Management of Local Anesthetics Systemic Toxicity In A 78 Year Old Man Undergoing Remove Of Inplate

Wike Yuliana, Heri Dwi Purnomo


Background: Local anesthetics have been widely used over the past 50 years in many clinical practices, ranging from emergency departments to operating rooms. Local anesthetics systemic toxicity (LAST) is a life-threatening condition when the effects of local anesthetics reach the systemic circulation with an incidence of 0.03% or 0.27 incidence of 1000 episodes of Peripheral nerve block (PNB).

Case: We report a 78-year-old male who underwent of remove of inplate (ROI) and open reduction internal fixation (ORIF) reconstruction. Preoperative physical examination revealed GCS E4V5M6, blood pressure 195/76, other vital signs within normal limits, SpO2 99% in the supine position. On examination of the lungs, there were increased bronchial breath sounds and rough crackles, especially in the 2-5 left intercostal space. Other physical and laboratory examinations were within normal limits. The patient was hemodynamically stable after infusion lipid emulsion. The main principle of LAST management is to ensure adequate ventilation and organ perfusion with sufficient oxygen-rich blood to reach the brain, heart, and kidneys to prevent acidosis until lipid emulsion therapy.

Conclusion: LAST management requires prompt and precise diagnosis and treatment to get a good outcome.


interscalene block; LAST; lipid emulsion; ROI

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