LAST: Local Anesthetic Systemic toxicity
Mount Sinai EM
AUGUST 20, 2023
Causes Inadvertent intravascular injection (even without exceeding max dose) Overdose (with single or multiple doses) Absorption from a vascular area Prevention Calculate max dose, considering comorbidities Direct US guidance, use saline to improve needle tip visualization Add epinephrine when possible. Epi decreases the systemic absorption of LA by reducing local blood flow, also if inadvertently injected IV will provoke tachycardia that can be seen on the monitor.