Local Anesthetic Toxicity: Optimal Management to Avoid Neurotoxic Injury and Treat Cardiac Arrest

Continued reports of major and minor neurologic sequelae following central neuraxial blockade have renewed concern regarding the potential toxicity of currently available local anesthetic agents. These reports, along with the experimental literature, have led to modifications in clinical practice. This lecture will summarize some of this clinical experience and the experimental findings that form the basis of these modifications, with particular emphasis on the rational selection of a local anesthetic for short-duration outpatient spinal anesthesia. In addition, the lecture will review the issue of local anesthetic systemic toxicity, focusing on the recent development of lipid rescue for bupivacaine cardiotoxicity, and the extension of lipid resuscitation beyond cardiotoxicity, and beyond treatment of the local anesthetics.