Local Anesthesia Toxicity
Local Anesthesia Toxicity
Treatment
Always have intravenous access prior to giving local anesthesia if there is concern for possible local anesthesia toxicity.
1. Avoid Respiratory Acidosis--may increase plasma free local anesthetic.
Ventilate and establish advanced airway as needed.
However, to maintain venous return and brain blood flow:
Also Avoid Hyperventilation.
2. Terminate seizures.
May see less hypotension with
Benzodiazepines compared to propofol.
3. ACLS/CPR
as indicated (i.e. pulseless people).
Use
smaller epinephrine doses because heart is sensitized for arrhythmia.
[consider < 1 mcg/kg epinephrine for first dose]
For ventricular arrhythmias:
Amiodarone may be preferred.
Avoid Lidocaine and Procainamide: They are local anesthestics!
Code can be very refractory:
Reports of good outcomes after 1 hour of CPR/Code.
Consider cardiopulmonary bypass support!
4. Intravenous Lipid Rescue:
20% Intralipid is commercial product.
Start at first signs of toxicity--ideally before heart is poisoned.
Give Early!
Over 70 kg
Initial bolus
dose: 100 ml
over 2-3 minute
Start Infusion: 200 to 250 ml over 15-20 minutes
Less than 70 Kg
Initial bolus dose: 1.5 ml/kg over 2-3 minute
Start Infusion: 0.25ml/kg/min
(ideal body weight)
If still unstable:
Repeat bolus once or twice and
Double Infusion Rate.
In prolonged resuscitation (> 30 minutes) can give 1 liter lipid.
See ASRA LAST checklist for more specifics and details!
