LA – Toxicity

We are regularly doing femoral blocks next to major vessels. So warn the patient of the symptoms, & keep them monitored(at least 15 min).

Symptoms of local anaesthetic toxicity

  • Circumoral and/or tongue numbness
  • Metallic taste
  • Lightheadedness/Dizziness
  • Visual/Auditory disturbances (blurred vision/tinnitus)
  • Confused/Drowsiness/Fitting
  • Arrhythmia
  • Cardio-Resp Arrest

Remember – Do basics WELL

Intralipid – in antidote cupboard (Green Majors treatment room)

    1. Bolus – 1.5ml/kg 20% lipid solution over 1min
    2. Then start Infusion – 15ml/kg/hr 20% lipid solution
    3. 5 mins reassess if Cardiac instability/deterioration
      • Rpt Bolus 1.5ml/kg over 1min (max 3 boluses inc. initial)
      • Increase infusion rate – up to 30ml/kg/hr
      • Total Max dose 12ml/kg

Propofol is not a suitable substitute for lipid emulsion

Without Cardio-Resp Arrest

Use conventional therapies to treat:

  • Seizures
  • Hypotension
  • Bradycardia
  • Tachyarrhythmia (Lidocaine should not be used as an anti-arrhythmic therapy)

In Cardio-Resp Arrest

  • CPR – using standard protocols (Continue CPR throughout treatment with lipid emulsion)
  • Manage arrhythmias – using standard protocols
  • Consider the use of cardiopulmonary bypass if available
  • Recovery from LA-induced cardiac arrest may take >1 h
  • Lidocaine should not be used as an anti-arrhythmic therapy

PDF:la_tox

 

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