Local Anaesthetic Toxicity - Guidelines for Crises in Anaesthesia Signs of severe toxicity: • Sudden alteration in mental status, severe agitation or loss of consciousness, with or without tonic-clonic convulsions. • Cardiovascular collapse: sinus bradycardia, conduction blocks, asystole and ventricular tachyarrhythmias may all occur. • Local anaesthetic toxicity may occur some time after an initial injection. ❶ Stop injecting the local anaesthetic (remember infusion pumps). ❷ Call for help and inform immediate clinical team of problem. ❸ Call for cardiac arrest trolley and lipid rescue pack. ❹ Give 100% oxygen and ensure adequate lung ventilation: • Maintain the airway and if necessary secure it with a tracheal tube. • Hyperventilation may help reduce acidosis. ❺ Confirm or establish intravenous access. ❻ If circulatory arrest: • Start continuous CPR using standard protocols. • Give intravenous lipid emulsion (Box A). • Recovery may take >1 hour. • Consider the use of cardiopulmonary bypass if available. If no circulatory arrest: • Conventional therapies to treat hypotension, brady- and tachyarrhythmia. • Consider intravenous lipid emulsion (Box A). ❼ Control seizures with small incremental dose of benzodiazepine, thiopental or propofol. By Association of Anaesthetists @ https://twitter.com/AAGBI Quick Reference Handbook - Guidelines for crises in anaesthesia #Local #Anaesthetic #Toxicity #Anesthesiology #Anesthesia #Intraoperative #Checklist #Diagnosis #Management #Workup
