A timely topic for me, as just a couple of days ago I actually caused a mild case of LA neurotoxicity. I was giving some IV lidocaine in the pre-op area, and as I was talking to her and slowly pushing the syringe I saw her get a look of distress on her face and tell me she didn't feel well. As I quickly started placing the Sp02 and ECG leads and was thinking to myself "I really wish I had some versed in my pocket" (as I often do in pre-op), she told me that she felt very lightheaded and "heard a noise in her head". She was slurring her speech a little as she told me this. Classic early signs of LAST. My heart fell into my gut for a minute, but her symptoms didn't get any worse than that, her EKG and VS never changed, and she felt fine a few minutes later. It's not uncommon for people to say they hear a little ringing in their ears or feel a little lightheaded if you give the lido a little too fast, but her reaction was much more dramatic than I've ever seen, and I don't think she'd even gotten 1 mg/kg when it started. I guess I just gave it too fast and/or she was sensitive to it. Got my attention in a hurry, though.
Aside from that, I have no experience with local anesthetic systemic toxicity (for those who might not know what LAST is), as it is a pretty rare occurrence. It's not unlike MH, insofar as being a critical but rare occurrence that everyone talks about and tries to be prepared for, but that most can't say they've personally dealt with.
Some good info on it from ASRA and NYSORA:
https://www.asra.com/advisory-guide...eatment-of-local-anesthetic-systemic-toxicity
http://www.nysora.com/mobile/region...of-ra/3075-toxicity-of-local-anesthetics.html
Never heard of lipids being used for anything other than LA toxicity, but I guess it makes sense that it would work for most lipid-soluble drugs. At least if there is truth to the most commonly taught reason for the effectiveness of lipids during LAST (the "lipid sink" theory).
