Tools of the Trade
Local Anesthetic Systemic Toxicity (LAST) is a rare adverse event of local anesthesia such as lidocaine commonly using in IR procedures, which can cause seizure, arrhythmias, and cardiovascular collapse.
Increased risk with intravascular injection or injection closer to the head and neck.
Recommended management if it occurs -
Secure airways and ventilate with 100% oxygen
Benzodiazepine such as lorazepam if seizure
Call a code or alert nearest facility with cardiopulmonary bypass capability
Manage cardiac arrhythmias avoiding vasopressin, CCBs, and b-blockers
Consider lipid emulsion (20%) therapy - continuous infusion 0.25 mL/kg/min for <10 min, can double to 0.5 mL/kg/min but avoid >10 mL/kg over first 30 min
It can be helpful to have an emergency box ready in/near the procedure suite.