Anaesthesia & ICU
Local Anaesthetic Systemic Toxicity (LAST)
Recognise CNS + cardiac toxicity, immediate lipid emulsion (Intralipid), modified ALS.
Source: AAGBI 2010; ASRA 2017
Step 1 of ~3
info
Recognise
Risk: high doses, intravascular injection, regional blocks in vascular sites, elderly / frail / cardiac / hepatic failure, pregnancy. Features (rapid):
• CNS: tinnitus, perioral numbness, agitation, confusion, dysarthria, seizures, coma.
• Cardiovascular: HTN → hypotension → bradycardia → asystole, arrhythmias (VT, torsades, refractory VF).
• Bupivacaine particularly cardiotoxic.
• Onset 1–10 min post-injection.
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
- Lipid Emulsion 20% (Intralipid) · Antidote / Resuscitation
- Lipid Emulsion 20% (Intralipid) · Antidote / Resuscitation
- Lidocaine (IV Infusion — Opioid-Sparing Analgesia) · Local Anaesthetic (IV Systemic — Opioid-Sparing / Anti-inflammatory)
- Bupivacaine · Local Anaesthetic (Amide)
- Levobupivacaine · Local Anaesthetic (Amide — S-Enantiomer)
- Ropivacaine · Local Anaesthetic (Amide — S-Enantiomer)
Pathways
- Difficult Airway Algorithm (DAS) · DAS 2015; Royal College of Anaesthetists
- Anaphylaxis Under Anaesthesia · AAGBI 2018; NAP6
- Malignant Hyperthermia · AAGBI 2011; MHAUS
- Spinal Anaesthesia Hypotension Management · AAGBI; ASA
- Postoperative Nausea & Vomiting · Society for Ambulatory Anesthesia 2020; AAGBI
- Surviving Sepsis Bundle (Adult ICU) · Surviving Sepsis Campaign 2021; NICE NG51
Decision support only. Always apply local guidelines and clinical judgement.