Lidocaine Associated Systemic Toxicity (LAST) Lidocaine Associated Systemic Toxicity (LAST) is a potentially life-threatening condition that occurs due to the excessive absorption of local anesthetics, particularly lidocaine, into the systemic circulation. LAST can result from inadvertent intravascular injection, overdose, or rapid absorption from highly vascularized areas. Pathophysiology: Lidocaine, like other local anesthetics, works by blocking sodium channels, inhibiting the initiation and propagation of nerve impulses. However, when systemic levels of lidocaine become excessively high, these sodium channels are blocked in vital organs such as the heart and brain, leading to serious complications. Clinical Presentation: LAST can manifest with a variety of symptoms that often progress through two stages: Neurological Symptoms : Early signs include circumoral numbness, metallic taste, tinnitus, and dizziness. As toxicity increases, more severe symptoms such as seizures,...
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