Treatment of Major Symptoms

Major symptoms

• Fits
• Arrhythmias
• Hypotension
• Respiratory failure
• Cardiac arrest

Immediate treatment for major toxicity

1. Stop the injection
2. GET HELP
3. Resuscitate using recognised guidelines
4. Control fits with small doses of Propofol or benzodiazepines
5. Consider ventilation if there is a metabolic acidosis

Specific treatment

As published by the Association of Anaesthetists of Great Britain and Ireland (AAGBI) in 2010 [12]

• In cardiac arrest or collapse use Intralipid 20%
• Give a bolus dose of 1.5ml/kg over 1 minute
• Start an intravenous infusion at 15ml/kg/hr
• Increase the infusion to 30ml/kg/hr after five minutes if no improvement
• Give up to two further bolus doses (same dose) every five minutes if cardiovascular stability deteriorates or has not been restored (maximum of three boluses including the initial dose)
• Continue the infusion until stable, or the maximum dose has been given (12ml/kg cumulative dose)

Important: Ensure you are somewhere where you can call for help when using local anaesthetics.

The AAGBI have produced guidance on the management of local anaesthetic toxicity.  It can be found here.