Local Anaesthetic Systemic Toxicity (LAST)

🔑 Key Priorities

  • Cease LA administration

  • Airway protection, seizure control, and lipid therapy

🧠 Team Actions

Role

Task

Team Leader

Coordinate diagnosis and initiate lipid therapy

Airway Manager

Secure airway, give 100% Oâ‚‚

Circulation

Stop LA injection, start IV access

Drug Assistant

Prepare intralipid, anticonvulsants

🧭 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

🔄 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

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