Local Anesthetic Systemic Toxicity

Gitman, Marina; Bornstein, Kasha; Porta, Alessandra Della; Zarkhah, Ayden; Weinberg, Guy

doi:10.1007/978-3-030-88727-8_5

Cited by 2 publications

(5 citation statements)

References 26 publications

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“…Bupivacaine is also more lipophilic than other local anesthetics and can accumulate in cardiac tissue and cellular mitochondria at a ratio of 6:1 relative to plasma. This accumulation results in cardiotoxicity and symptoms occurring at plasma levels lower than expected (Gitman et al, 2021).…”

Section: Overviewmentioning

confidence: 97%

“…Monitoring of vital signs, cardiac rhythm, and neurologic status will continue for several hours postevent (ASRA, 2020). See Figure 2 for Local Anesthetic Systemic Toxicity treatment checklist (Gitman et al, 2021).…”

Section: Evidence-based Treatment Guidelinesmentioning

confidence: 99%

“…Potential side effects of lipid emulsion include allergic reaction, hyperamylasemia, interference with certain lab values, bronchospasm, and chest pain (Gitman et al, 2021).…”

Section: Lipid Emulsion Side Effectsmentioning

confidence: 99%

“…meulemeester et al, 2018). Treatment for neonates has been reported to be successful using lipid emulsion therapy (Gitman et al, 2021). When local anesthetics have been used, it is important to monitor both the mother and baby for any adverse effects.…”

Section: Patient Teachingmentioning

confidence: 99%

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Local Anesthetic Systemic Toxicity during Labor, Birth, and Immediate Postpartum

Mock

Griggs

Mileto

2021

McN: The American Journal of Maternal/Child Nursing

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Local anesthetic systemic toxicity (LAST) is a life-threatening event caused by elevated local anesthetic plasma concentration. It is often unrecognized or misdiagnosed. Peripartum women are at increased risk for toxicity due to pregnancy-related physiological changes. Rising serum drug levels can cause cellular level impairment of mitochondria and voltage-gated ion channels leading to a cascade of symptoms that can end in cardiac arrest. Local anesthetic systemic toxicity can mimic other maternal pathologies but may be considered if local anesthetics have been used. Published treatment guidelines for this event include lipid emulsion which is approved for use in pregnant women. We review LAST in the maternity care setting, published treatment protocols, management of maternity patients with toxicity, and recommendations to increase awareness among maternity care clinicians for this medical emergency.

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Section: Overviewmentioning

confidence: 97%

Section: Evidence-based Treatment Guidelinesmentioning

confidence: 99%

“…Potential side effects of lipid emulsion include allergic reaction, hyperamylasemia, interference with certain lab values, bronchospasm, and chest pain (Gitman et al, 2021).…”

Section: Lipid Emulsion Side Effectsmentioning

confidence: 99%

Section: Patient Teachingmentioning

confidence: 99%

See 2 more Smart Citations

Local Anesthetic Systemic Toxicity during Labor, Birth, and Immediate Postpartum

Mock

Griggs

Mileto

2021

McN: The American Journal of Maternal/Child Nursing

View full text Add to dashboard Cite

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“…The interactive lecture was developed using the most recent evidence and clinical guidelines from the New York School of Regional Anesthesia, 10 ASRA 6 and LipidRescue.org. 11 The information outlined within the lecture focused on the following: pharmacological mechanism for local anaesthetic toxicity, the neurological symptoms of toxicity, cardiovascular symptoms of toxicity and treatment.…”

Section: Activity Descriptionmentioning

confidence: 99%

Multidisciplinary simulation of local anaesthetic systemic toxicity improves diagnostic and treatment skills and self-confidence for pain clinic procedural staff

et al. 2023

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Local anaesthetic systemic toxicity (LAST) is a rare complication after outpatient interventional pain procedures, which can present as an emergent and life-threatening condition. Proficiency and confidence in managing this rare situation necessitates strategies to ensure team members can perform necessary tasks. The primary objective was to familiarse the pain clinic procedural staff—physicians, nurses, medical assistants, and radiation technologists—with concise and current instruction and an opportunity to practice in a controlled environment. A two-part series was designed and led by the pain physicians, with the assistance of the simulation centre and clinic staff. A 20 min didactic session was held to familiarise the providers with relevant details and information regarding LAST. Then, 2 weeks later, all team members participated in a simulation exercise intended to portray a LAST encounter, tasking participants to recognise and manage the condition in a team-based model. Before and after the didactic and simulation sessions, the staff was administered a questionnaire to assess knowledge of LAST signs, symptoms, management strategies, and priorities. Respondents were better able to identify signs and symptoms of toxicity and prioritise management steps, and felt more confident in recognising symptoms, starting treatment and coordinating care. Furthermore, participants emphasised the positive of debriefing, practicing a rare situation and learning strategies for effective communication, team dynamics and role clarity.FormatSmall group didactic session, simulation exercise in a clinical simulation lab.Target audienceAttending, fellow, and resident physicians, medical students, registered nurses, certified medical assistants, and radiation technologists working in a pain clinic procedure suite.ObjectivesTo acquaint the pain clinic procedural staff with current training related to LAST and an opportunity to practice in a controlled environment.

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Local Anesthetic Systemic Toxicity

Cited by 2 publications

References 26 publications

Local Anesthetic Systemic Toxicity during Labor, Birth, and Immediate Postpartum

Local Anesthetic Systemic Toxicity during Labor, Birth, and Immediate Postpartum

Multidisciplinary simulation of local anaesthetic systemic toxicity improves diagnostic and treatment skills and self-confidence for pain clinic procedural staff

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