In the management of LAST, which therapy is considered per guidelines?

• A. Lipid Emulsion Therapy
• B. Activated Charcoal
• C. Dialysis
• D. Epinephrine Only

Answer: (A)

When local anesthetic systemic toxicity happens, the treatment that guidelines emphasize as the main therapy is intravenous lipid emulsion therapy. It works by acting as a lipid sink that binds lipophilic local anesthetics in the bloodstream, reducing the free concentration of the drug and helping the heart and brain recover function more quickly.

Begin with a bolus of 1.5 mL/kg of a 20% lipid emulsion given IV over about a minute, then start an infusion at 0.25 mL/kg/min. If symptoms persist, a second bolus can be given and the infusion continued, keeping total doses within recommended limits (approximately up to 10 mL/kg in the first 30–60 minutes, then adjust as the patient improves). While this is happening, stop administering the local anesthetic and provide supportive care: secure the airway, administer 100% oxygen, treat seizures with benzodiazepines, and support ventilation as needed.

Other options, like activated charcoal, have limited usefulness once toxicity signs appear and are not the primary therapy for LAST; dialysis is not effective for removing the drug in this scenario; and epinephrine alone is not the favored approach due to potential for worsening arrhythmias—vasopressors such as norepinephrine are preferred if needed, with antiarrhythmics like amiodarone reserved for refractory cases.

In short, lipid emulsion therapy is the recommended, guideline-backed treatment for LAST.