How do you manage local anesthetic toxicity?
Management of local anaesthetic toxicity is largely supportive, with the use of intravenous lipid emulsion in severe cases. Methaemoglobinaemia can occur and is more likely caused by the administration of benzocaine, lignocaine (lidocaine) or prilocaine.
How is bupivacaine toxicity treated?
Total cardiovascular collapse may be treated with CPR plus 1.5-4 mL/kg bolus of 20% lipid solution followed by 0.25-0.5 mL/kg/min for 10-60 minutes. Dose-dependent blockade of sodium channels.
How can you reduce the risk of LA toxicity?
The factors that should decrease the risk of toxicity while the block is being performed are:
- frequent aspiration,
- incremental injection,
- test dose,
- tracer, e.g. epinephrine (controversial),
- ultrasound-guided needle placement.
What is the treatment for last?
Lipid infusion should be considered early, and the treating physician should be familiar with the method. We also recommend avoiding vasopressin and using epinephrine only in small doses. Vigilance, preparedness, and quick action will improve outcomes of this dreaded complication.
What is the antidote for anesthesia?
Antidotes to Anesthetic Catastrophe: Lipid Emulsion and Dantrolene.
How is local anesthetic toxicity diagnosed?
Initial signs and symptoms include agitation, confusion, dizziness, drowsiness, dysphoria, auditory changes, tinnitus, perioral numbness, metallic taste, and dysarthria. Without adequate recognition and treatment, these signs as symptoms can progress to seizures, respiratory arrest, and/or coma.
How does local anaesthetic toxicity occur?
Local anesthetic toxicity can occur because of inadvertent intravascular injection or dosing error. Intravascular injection can cause toxicity even if the anesthetic was administered within the recommended dose range.