Episode 222: Local Anesthetic Systemic Toxicity (LAST)

This podcast addresses Local Anesthetic Systemic Toxicity (LAST), a rare but critical emergency for emergency medicine physicians. Dr. Elaine Jonas defines LAST as a condition where the plasma concentration of local anesthetics exceeds toxic levels, leading to neurotoxicity and cardiovascular collapse. The discussion emphasizes the importance of timing in diagnosis, noting that symptoms can manifest within seconds, minutes, or hours after anesthetic administration, and may not always present with a clear neurological prodrome. Risk factors include extremes of age, low muscle mass, cardiac or hepatic dysfunction, renal insufficiency, and pregnancy. The podcast underscores the need for early recognition, treatment with benzodiazepines for seizures, management of metabolic derangements, and prompt administration of intralipid, highlighting that early intervention leads to a good prognosis.