Local anesthesia toxicity Regional anesthesia lipid emulsion Central nervous system management of LAST airway management
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Local anesthesia (LA) provides a way to relieve temporary pain in a small part of the body and has been used for over 100 years (Fencl, 2015). LA also prevents the passage of surgical stimuli into the central nervous system (CNS) making a surgical procedure less painful for the patient (Noble, 2015). According to Noble, “altering the passage of stimuli from smaller diameter neurons in a confined area with lower drug dosages is called LA, such as the injection of LA around a surgical incision” (Noble, 2015, p.325). LA can be used in a variety of settings, such as in dentist/medical offices and in the operating room (OR). LA can be administered via injection, infiltration or topical application with anesthesia professions, surgeons or dentists administering it. When performing LA administration one must be aware of the risk of local anesthetic systemic toxicity (LAST) (Fencl, 2015). It is a very serious and sometimes fatal complication to administration. It can result from the patient’s risk factors, current medications or inadvertent injection directly into the vascular system- resulting in immediate absorption of the anesthetic agent into an exceptionally vascular area (Fencl, 2015). Early response at the first sign of toxicity is pertinent and improves chances of successful treatment. Once the reaction is noticed, immediate supportive care needs to be initiated due to the chance of severe cardiac depression. Advanced Cardiac Life Support (ACLS) should be started immediately and is considered the first-line treatment for this complication (Noble, 2015). Lipid emulsion therapy can also be used to help reduce the toxic plasma levels of LA, ultimately reversing the severe symptoms of LAST. Prevention measures (in a checklist form) have been put in place to help reduce the risk of LAST by The American Society of Regional Anesthesia and Pain Management (ASRA) (Noble, 2015). This is a helpful tool utilized by anesthesia staff to help focus on the immediate needs of the patient and manage cardiac events for someone diagnosed with LAST. By educating all staff, effective management of this emergent situation will help influence a positive patient outcome. Comprehensive training on LAST guidelines and treatment, along with best practice measures for patients receiving LA are essential for optimistic patient outcomes.
McCleery, Nicole, "Local Anesthesia Toxicity" (2017). Master of Science in Nursing (MSN) Student Scholarship. 235.
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