Insights

The rare risk we plan for: local anesthetic toxicity

Local anesthetics are very safe at the right dose, and a real problem above it. Dose is why a physician is watching.

Safety & setting · 2 min read

Local anesthetic systemic toxicity (LAST) happens when too much local anesthetic reaches the bloodstream. It is rare, and it is the reason dose is calculated for your body weight and tracked throughout.

A clinical review in the Canadian Journal of Anaesthesia covers how LAST presents and is treated, and why preparation and vigilance matter. In the breast augmentation series above, the maximum lidocaine dose used was 17 mg/kg, and no signs of lidocaine or adrenaline toxicity were reported in a separate 300-patient series.

What this means for you: awake surgery is only as safe as the person doing the math and watching the monitors. At awakeMD that is a physician anesthesiologist, with emergency drugs and training on hand.

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References

  1. Dillane D, Finucane BT. Local anesthetic systemic toxicity. Can J Anaesth. 2010;57(4):368-380. PMID 20151342
  2. Rusciani A, Pietramaggiori G, Troccola A. The outcome of primary subglandular breast augmentation using tumescent local anesthesia. Ann Plast Surg. 2016;13-17. PMID 26670133
  3. Bolletta A, Dessy LA, Fiorot L, Tronci A. Sub-muscular breast augmentation using tumescent local anesthesia. Aesthetic Plast Surg. 2019;7-13. PMID 29995233