MANAGEMENT OF LOCAL ANAESTHETIC SYSTEMIC TOXICITY Ensure 100% oxygenation via mask or endotracheal tube Treat hypotension, bradycardia, arrhythmia Treat seizures with midazolam or thiopentone Airway Breathing Circulation Call for help & get LIPID EMULSION Activate cardiopulmonary bypass team Stop injecting local anaesthetic STOP >70kg Bolus-100ml over 2-3min Infusion- 250ml over 15min <70kg Bolus-1.5ml/kg over 2-3 min Infusion- 0.25ml/kg/min Unstable Maximum 3 boluses Maximum dose-12ml/kg After 5min Avoid vasopressin, beta blockers, calcium channel blockers, local anaesthetics, propofol Use adrenaline in low doses (<1mcg/kg) Monitor in ICU for upto 6h INTRAVENOUS LIPID EMULSION THERAPY Step 1 Step 2 Step 3 Stable Repeat bolus & Double the infusion CAUTION! Intralipid 20% LIPID EMULSION Paediatric dose 1.5-2ml/kg