LAST (Local Anesthetic Systemic Toxicity): A practical update for clinicians

In this video we discuss the mechanism, presentation, prevention and treatment of local anesthetic systemic toxicity (LAST).

Follow this link to access the American Society of Regional Anesthesia and Pain Medicine's checklist for management of LAST:

Follow this link to access the Association of Anaesthetists of Great Britain & Ireland's guide to management of severe local anaesthetic toxicity:

Anyone interested in LAST should also visit:

[jimothyh]

To add to the don't dos: don't use phenytoin for seizures (it's also a sodium channel blocker).

[AlanZablocki]

Ultrasound has increased safety in another way: With every 2-3 ml, you should see the tissue expand. If you don't, the needle tip maybe in a vein. Negative aspiration is not always reliable- negative pressure may suck the vein flat resulting in no blood aspirated. if one does not see the tissue expand with hypoechoic local anesthetic, the needle should be repositioned.

[vpr]

This is really good stuff! I work with patients who get blocks / locals all the time and this info has never been shared.

[JustPeaceLoveAndKindness]

Love your photo of the elderly pt sipping on BUD LIGHT. Thanks for the wonderful videos you guys produce. I think it is the best on the internet!

[mommany]

I have had 5 LAST reactions. One in my arm, 4 at the dentist. It was terrifying. Only the last reaction involved my heart, as far as I know. Are some people prone to this reaction or is it always the guy with the syringe? Is General anaesthesia the answer?
I present with intense confusion, I can’t hear or process what is said and I am unable to make words or connect to my mouth. Tears run down my face and I feel buzzing all over. I apparently turn very pale. I am not at all afraid if needles, or "just anxious" as previous providers suggested. I have been numbed several times without this reaction. And here's the kicker- none of the doctors knew what happened! They just moved on.

[tharwathabib]

Thanks a lot for this helpful video, really like all of it. I have one question if you please, for the intralipid is to be considered once you have early signs of toxicity or only if become unresponsive with starting CPR?

[mfcoelho]

Why is Epinephrine is used as a marker for detecting intravascular injection? I mean if the pacient is monitorized you can see the heart rate rising instantly but if it’s just a local injection how it helps?

[instagrammable]

I have had a doctor tell me that the dose of bupivacaine they give is too small to cause cardiac arrest, if administered to the bloodstream. Is this true?

[Jojoma]

Can I have toxicity from local dental anesthesia? I had a filling done that took for 2.5 hours few days later I developed a vertigo, headache, nausea, later I developed migraine symptoms like one eye issue, brain fog anxiety and panic attacks. no cardiac issues that I remember. Fast forward to 4 months form then I still have head pressure in the neck and throat and head, nausea. I don’t have brain fog anymore but still not feel super great. Can it be that I got injured from dental injection ?

[evgenyreider]

Thank you! How to count the maximal daily dose for continuous bupivacaine infusion? Thank youp

[Norfolkinskill]

Can you get a mild reaction like last. I went to get stitches and felt like I lost control of my body and couldn’t breath. Could feel my hands and face twitching but only lasted a little while and then was able to breath 😳