Before we jump in to discussing local anesthetics, did you know that Alberta Health Services employees have free online access to the Journal of PeriAnesthesia Nursing? Not only do you have access to past journal issues and articles, you can also access textbooks such as Drain’s 7th Edition of PeriAnesthesia Nursing: A Critical Care Approach. Just in time for your CARNA Registration Renewal!! At the end of our post today, we will show you how to access these great resources through the Knowledge Resource Services on Insite.
Now let’s get to the August 2020 JOPAN issue which focuses on postoperative pain management 🙂
With the increase in use of Local Anesthetics also comes the increase in risk of LAST (Local Anesthetic Systemic Toxicity). Although rare, this reaction to local anesthetic can be fatal. Do you know how to recognize LAST? Are you aware of your unit’s protocols and resources? A recent study shows that an educational gap is present and that LAST education resulted in more than 50% improvement in nurses’ knowledge of LAST.
Take me for example, I am not ashamed (ok maybe a little bit) to admit I only heard of this a mere 5 years ago. Granted, The American Society of Regional Anesthesia and Pain Medicine only created a checklist for the management of local anesthetic systemic toxicity (LAST) in 2010. It was last revised in 2017. Little did I know that this checklist could be found inside our crash cart on our unit (your unit may store it in a different place) and that the Lipids were found in a different location. Shouldn’t this be standardized across the province? Isn’t that why we created AHS? Ok ok, I realize this is a big ask, but my point is, are you familiar with the checklist, its recommendations and its emplacement?
Let us know if you found yourself going on a scavenger hunt for lipids! If you are already familiar with this concept, take this as a reinforcement of your knowledge, if not, happy learning! We would love to know if you have had education about LAST in your workplace and do you feel that this should be standardized? We would love to hear your thoughts and experiences!
ASRA Checklist for the management of LAST:
https://sparc360.com/wp-content/uploads/2019/04/Checklist_LAST.pdf
Article in Discussion: Local Anesthetic Systemic Toxicity (LAST): Increasing Awareness Through Education
To access this article and the August 2020 edition of the Journal of PeriAnesthesia Nursing, select the link above and enter your AHS login. If you cannot access the journal or you do not have an AHS login, please contact us at info.pananac@gmail.com – we will find a way to get it to you!
To find other articles, journals and textbooks, search Knowledge Resource Serices on Insite! Happy Learning!
Hey! Great job guys!
The one thing I will have to say is that over the last ( no pun intended) year or so we have found some discrepancies with the ASRA LAST guideline. If you do the math, it looks like the smaller person would actually receive more intralipid than the larger one. For this reason General systems at the UAH wanted to come up with their own formula . That being said, if a LAST emergency occurs it will be that initial bolus of intralipid that mainly reverses the toxicity.
Also just FYI currently at the U a bag of intralipid is stored on each unit on the 3rd floor, soon to be on the crash carts in the MAZ. Level 3 PACU has a rescue bag as does the block area.
It is rare, the times we have seen it are in the block area with the initial bolus or in the OR occasionally.
Keep up the posts ladies! They are great!
Chris Douglas
Acute Pain Service
UAH
Hi ladies,
The article you highlighted re: LAST discusses an online module to improved awareness. Can we get access to that module, or something similar?