Local Anaesthetic Toxicity - Guidelines for Crises in Anaesthesia

Signs of severe toxicity:

 • Sudden alteration in mental status, severe agitation or loss of consciousness, with or without tonic-clonic convulsions.

 • Cardiovascular collapse: sinus bradycardia, conduction blocks, asystole and ventricular tachyarrhythmias may all occur.

 • Local anaesthetic toxicity may occur some time after an initial injection.



❶ Stop injecting the local anaesthetic (remember infusion pumps).

❷ Call for help and inform immediate clinical team of problem.

❸ Call for cardiac arrest trolley and lipid rescue pack.

❹ Give 100% oxygen and ensure adequate lung ventilation:

  • Maintain the airway and if necessary secure it with a tracheal tube.

  • Hyperventilation may help reduce acidosis.

❺ Confirm or establish intravenous access.

❻ If circulatory arrest:

  • Start continuous CPR using standard protocols.

  • Give intravenous lipid emulsion (Box A).

  • Recovery may take >1 hour.

  • Consider the use of cardiopulmonary bypass if available.

 If no circulatory arrest:

  • Conventional therapies to treat hypotension, brady- and tachyarrhythmia.

  • Consider intravenous lipid emulsion (Box A).

❼ Control seizures with small incremental dose of benzodiazepine, thiopental or propofol.



By Association of Anaesthetists @ https://twitter.com/AAGBI

Quick Reference Handbook - Guidelines for crises in anaesthesia 



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