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Local Anesthetic Systemic Toxicity in Pregnancy 

Local Anesthetic Systemic Toxicity in Pregnancy
Local Anesthetic Systemic Toxicity in Pregnancy

Brian F. S. Allen

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date: 23 June 2021

Local anesthetic systemic toxicity (LAST) is a concern for all practitioners who administer local anesthetics, including neuraxial and regional analgesia and anesthesia for pregnant patients. Toxicity can manifest as neurologic (e.g., seizure) or cardiac (e.g., dysrhythmia) sequelae and even death. Management of LAST differs from advanced cardiovascular life support (ACLS) in several important ways, and the parturient suffering LAST requires even more specific therapy. This chapter reviews the pathophysiology, assessment, and management of LAST in pregnancy, highlighting key differences from ACLS and LAST therapy in the nonpregnant patient. Prevention of this complication is also discussed. Knowledge of this material is essential for timely and appropriate care in order to ensure optional outcome.

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