Episode 95.0 – Local Anesthetic Systemic Toxicity (LAST)

The podcast addresses local anesthetic systemic toxicity (LAST), a rare but life-threatening reaction to local anesthetics. It typically occurs within minutes of injection due to systemic circulation, rapid absorption, or exceeding maximum recommended doses during procedures like bronchoscopies or liposuction. Lidocaine and bupivacaine toxic doses are detailed, emphasizing the importance of calculating maximum doses before administration, especially in children. The podcast distinguishes between CNS and cardiovascular symptoms, noting that lidocaine toxicity usually presents with neurological signs first, while bupivacaine may lead to sudden cardiovascular issues. Management includes prevention through careful dosing, aspiration before injection, and awareness of early symptoms, followed by supportive care, ACLS protocols, and lipid emulsion therapy in severe cases.