![]() Delayed-onset LAST may be harder to diagnose because it's not obviously temporally linked to anesthetic administration and clinically it may evolve in a more gradual fashion.ii) Due to accumulation following a continuous infusion of local or systemic medication (e.g., intravenous lidocaine infusion).This may occur several hours after administration. i) Due to gradual systemic absorption, following a single administration of local anesthetic.LAST can occur within minutes of local anesthetic administration (due to inadvertent intravenous administration).At a large center which performs lots of nerve blocks, LAST is an event which will occasionally occur.Overall, nerve blocks are a very safe procedure (often safer than the use of systemic analgesics).( 33426662) This creates an interesting duality: ![]() LAST has an incidence of roughly one per thousand nerve blocks.Large-volume, subcutaneous administration (e.g., to facilitate liposuction).Mucosal administration (e.g., bronchoscopy or awake intubation).Bupivacaine has greater risks than ropivacaine or lidocaine.Placement of catheter for prolonged anesthetic infusion.High-volume blocks, with doses approaching the maximal safe dose range (see table below).Mitochondrial diseases, carnitine deficiency.Pregnancy (hyperdynamic circulation may accelerate systemic absorption following nerve blocks reduced concentration of alpha-1 acid glycoprotein leads to higher free drug levels).Low muscle mass (e.g., older age, cachexia).Renal dysfunction: Uremia and acidosis may increase free drug levels, exacerbating toxicity. ![]()
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