Management of Local Anesthetic Systemic Toxicity (LAST)

  • Preetham J. Suresh


Local anesthetic system toxicity (LAST) is an infrequent but potentially life-threatening emergency that requires immediate and decisive steps. Some of these interventions are unique to LAST, and interestingly some interventions that are routine in other scenarios are potentially contraindicated in LAST. A clear understanding of the indications and risks associated with the specific treatments is required in order to effectively deliver care during this scenario. This chapter outlines these aspects in the context of an obstetric scenario.


Local anesthetics Bupivacaine Lidocaine Lipid solubility pKa Systemic toxicity LAST Checklist Pregnancy Fetus Seizure Lipid emulsion Lipid sink Metabolic hypothesis Propofol Cardiac arrest Hypoxia Acidosis Resuscitation Epinephrine Vasopressin 


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Preetham J. Suresh
    • 1
  1. 1.Department of AnesthesiologyUniversity of CaliforniaSan DiegoUSA

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