HWN Suggests

LAST Chance to Verify That Dose

Lipid emulsion is the antidote for LAST, though evidence-based, validated guidelines for when and how to administer this drug are lacking. It is generally accepted that for severe or rapidly deteriorating CNS and/or cardiovascular toxicity, lipids should be given in combination with the typical treatments listed above. However, in early or less severe cases, treatment is largely left up to physician discretion. It is recommended that some combination of a bolus and infusion be administered with a total dose of up to 10-12mL/kg, but there are few definite rules beyond this.

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Articles of Interest

Local Anesthetic Systemic Toxicity (LAST)

A life-threatening adverse reaction resulting from local anesthetic reaching significant systemic circulating levels. Local Anesthetic Systemic Toxicity (LAST) is rare and almost always occurs within minutes of injection of the local anesthetic.

Local Anesthetic Systemic Toxicity (LAST)

The antidote to LAST is 20% lipid emulsion (e.g., Nutrilipid, Intralipid, or Liposyn III 20%).

Local Anesthetic Toxicity

Local anesthetics are commonly used in most medical and dental practices. While adverse effects are rare, the rising prevalence of local anesthetics in practice has resulted in a greater incidence of local anesthetic toxicity. From minor symptoms to major cardiac or central nervous system (CNS) effects, local anesthetic systemic toxicity (LAST) is an important consequence of which to be aware.

Local Anesthetics and LAST

Treat LAST with lipid emulsion therapy i.e. ‘Intralipids’ to create a lipid sink that absorbs anesthetic agent. Administer initial 1.5 ml/kg bolus (approximately 100 ml in 70 mg adult) followed by infusion rate of 0.25 mg/kg/hour. Do not surpass 10 mg/kg total.

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Core EM

A life-threatening adverse reaction resulting from local anesthetic reaching significant systemic circulating levels. LAST is rare and almost always occurs within minutes of injection of the local anesthetic.