LAST (Local Anesthetic Systemic Toxicity): A practical update for clinicians

[@jimothyh]

To add to the don't dos: don't use phenytoin for seizures (it's also a sodium channel blocker).

[@v8pr599]

This is really good stuff! I work with patients who get blocks / locals all the time and this info has never been shared.

[@JustPeaceLoveAndKindness]

Love your photo of the elderly pt sipping on BUD LIGHT. Thanks for the wonderful videos you guys produce. I think it is the best on the internet!

[@AlanZablocki]

Ultrasound has increased safety in another way: With every 2-3 ml , you should see the tissue expand. If you don't, the needle tip maybe in a vein. Negative aspiration is not always reliable- negative pressure may suck the vein flat resulting in no blood aspirated. if one does not see the tissue expand with hypoechoic local anesthetic, the needle should be repositioned.

[@tharwathabib2613]

Thanks a lot for this helpful video, really like all of it. I have one question if you please, for the intralipid is to be considered once you have early signs of toxicity or only if become unresponsive with starting CPR?

[@zainabsami9249]

thank you so much - well explained 🙏🙏

[@regionalanesthesiology]

Glad it was helpful! Thank you for watching the channel!

[@mom2many166]

I have had 5 LAST reactions. One in my arm, 4 at the dentist. It was terrifying. Only the last reaction involved my heart, as far as I know. Are some people prone to this reaction or is it always the guy with the syringe? Is General anaesthesia the answer? I present with intense confusion, I can’t hear or process what is said and I am unable to make words or connect to my mouth. Tears run down my face and I feel buzzing all over. I apparently turn very pale. I am not at all afraid if needles, or "just anxious" as previous providers suggested. I have been numbed several times without this reaction. And here's the kicker- none of the doctors knew what happened! They just moved on.

[@mfcoelho4]

Why is Epinephrine is used as a marker for detecting intravascular injection? I mean if the pacient is monitorized you can see the heart rate rising instantly but if it’s just a local injection how it helps?

[@evgenyreider8596]

Thank you! How to count the maximal daily dose for continuous bupivacaine infusion? Thank youp

[@evgenyreider8596]

@@regionalanesthesiology Thank you very much!

[@instagrammable]

I have had a doctor tell me that the dose of bupivacaine they give is too small to cause cardiac arrest, if administered to the bloodstream. Is this true?

[@Norfolkinskill]

Can you get a mild reaction like last. I went to get stitches and felt like I lost control of my body and couldn’t breath. Could feel my hands and face twitching but only lasted a little while and then was able to breath 😳

[@Norfolkinskill]

@@regionalanesthesiology thank you. It was a wound to the knee so maybe it was where it was injected. As it didn’t seem to numb the wound.

[@Jojoma449]

Can I have toxicity from local dental anesthesia? I had a filling done that took for 2.5 hours few days later I developed a vertigo , headache, nausea, later I developed migraine symptoms like one eye issue, brain fog anxiety and panic attacks. no cardiac issues that I remember. Fast forward to 4 months form then I still have head pressure in the neck and throat and head, nausea. I don’t have brain fog anymore but still not feel super great. Can it be that I got injured from dental injection ?