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ASRA Practice Advisory on Local Anesthetic Systemic Toxicity
  1. Joseph M. Neal, MD*,
  2. Christopher M. Bernards, MD*,
  3. John F. Butterworth, MD,
  4. Guido Di Gregorio, MD,
  5. Kenneth Drasner, MD§,
  6. Michael R. Hejtmanek, MD*,
  7. Michael F. Mulroy, MD*,
  8. Richard W. Rosenquist, MD and
  9. Guy L. Weinberg, MD
  1. From the *Virginia Mason Medical Center, Seattle, WA;
  2. University of Indiana, Indianapolis, IN;
  3. Department of Anesthesiology, University of Illinois and the Jesse Brown VA Medical Center, Chicago, IL;
  4. §University of California, San Francisco, CA; and
  5. University of Iowa, Iowa City, IA.
  1. Address correspondence to: Joseph M. Neal, MD, 1100 Ninth Ave (B2-AN), Seattle, WA 98111 (e-mail: anejmn{at}vmmc.org).

Abstract

The American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity assimilates and summarizes current knowledge regarding the prevention, diagnosis, and treatment of this potentially fatal complication. It offers evidence-based and/or expert opinion-based recommendations for all physicians and advanced practitioners who routinely administer local anesthetics in potentially toxic doses. The advisory does not address issues related to local anesthetic-related neurotoxicity, allergy, or methemoglobinemia. Recommendations are based primarily on animal and human experimental trials, case series, and case reports. When objective evidence is lacking or incomplete, recommendations are supplemented by expert opinion from the Practice Advisory Panel plus input from other experts, medical specialty groups, and open forum. Specific recommendations are offered for the prevention, diagnosis, and treatment of local anesthetic systemic toxicity.

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Footnotes

  • This study was supported by the American Society of Regional Anesthesia and Pain Medicine (ASRA).

  • The authors of this document are pleased to announce that their colleagues in the Association of Anaesthetists of Great Britain and Ireland, coincident with this ASRA Practice Advisory, have developed "Guidelines for the Management of Severe Local Anaesthetic Toxicity." Dr. Weinberg contributed to this document. Physicians with particular interest in local anesthetic toxicity may wish to also consult the work of the Association of Anaesthetists of Great Britain and Ireland.

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