Local Anesthetic Systemic Toxicity (LAST): Mini Review - Abstract
Local anesthetic systemic toxicity (LAST) significantly negatively affects life-threatening anesthesia practice. It arises after the increasing application of local anesthetic (LAs) drugs in clinical practice by various means and many anesthetic techniques. LAs exert different cellular effects in the central nervous (CNS) and cardiovascular systems (CVS); therefore, the underlying mechanisms of LAST are multifactorial. Although LAST, the most common neurological presentation, can occur atypically or less frequently with cardiovascular disease. There are various risk factors related to the drug used and the application. Ultrasound (US), while increasing the success of regional anesthesia (RA) techniques with its use, also increases the LAs dose and reduces the risk of anesthetic toxicity and complications. Critical points in LAST treatment are early lipid emulsion administration, rapid seizure management, and airway-respiratory and CVS-encouraging drug therapy. In preventing and treating LAST, knowing the underlying mechanisms, risk factors, pharmacokinetics, and pharmacodynamics of LAs drugs are vital in clinical practice for the practicing physician. Anesthesiologists can lead the education and training of those who practice LAs in the hospital setting in preventing and managing LAST. This review aims to emphasize LAST’s importance in our anesthesia practice.