TYK4 - Revision history

WikiSysop at 22:39, 22 January 2022

2022-01-22T22:39:44Z

← Older revision		Revision as of 22:39, 22 January 2022
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	All of the following are true concerning the treatment of local anesthetic systemic toxicity (LAST) EXCEPT which of the following?		All of the following are true concerning the treatment of local anesthetic systemic toxicity (LAST) EXCEPT which of the following?
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	D. Propofol is usually avoided despite its lipid content		D. Propofol is usually avoided despite its lipid content

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	==Answer==		==Answer==

	The answer is C. Epinephrine doses are usually limited to <b>< 1 mcg/kg</b> for individual doses. This is a 10 fold decrease from current recommendations of Pediatric Advanced Life Support which are 10 mcg/kg or 0.01 mg/kg. There is some recent evidence that epinephrine can impair resuscitation from LAST and reduce the efficacy of intralipid rescue. However, the use of epinephrine must be balanced between the need for critical coronary perfusion pressure (CPP) and the risk of increased arrhythmias and increased oxygen consumption. Therefore it is recommended to avoid high doses of epinephrine and use smaller doses, e.g., <1 mcg/kg, for treating hypotension. Propofol is usually avoided in LAST due to its propensity to cause hemodynamic instability. Propofol's lipid emulsion (1%) is much lower than Intralipid (20%) and would cause significant hypotension if used in a volume needed for its lipid effects. Vasopressin is generally avoided as it may worsen the acidosis and has been associated with no improvement over acidosis.<ref>Regional Anesthesia & Pain Medicine:March/April 2010 - Volume 35 - Issue 2 - pp 188-193 [http://journals.lww.com/rapm/Abstract/2010/03000/Treatment_of_Local_Anesthetic_Systemic_Toxicity.12.aspx]</ref>		The answer is C. Epinephrine doses are usually limited to <b>< 1 mcg/kg</b> for individual doses. This is a 10 fold decrease from current recommendations of Pediatric Advanced Life Support which are 10 mcg/kg or 0.01 mg/kg. There is some recent evidence that epinephrine can impair resuscitation from LAST and reduce the efficacy of intralipid rescue. However, the use of epinephrine must be balanced between the need for critical coronary perfusion pressure (CPP) and the risk of increased arrhythmias and increased oxygen consumption. Therefore it is recommended to avoid high doses of epinephrine and use smaller doses, e.g., <1 mcg/kg, for treating hypotension. Propofol is usually avoided in LAST due to its propensity to cause hemodynamic instability. Propofol's lipid emulsion (1%) is much lower than Intralipid (20%) and would cause significant hypotension if used in a volume needed for its lipid effects. Vasopressin is generally avoided as it may worsen the acidosis and has been associated with no improvement over acidosis.<ref>Regional Anesthesia & Pain Medicine:March/April 2010 - Volume 35 - Issue 2 - pp 188-193 [http://journals.lww.com/rapm/Abstract/2010/03000/Treatment_of_Local_Anesthetic_Systemic_Toxicity.12.aspx]</ref>

	==Notes==		==Notes==
	<references />		<references />


	:[[Wikipedia:Local_anesthetic_toxicity]]		:[[Wikipedia:Local_anesthetic_toxicity]]
	:[http://www.asra.com/checklist-for-local-anesthetic-toxicity-treatment-1-18-12.pdf ASRA Checklist]		:[http://www.asra.com/checklist-for-local-anesthetic-toxicity-treatment-1-18-12.pdf ASRA Checklist]
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WikiSysop: 1 revision imported

2021-03-20T16:48:27Z

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← Older revision	Revision as of 16:48, 20 March 2021
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https://pedsanesthesia.net/wikiOLD032021>JustinHamrick at 20:11, 24 February 2015

2015-02-24T20:11:25Z

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<div class="mw-collapsible mw-collapsed" style="width:100%">

All of the following are true concerning the treatment of local anesthetic systemic toxicity (LAST) EXCEPT which of the following?

A. Vasopressin is generally avoided in patients with LAST syndrome

B. Intralipid is a known effective treatment for systemic toxicity

C. Epinephrine doses of >1 mcg/kg are usually indicated for resuscitation

D. Propofol is usually avoided despite its lipid content

<div class="mw-collapsible-content">
==Answer==

The answer is C. Epinephrine doses are usually limited to <b>< 1 mcg/kg</b> for individual doses. This is a 10 fold decrease from current recommendations of Pediatric Advanced Life Support which are 10 mcg/kg or 0.01 mg/kg. There is some recent evidence that epinephrine can impair resuscitation from LAST and reduce the efficacy of intralipid rescue. However, the use of epinephrine must be balanced between the need for critical coronary perfusion pressure (CPP) and the risk of increased arrhythmias and increased oxygen consumption. Therefore it is recommended to avoid high doses of epinephrine and use smaller doses, e.g., <1 mcg/kg, for treating hypotension. Propofol is usually avoided in LAST due to its propensity to cause hemodynamic instability. Propofol's lipid emulsion (1%) is much lower than Intralipid (20%) and would cause significant hypotension if used in a volume needed for its lipid effects. Vasopressin is generally avoided as it may worsen the acidosis and has been associated with no improvement over acidosis.<ref>Regional Anesthesia & Pain Medicine:March/April 2010 - Volume 35 - Issue 2 - pp 188-193 [http://journals.lww.com/rapm/Abstract/2010/03000/Treatment_of_Local_Anesthetic_Systemic_Toxicity.12.aspx]</ref>

==Notes==
<references />

:[[Wikipedia:Local_anesthetic_toxicity]]
:[http://www.asra.com/checklist-for-local-anesthetic-toxicity-treatment-1-18-12.pdf ASRA Checklist]
</div>

==Keywords==

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<p style="text-align: center;">[[TYK About | About Test Your Knowledge]]</p>

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