We are regularly doing femoral blocks next to major vessels. So warn the patient of the symptoms, & keep them monitored(at least 15 min).
Symptoms of local anaesthetic toxicity
- Circumoral and/or tongue numbness
- Metallic taste
- Lightheadedness/Dizziness
- Visual/Auditory disturbances (blurred vision/tinnitus)
- Confused/Drowsiness/Fitting
- Arrhythmia
- Cardio-Resp Arrest
Remember – Do basics WELL
Intralipid – in antidote cupboard (Green Majors treatment room)
-
- Bolus – 1.5ml/kg 20% lipid solution over 1min
- Then start Infusion – 15ml/kg/hr 20% lipid solution
- 5 mins reassess if Cardiac instability/deterioration
- Rpt Bolus 1.5ml/kg over 1min (max 3 boluses inc. initial)
- Increase infusion rate – up to 30ml/kg/hr
- Total Max dose 12ml/kg
Propofol is not a suitable substitute for lipid emulsion
Without Cardio-Resp Arrest
Use conventional therapies to treat:
- Seizures
- Hypotension
- Bradycardia
- Tachyarrhythmia (Lidocaine should not be used as an anti-arrhythmic therapy)
In Cardio-Resp Arrest
- CPR – using standard protocols (Continue CPR throughout treatment with lipid emulsion)
- Manage arrhythmias – using standard protocols
- Consider the use of cardiopulmonary bypass if available
- Recovery from LA-induced cardiac arrest may take >1 h
- Lidocaine should not be used as an anti-arrhythmic therapy
PDF:la_tox
