risks.