Local Anesthetic Toxicity

Local anesthetic toxicity is extremely rare in a patient who has an established neuraxial or peripheral nerve catheter. If suspected, all local anesthetic infusions should be immediately stopped. Occasionally the presenting symptom is cardiac arrest. In cardiac arrest, the patient should immediately receive 1.5 ml/kg of 20% Intralipid while receiving chest compressions and other ACLS interventions such as airway management. Repeat the bolus 1-2 times as needed for persistent asystole, pulseless electrical activity, or reemergence of hemodynamic insanity. Increase the infusion rate to 0.5 mL/kg/min if hemodynamic instability persists or recurs. Continue the infusion for at least 10 min after hemodynamic stability is restored; discontinue within 1 hour if possible.

Another rare symptom of local anesthetic toxicity is seizure. Once again, the infusion should be stopped, seizure should be treated with an anti-seizure medication and the airway should be controlled if necessary. Much more common symptoms of local anesthetic toxicity are tinnitus, anxiety, restlessness, dizziness, and blurred vision; in the case of these symptoms, the infusion should be stopped.

1000 ml of 20% Intralipid should accompany patients receiving local anesthetic infusions during transport in the AE system.