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Local anesthetic systemic toxicity in children: a review of recent case reports and current literature - an infographic
  1. Rajnish K Gupta1 and
  2. Eric S Schwenk2
  1. 1 Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  2. 2 Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Rajnish K Gupta, Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; raj.gupta{at}

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Local anesthetic systemic toxicity (LAST) in children is an understudied complication of regional anesthesia but is uniquely different in many ways when compared with adult LAST. The estimated risk of LAST in children is 8/100,000 (95% CI, 0.3 to 1.6) whereas that risk in adults is approximately 27/100,000. In this review of the literature and case reports, Ramesh and Boretsky discovered that 68% of LAST events in children occurred under general anesthesia and only 42% received lipid emulsion as treatment.1 Ultrasound was not used in 87% of the cases when LAST occurred and a vascular marker (epinephrine) was not used in 84% of cases. Over half of the cases were in children under 3 years of age with 73% occurring in males. Penile blocks, caudal blocks, and dental local infiltrations represented the most frequent procedures where toxicity occurred. Notably, dentists and primary care physicians are more likely to use greater than the maximum recommended dosage of local anesthetic.

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We would like to acknowledge Jim Snively, artist, of Pittsburgh, PA, for creation of this infographic.



  • Twitter @dr_rajgupta, @ESchwenkMD

  • Correction notice This article has been corrected since it published Online First. The infographic image has been corrected.

  • Collaborators Jim Snively

  • Contributors I provided the editing and content for the infographic along with design ideas and concept.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests Both coauthors are associate editors for Regional Anesthesia and Pain Medicine.

  • Provenance and peer review Commissioned; internally peer reviewed.

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