Thu7October1232PM 10

In the management of local anaesthetic toxicity:

True / False

The initial bolus of intravenous 20% lipid emulsion should be 1.5 ml/kg Correct

Three boluses of intravenous 20% lipid emulsion are permitted if cardiovascular stability is not restored Correct

Cases in the UK should be reported to the National Patient Safety Agency (NPSA) Correct

Hyperventilation should be avoided Correct

The initial bolus should be given over 15 minutes Correct

Explanation

All cases of local anaesthetic toxicity should be reported to the NPSA.

According to the AAGBI, "hyperventilation may help by increasing plasma pH in the presence of metabolic acidosis" in cases of local anaesthetic toxicity.

The initial bolus of 20% lipid emulsion is 1.5 ml/kg followed by an infusion of 15 ml/kg/hour.

The bolus should be given over one minute.

A maximum of two repeat boluses of 1.5 ml/kg are permitted if:

cardiovascular stability has not been restored or

an adequate circulation deteriorates

A maximum of three boluses can be given (including the initial bolus). The infusion rate can be doubled to 30 ml/kg/hr if these circumstances prevail.

Reference:

The Association of Anaesthetists of Great Britain & Ireland (AAGBI). Management of Severe Local Anaesthetic Toxicity.

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Average score: 68.42%

Times answered: 228