Local Anesthetic Systemic Toxicity (LAST) in an Infant

Abstract

We reported a case of a 3-month-old baby diagnosed with the constriction ring syndrome at right wrist and both ankles. He was scheduled for a Z-plasty operation at both ankles and a tendo-achilles lengtheningat right leg. General anesthetic with endotracheal tube combined with caudal block was planned. After caudal block, there was an episode of hypotension and ventricular tachycardia. The local anesthetic systemic toxicity was diagnosed. Treatment consisted of intravenous administration of 1.5 ml/kg of 20% lipid emulsion with chest compression according to pediatric advanced life support (PALS) guidelines. Defibrillator was prepared but the cardiac rhythm returned to normal sinus rhythm immediately after the lipid emulsion administration without defibrillation. Then the cardiovascular status was normal. The surgeon proceeded with the planned operation. After the operation, the patient was extubated and observed in intensive care unit for 24 hours. There was no postoperative complication and the patient was discharged from the hospital uneventfully.