Local anaesthetic systemic toxicity can begin with perioral tingling, tinnitus, confusion or seizures, or go straight to arrhythmia and cardiovascular collapse, sometimes many minutes after injection.
Stop injecting, call for help, maintain the airway and give 100% oxygen. Treat seizures with a benzodiazepine. Give 20% lipid emulsion early, as a bolus followed by an infusion, and follow advanced life support, expecting resuscitation to take longer than usual. Know where the lipid is kept wherever blocks are performed.
- Stop injecting at the first neurological or cardiac sign.
- Give 20% lipid emulsion early, as bolus then infusion.
- Treat seizures with a benzodiazepine; avoid propofol in cardiovascular instability.
- Keep lipid emulsion and a toxicity card wherever regional blocks are done.
Why it matters
Delay in reaching for lipid is the step most often missed when toxicity is not expected.
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