Local anesthetic systemic toxicity

Revision as of 00:15, 29 October 2014 by Kxl328 (talk | contribs) (Background)

Background

  • Complication of lidocaine injection (accidental into systemic circulation)
    • 0.2% of nerve blocks
  • Occurs within minutes of injection
    • 75% occuring within 5 minutes

Specific Anesthetics

  • Lidocaine - 5 mg/kg max, no more than 300 mg (1% soln contains 10 mg/ml)
  • Lidocaine with epi - 7 mg/kg man
  • Bupivacaine - 2.5 mg/kg, no more than 175 mg (0.5% soln contains 5 mg/ml)

Diagnosis

  • CNS symptoms
    • Agitation
    • Auditory changes
    • Metallic taste
    • Seizures or drowsiness
    • Coma
    • Respiratory arrest
  • Cardiovascular
    • First excitation
      • Tachycardia
      • Ventricular dysrhythmia
      • Hypertension
    • Followed by depression

Management

  • Lipid emulsion
    • 1.5 mL/kg bolus over 1 minute
    • Then, 15 mL/kg per hour x 20-minute infusion

See Also