Local anesthetic systemic toxicity: Difference between revisions
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**1.5 mL/kg bolus over 1 minute | **1.5 mL/kg bolus over 1 minute | ||
**Then, 15 mL/kg per hour x 20-minute infusion (0.25 mL/kg/min for 20 min or until hemodynamic stability) | **Then, 15 mL/kg per hour x 20-minute infusion (0.25 mL/kg/min for 20 min or until hemodynamic stability) | ||
*Manage seizures with benzodiazepines; propofol is an option but may worsen CV toxicity | |||
*ACLS modifications per ASRA (Am Soc of Regional Anesthesia): | |||
**Small initial doses of 100 μg boluses in adults | |||
**No vasopressin | |||
**Avoid CCBs and BBs | |||
**Amiodarone preferred in ventricular dysrhythmias | |||
==See Also== | ==See Also== | ||
Revision as of 00:43, 29 October 2014
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
- Bradycardia
- Conduction block
- Asystole
- First excitation
Management
- Lipid emulsion, 20% solution
- 1.5 mL/kg bolus over 1 minute
- Then, 15 mL/kg per hour x 20-minute infusion (0.25 mL/kg/min for 20 min or until hemodynamic stability)
- Manage seizures with benzodiazepines; propofol is an option but may worsen CV toxicity
- ACLS modifications per ASRA (Am Soc of Regional Anesthesia):
- Small initial doses of 100 μg boluses in adults
- No vasopressin
- Avoid CCBs and BBs
- Amiodarone preferred in ventricular dysrhythmias