Local Anesthetic Systemic Toxicity (LAST) Nursing Interventions for Certified Perioperative Nurse (CNOR)

Local Anesthetic Systemic Toxicity (LAST) Nursing Interventions

Guidelines:

• Wide variety of symptoms (difficult to differentiate from normal pacu patient)
  • Mouth numbness/metallic taste
  • confusion
  • Seizures
  • Hallucinations
  • Dysrhythmia
  • Low BP
• Old and young vulnerable
  • Kidney disease
• LIPOSOMAL BUPIV (Exparel)
• Bier block
• Lipid emulsion
  • 20% IV solution
  • Moves anesthetic away from organs into muscles/liver

Considerations:

• Epi vs non-Epi
• Regional blocks AND local
• Multiple teams each with local
• S/S mimic most PACU patients
• Difficult to determine amount used if poorly documented

Nurse’s role:

• Identification
• Documentation of all medications given
• Track amount used, limit amount placed on field
• Communicate and calculate maximum
• Verify labeling of local
• EXPAREL armband
• Proper reporting and turnover

Pitfalls:

• EXPAREL with lido
• Inadequate tracking of dosage
  • Blocks
• Local/mac for inappropriate procedure
• Improper labeling

Examples:

• Surgeon requests additional local intraop, concerning RN (communicate amount given, include anesthesia, time out as needed)
• PACU patient seizes, dysrhythmia (procedure? Local given? History? Alarm provider, anticipate LAST protocol)

Linchpins (Key Points):

• LAST can be prevented easily with proper attention to detail and surgical system function