Local anesthetic systemic toxicity (LAST)

Stop local anesthetic; secure airway/oxygenation
Treat seizures promptly
IV lipid emulsion is specific rescue therapy
Use modified ACLS for arrhythmia/shock
Avoid large epinephrine doses and vasopressin
Refractory cardiovascular collapse → ECMO consideration

Use at a glance

Stop local anesthetic; secure airway/oxygenation

Escalation / refractory disease

Refractory cardiovascular collapse → ECMO consideration

Treatment options

IV lipid emulsion is specific rescue therapy
Use modified ACLS for arrhythmia/shock

Safety / pitfalls

Treat seizures promptly
Avoid large epinephrine doses and vasopressin

Self-check

Which doses should be avoided in LAST resuscitation?
Large epinephrine doses.
What is the specific rescue therapy for local anesthetic systemic toxicity?
IV lipid emulsion.

Drugs used for this (1)

IV lipid emulsion ballicule — decagon mechanism diagram — IV lipid emulsion — off-label

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