Local anesthetic systemic toxicity: awareness, recognition, and risk mitigation in the emergency department

Abstract

Local anesthetic systemic toxicity (LAST) is a rare but potentially devastating adverse event re-sulting from the uptake of local anesthetic (LA) in the central nervous system (CNS) and cardiovascular system. Though uncommon, the incidence of LAST is clinically relevant [1]. Owing to its low incidence, underreporting, and the misrecognition of widely varying presentations, the true incidence of LAST is difficult to ascertain [2]. Because of the paucity of data, the American Society of Regional Anesthesia (ASRA) has established a practice advisory rather than a formalized clinical practice guideline [3]. Therefore, any physician who employs LA, including emergency physicians, should be knowledgeable on proper injection techniques, patient risk factors and se-lection, and reversal guidelines for LAST [3]. In this editorial, the authors discuss the epidemiolo-gy, pathophysiology, recognition, and treatment of LAST.