Table 2 Summaries included studies
Authors/Year | Patients | Block type | Local Anaesthetic | Central nervous system symptoms | Cardiovascular symptoms | Possible causes | Lipid emulsion (20%) | Other treatment for LAST | Outcomes | |
|---|---|---|---|---|---|---|---|---|---|---|
LAST treated with lipid | ||||||||||
Anada & Yoshida 2017 [23] | Age: 28 Gestation: 35 wks 150 cm, 50 kg (pre-pregnancy 40 kg) | TAP block after CS with general anaesthesia | Ropivacaine 225 mg | Restlessness Seizure | Hypertension Tachycardia Hypotension Cardiac arrest | Overdose of ropivacaine | Intralipos | Boluses 1.5 ml/kg/min (75 ml) × 3 boluses at 5-min intervals Infusion 0.250.5 ml/kg/min | ACLS including intubation and defibrillation for VF, adrenaline 1 g, midazolam 5 mg | Mother: ROSC, Symptoms resolved Baby: N/A |
Diaz et al. 2012 [33] | Age: NR Gestation: Term– cm, 75 kg | CS after epidural for labor | CS: Lidocaine 340 mg Labour: levo-bupivacaine 34.25 mg over 3.5 h | Nausea, Drowsiness, Hand tremors, Nystagmus, Loss of consciousness | Hypotension | NR | Media-lipide | Bolus 100 ml over 5 min Infusion 400 ml | Phenylephrine Ondansetron | Mother: Symptoms resolved Baby: N/A |
Dun-Chi Lin et al., 2017 [34] | Age: 29 Gestation: 39 wks 163 cm, 87.3 kg | Combined spinal–epidural for labor + PCEA | Lidocaine 45 mg + epinephrine Bupivacaine 29.25 mg over 50 min | Tinnitus Metallic taste Experience of ‘something was off’ ‘having an out-of-body’ | Tachycardia Hypertension Palpitations | Intravascular migration of an epidural catheter | Intralipid | Bolus 1.5 mL/kg. Infusion 0.25 mL/kg/min | Oxygen | Mother: Symptoms resolved Baby born healthy by CS |
Naidu & Richebe 2013 [35] | Age: 25 Gestation: 37 wks 150 cm, 51 kg | TAP block after CS with general anaesthesia | TAP: Bupivacaine 150 mg × 2 with 15 h interval CS: lidocaine 60 mg | Seizure | No hemodynamics stable | NR | Intralipid | Bolus 1.5 ml/kg | Intubation, lorazepam, propofol | Mother: Symptoms resolved Baby: N/A |
Singh et al 2019 [36] | Age: 28 Gestation: 38 wks – cm, 75 kg | Epidural for labor | Isobaric bupivacaine 20 mg | Agitation Twitching of face or /limbs | Tachycardia Hypertension | NR | Intralipid | Bolus 1.5 ml/kg (112.5 ml) × 2 at 10 min interval | NR | Mother: Symptoms resolved Baby born healthy by CS |
Spence et al. 2007 [37] | Age: 18 Gestation: 38 wks – cm, 86 kg | Epidural for labor CS | Labour: lidocaine 80 mg, isobaric bupivacaine 15 mg CS: bupivacaine 50 mg | Restlessness Agitation face/limbs twitching Unresponsiveness Seizure | Tachycardia Hypertension | Intravascular migration of an epidural catheter | Intralipid | Bolus: 100 ml Infusion: 400 ml | Diazepam MgSO4–labetalol infusions | Mother: Symptoms resolved Baby born by CS |
Weiss et al. 2014 [38] | Age: 36 Gestation: 38 wks 152 cm, 56 kg | TAP block after CS with spinal anaesthesia | TAP: levo-bupivacaine 150 mg CS: Hyperbaric bupivacaine 10 mg | Unresponsive Seizure Respiratory arrest | None Hemodynamic parameters stable | Partial intramuscular injection | Intralipid | Bolus 100 ml over 2 min Infusion 0.25 ml/kg/min (total: 200 ml) | Bag-mask ventilation Benzodiazepine | Mother: Symptoms resolved Baby: N/A |
Age: 33 Gestation: 36 wks 170 cm, 61 kg | TAP block after CS with intrathecal anaesthesia | TAP: ropivacaine 300 mg CS: hyperbaric bupivacaine 10 mg | Seizure Respiratory arrest | ‘No hemodynamic change was noted’ | Overdose of ropivacaine | Intralipid | Bolus 100 ml over 2 min. Infusion 0.25 ml/kg/min. (total:250 ml) | Bag-mask ventilation Medication for high blood pressure | Mother: Symptoms resolved Baby: N/A | |
Lipidrescue.org (Weinberg) [29] Cases 1–7 | ||||||||||
Case 1, posted on May 21, 2011 | Age: 20 Gestation: NR – cm, 60 kg | Epidural for perineal tear after epidural for labour | Perineal repair: Bupivacaine 50 mg Labor: Bupivacaine 100 mg over 4 h | Loss of consciousness, Seizure | Hypertension (LAST or pre-existing unknown) | Intravascular migration of an epidural catheter | Intralipid | Bolus 100 ml Infusion (rate: NR) | Intubation Thiopentone Suxemethonium Magnesium | Mother: Symptoms resolved Baby: N/A |
Case 2, posted on Apr 14, 2013 | Age: 40 Gestation: NR – cm, 62 kg | Epidural for labor | Bupivicaine 105 mg | Dizziness, Tingling of nose and cheeks | Tachycardia | NR | Intralipid | Bolus 100 ml over 2–3 min | NR | Mother: Symptoms resolved Baby born healthy by vaginal birth |
Case 3, posted on May 1, 2014 | Age: NR Gestation: NR – cm, – kg | TAP block after CS with epidural anaesthesia | TAP: Bupivacaine (Marcaine) (150 mg) CS: lidocaine (380 mg) | Hearing and taste abnormalities ‘Difficulty with speech and movement’ | Hypertension | NR | Type: NR | Bolus 1.5 ml/kg. Infusion 0.25 ml/kg/min. (total 500 ml) | 100% non-rebreather mask | Mother: Symptoms resolved Baby: N/A |
Case 4, posted on Jul 17, 2016 | Age: 21 Gestation: NR – cm, – kg | N/A | Bupivacaine 250 mg | Perioral numbness, Tinnitus, Seizure, Stupor, Apnoea | Tachycardia Hypotension | Wrong route drug error | Intralipid | Bolus 150 ml. Infusion 0.25 ml/kg/min for 15 min | No CPR | Mother: Symptoms resolved Baby born healthy by vaginal birth |
Case 5, posted on Feb 27, 2020 | Age: 29 158 cm, 62 kg | Spinal for CS | Bupivacaine 12.5 mg with epinephrine | NR | Arrhythmia | NR | Intralipid | Bolus 70 ml + 25 ml at 3-min intervals | NR | Mother: Symptoms resolved (apart from heartburn) Baby: NR |
Case 6, posted on Dec 8, 2020 | Age: NR Gestation: 26 wks – cm, – kg | Infiltration anaesthesia for fetal thoracentesis | Lidocaine 800 mg without epinephrine | Short of breath, Dizziness, Slurred speech, Seizure, Loss of consciousness, Respiratory arrest | NR | Overdose of lidocaine | Type: NR | Bolus 100 ml. Infusion 0.25 ml/kg/min for 1 h | Intubation Midazolam Propofol | Mother: Symptoms resolved Baby born alive by CS |
Case 7, posted on Jan 3, 2021 | Age: 35 Gestation: NR 163 cm, 66 kg | Ilioinguinal nerve block after CS with spinal anaesthesia | Ropivacaine 112.5 mg CS: heavy bupivacain 9 g | Dizziness, Tinnitus, Slurred speech, Breathing difficulties | None ‘ECG and BP, HR remained normal’ | NR | Intralipid | Bolus 90 ml | NR | Mother: Symptoms resolved Baby: N/A |
LAST treated without lipid | ||||||||||
Griffiths et al. 2013 [39]Cases 1–3 | Age: mean = 34 (range 32–36) Weight: mean = 91 (SD = 6.4) BMI: mean = 34.8 (SD = 6.4) | TAP block after CS with spinal anaesthesia | TAP: ropivacaine mean = 229 mg (SD = 19.1) | Case 1. Perioral tingling slurred speech | ‘No patients exhibited evidence of cardiovascular disturbance’ (p. 998) | NR | Not used | N/A | ‘All symptoms resolved without treatment’ (p.998) | Mother: Symptoms resolved Baby: N/A |
Case 2. Perioral tingling tongue paraesthesia | ||||||||||
Case 3. Metallic taste | ||||||||||
Ideno et al. 2013 [40] | Age: 20 Gestation: 37 wks 165 cm, 49 kg (prepregnancy 42 kg) | TAP block after CS with spinal anaesthesia | TAP: lidocaine 200 mg Ropivacaine 150 mg CS: hyperbaric bupivacaine 10 mg | Dizziness Dysarthria, Numbness of lips, Visual disturbance | None | NR | Not used | N/A | Colloid infusion | Mother: Symptoms resolved Baby: N/A |
Wada et al. 2011 [41] | Age: 28 Gestation: 32 wks | TAP block after CS | Ropivacaine (dose: NR) | Restlessness Seizure | NR | NR | Not used | N/A | Magnesium sulphate diazepam | Mother: Symptoms resolved Baby: N/A |
Smetzer et al 2010 [42] | Age: 16 | N/A | Intravascular infusion of Bupivacaine | Seizure Respiratory distress Apnoea | Cardiac arrest | Wrong route drug error | Not used | N/A | ACLS | Mother: Death Baby born healthy by CS |
Sud & Szawarski 2018 [43] | Age: 30 | N/A | Intravascular infusion of bupivacaine 150 mg | Dizziness, Loss of consciousness, Seizure | Ventricular fibrillation Cardiac arrest | Wrong route drug error | Not used | N/A | ACLS | Mother: Death Baby: N/A |