Local anesthetic systemic toxicity

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

Management

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

See Also

• Lidocaine
• Nerve Blocks (Main)