Developing a Local Anesthetic Systemic Toxicity Protocol in a Mississippi Hospital

Local anesthetic systemic toxicity (LAST) is a rare complication of administering local anesthetic medications. However, this complication is potentially deadly, especially without prompt and correct treatment. Due to the rarity of LAST and the fact that its treatment differs from the conventional treatment of cardiac arrest, the authors sought a best practice recommendation to guide its treatment. While the most effective treatment for LAST has been well established, a thorough review of literature and survey of clinical preceptors demonstrated that most providers have not encountered LAST in clinical practice. Additionally, lipid emulsion therapy is a somewhat controversial treatment among some providers, even though its effectiveness is well documented. This doctoral project sought to develop a best practice recommendation to guide the treatment of LAST events and increase the confidence of providers in their ability to recognize and treat LAST. The recommendation was developed after a thorough review of the literature. The information was used to create a report of findings that were presented to a panel of experts. Feedback from the expert panel revealed that the respondents have not encountered a LAST event in their clinical practice. They all agreed that this practice recommendation would potentially help to guide the correct treatment of LAST. Their feedback, along with the report of findings was subsequently used to develop an executive review that was sent to a hospital affiliated with the Nurse Anesthesia Program at The University of Southern Mississippi in which the evaluation was performed. The executive summary also included an education module for the anesthesia staff