Local anesthetic systemic toxicity: Continuing Professional Development

Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie
Kariem El-Boghdadly, Ki Jinn Chin

Abstract

Regional anesthesia is enjoying a renaissance due in part to the advent of ultrasound guidance and the development of new techniques such as tissue plane blocks and local infiltration analgesia. The purpose of this Continuing Professional Development module is to provide practitioners with an understanding of the current state of knowledge surrounding local anesthetic systemic toxicity (LAST) in order to help them prevent and manage this complication more effectively. The causes of LAST are multifactorial, but recognized risks include patient factors, drug doses, pharmacokinetics, and choice of regional anesthetic technique. Local anesthetic systemic toxicity produces a biphasic course of clinical events that generally begin with central nervous system excitation followed by inhibition. At the same time, it causes cardiovascular compromise due to dysrhythmias, myocardial depression, and reduced systemic vascular resistance. Clinical presentation can be highly variable, however, and atypical presentations are not uncommon. Local anesthetic systemic toxicity is prevented by careful choice and dosing of drugs, aspiration before injection, dose fractionation, use of intravascular markers and ultrasound guidance. The management of L...Continue Reading

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Citations

Jul 8, 2017·Chinese Medical Journal·Xiao-Feng ShiJun-Fei Shen
Jul 14, 2018·Current Opinion in Anaesthesiology·Amit Pawa, Kariem El-Boghdadly
Sep 11, 2019·International Anesthesiology Clinics·Ann MonahanPhillip Traylor
Sep 11, 2019·Journal of Dental Anesthesia and Pain Medicine·Seung-Hyun RheeMyong-Hwan Karm
Jan 29, 2019·Anesthesiology·Hesham ElsharkawyMichael Barrington
Aug 17, 2019·The Journal of Vascular Access·Ahmet MurtNurhan Seyahi
Nov 15, 2017·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Mauricio ForeroKi Jinn Chin
Apr 29, 2021·Local and Regional Anesthesia·Christopher Little, Siamak Rahman
May 20, 2021·Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·Song WenLiu-Lin Xiong
Jun 20, 2021·Regional Anesthesia and Pain Medicine·Ki Jinn ChinStephan K W Schwarz
Sep 1, 2021·Nursing·Katlyn BrownDan Sheridan
Aug 3, 2021·MCN. the American Journal of Maternal Child Nursing·Nicole D MockLisa A Mileto

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