Local anaesthetic (LA) toxicity usually occurs in the setting of regional anaesthesia. Ropivicaine and lignocaine are the most common LAs used in the hospital.
Toxicity occurs with inadvertent intravascular injection or rapid systemic redistribution.
Herald signs are dizziness, tinnitus, unexpected agitation, confusion and tachycardia which may progress to seizures, coma and cardiovascular compromise.
Management:
Stop procedure. Summon help immediately. Resuscitate if necessary.
Reinflate cuffs if performing Bier's block.
Treat seizures with benzodiazepines. Arrhythmias may be treated with sodium bicarbonate 8.4% 100 mL by IV bolus. Repeat if necessary. Cardiac arrest or pre-arrest states can be treated initially with lipid emulsion (Intralipid) 1.5 mL/kg of 20% IV push.