Intravenous lipid emulsion – rescued at LAST

Ciechanowicz, S.; Patil, Vinod

doi:10.1038/sj.bdj.2012.187

Cited by 16 publications

(16 citation statements)

References 41 publications

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“…According to a report published in 2013 by the US Poison Control Center, there were 1454 reports of lidocaine exposure with five cases ending up as a fatality [2]. Miscalculation of the dose, injection of the drug into a blood vessel or repeated administration of therapeutic doses are the major causes of systemic toxicity [2-3]. …”

Section: Discussionmentioning

confidence: 99%

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Lidocaine-Induced Systemic Toxicity: A Case Report and Review of Literature

Hasan¹,

Asif²,

Hasan³

2017

Cureus

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For the past 50 years, local anesthetics such as lidocaine have been commonly used in various clinical settings. Its use is not just limited to anesthesia and surgery but is also frequently utilized in internal medicine and in primary care setting for bedside procedures. Despite its widespread use, most physicians are not familiar with the life-threatening manifestations of lidocaine toxicity and its treatment. Our case demonstrates a successful resuscitation after cardiac arrest in a healthy 33-year-old female with systemic lidocaine toxicity after she received lidocaine as a local anesthetic. Our goal is to educate general internists and primary care physicians of the possible hazards of lidocaine use. We also aim to create mindfulness of the symptoms of lidocaine toxicity and the use of intravenous lipid emulsion as an antidote.

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Section: Discussionmentioning

confidence: 99%

“…Various mechanisms have been postulated on how lipid infusion works, but the most widely accepted is the “Sink” theory by which lipids create a sink that extracts local anesthetics from plasma making them unavailable for myocardial tissue [5]. Repeated aspiration before each injection is a useful strategy to prevent toxicity [3]. …”

Section: Discussionmentioning

confidence: 99%

Lidocaine-Induced Systemic Toxicity: A Case Report and Review of Literature

Hasan¹,

Asif²,

Hasan³

2017

Cureus

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“…She documents these in the patient's record according to the facility policy and procedures. Nurse A also assesses for any signs or symptoms of an adverse or allergic reaction to the local anesthetic, including changes in heart rate; respiratory rate, or blood pressure; any central nervous system changes; or any cardiovascular system changes 2,4,6,8‐10,16‐20 …”

Section: Key Takeaways Discussionmentioning

confidence: 99%

“…Although it is rare, LAST is an adverse outcome that could affect the patient 3,4,6,7,15,17,21 . Local anesthetic systemic toxicity occurs when the serum level of the local anesthetic increases to an unsafe level 2,5,9,11,18‐20 . It can be attributed to many causes, including the patient's risk factors, medications, direct injection of the local anesthetic into the vascular system, surpassing the recommended maximum dose of the local anesthetic, or instant absorption of the anesthetic agent when it is injected into an extremely vascular area 4,6,17,18 …”

Section: Key Takeaways Discussionmentioning

confidence: 99%

Guideline Implementation: Local Anesthesia

Fencl¹

2015

AORN Journal

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It is not uncommon in perioperative settings for patients to receive local anesthesia for a variety of procedures. It is imperative for patient safety that the perioperative RN has a comprehensive understanding of best practices associated with the use of local anesthesia. The updated AORN "Guideline for care of the patient receiving local anesthesia" provides guidance on perioperative nursing assessments and interventions to safely care for patients receiving local anesthesia. This article focuses on key points of the guideline to help perioperative personnel become knowledgeable regarding best practice as they care for this patient population. The key points address patient assessment, the importance of having an overall understanding of the local agent being used, recommended monitoring requirements, and potential adverse events, including life-threatening events. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

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“…A first line of treatment for LAST is an infusion of lipid emulsion . Although the mechanism of action is not well understood, researchers have hypothesized that lipid emulsion therapy reduces the concentration of the local anesthetic in the bloodstream . Lipid emulsion is a weight‐based treatment administered via IV as a bolus, and then followed with a maintenance infusion .…”

Section: Local Anesthetic Systemic Toxicity (Last)mentioning

confidence: 99%

Regional Anesthesia: An Overview

Pincus¹

2019

AORN Journal

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Advances in anesthesia techniques and guidance imaging have made regional anesthetics effective both for pain management and as a primary anesthesia modality for patients undergoing operative and other invasive procedures. Patients can receive regional anesthesia in most areas of the body, including the upper and lower extremities and torso. It is critical that perioperative nurses are familiar with regional anesthetic options and understand them well enough to support their patients in the preoperative, intraoperative, and postoperative phases of surgical care. They also should be familiar with the signs and symptoms of local anesthetic systemic toxicity and be prepared to help treat this condition as soon as indicated. Nurses play a pivotal role in ensuring patients are properly educated about regional anesthetics and remain safe throughout all phases of perioperative care.

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Intravenous lipid emulsion – rescued at LAST

Cited by 16 publications

References 41 publications

Lidocaine-Induced Systemic Toxicity: A Case Report and Review of Literature

Lidocaine-Induced Systemic Toxicity: A Case Report and Review of Literature

Guideline Implementation: Local Anesthesia

Regional Anesthesia: An Overview

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