Local Anaesthetic Systemic Toxicity (LAST)

🔑 Key Priorities

• Cease LA administration

• Airway protection, seizure control, and lipid therapy

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🧠 Team Actions

Role	Task
Team Leader	Coordinate diagnosis and initiate lipid therapy
Airway Manager	Secure airway, give 100% O₂
Circulation	Stop LA injection, start IV access
Drug Assistant	Prepare intralipid, anticonvulsants

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🧭 Management Algorithm

1. Stop LA injection immediately

2. Call for help and initiate ACLS if needed

3. Maintain oxygenation and ventilation (avoid acidosis)

4. Control seizures: midazolam 0.1 mg/kg IV or propofol 1–2 mg/kg

5. Administer 20% lipid emulsion:

   • Initial bolus 1.5 mL/kg over 1 min

   • Then infusion 0.25 mL/kg/min over 30–60 min

   • Repeat bolus and increase rate if unstable (max 12 mL/kg)

6. Avoid vasopressin, calcium channel blockers, and local anaesthetics

7. Continue CPR if cardiac arrest

8. Consider cardiopulmonary bypass if refractory

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🔄 Ideal Crisis Flow

             Suspected LAST
                 ↓
        Stop LA + Secure Airway
                 ↓
       Control Seizures + Give Lipid Bolus
                 ↓
     Start Lipid Infusion, Monitor Response
                 ↓
     Escalate to Bypass if No ROSC / Stability