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LIPID EMULSION THERAPY FREE

Restores calcium transport, which was interrupted by anesthetics.

Augments cardiac energy source delivery, which the local anesthetics interrupted.

LIPID EMULSION THERAPY FREE

“Lipid Sink” metaphor – the lipid emulsion acts as another compartment for the lipophilic drugs to reach equilibrium with, thus reducing the available free drug.Consider LAST in any patient with altered mental status, new neurologic symptoms, or signs of cardiovascular instability that develop after use of local anesthetic.Establish IV and place on monitors, if not already.Stop any infusion of local anesthetic at the first sign of symptoms.Pay attention to the subtle signs of toxicity!.Always aspirate as you advance the needle looking to avoid injecting into blood vessels.Double check your dosing of the specific anesthetic.It is best to avoid LAST from occurring!.Region of administration is a smaller target in young children… so may be missed, or inadvertently affecting adjacent structures in close proximity.Amides are metabolized by the Liver (although, metabolism of esters also involves liver products) – so patients with liver disease, or reduced liver function, LIKE CHILDREN, may have potentiated effects.Plasma protein binding of the local anesthetic is reduced in neonates and infants.Children are at greater risk for systemic toxicity of local anesthetics.Torsades de Pointes, Ventricular Fibrillation.Wide QRS complexes, Ventricular dysrhythmias.Severe clinical toxicity is characterized by a dose-related CNS and Cardiovascular toxicity.Early signs of toxicity can be subtle (especially if patient is sedated):.ex, consumption of over the counter product by toddler.ex, use of anesthetic at dose greater than recommended.

Can be do to excessive absorption from highly vascularized area.Can be do to inadvertent injection into the vascular system.Local Anesthetic Systemic Toxicity (LAST) is a severe and life-threatening adverse reaction due to local anesthetic reaching significant systemic levels.Toxicity duration and severity is also greater with Long-Acting.Long-Acting, like Bupivacaine, have greater potency and duration.Can be classified as either Short-Acting or Long-Acting local anesthetics.Amides = Lidocaine, Mepivacaine, Ropivacaine, Bupivacaine.Esters = Benzocaine, Cocaine, Procaine, Tetracaine, Chloroprocaine.They also effect GABA pathways leading to unopposed excitatory activity.

Local anesthetics inhibit sodium channels in neurons.

Risk of severe Local Anesthetic Systemic Toxicity (LAST) is also low – 0.76:10,000 in one study.

Overall, regional anesthesia is safe when performed correctly!.

In the ED, they can be used for laceration repairs as well as pain management of extremity injuries… and they let us use our cool Ultrasounds for another procedure (what fun!).

Regional anesthesia has become more commonly used in children.

Let us take a minute to review LAST and its therapy, Lipid Emulsion: That is when we need to remember LAST (Local Anesthetic Systemic Toxicity). Certainly topical preparations work amazingly well, even for our tiniest of patients ( Neonatal Analgesia), but sometimes we need to use it locally or for regional blocks. Whether it is a Fish Hook where it shouldn’t be or a Tongue Laceration or whether it is Mandibular Fracture or a Facial Laceration, anticipating and managing the child’s pain is critical! We have previously discussed using Intranasal Analgesics and Nitrous Oxide to provide relief of pain, but most often good ol’ fashioned lidocaine is all that is needed. Managing injuries is all too common when caring for children.