What is the initial lipid emulsion dose for LAST therapy?

What is the initial lipid emulsion dose for LAST therapy?

• A. 0.5 mL/kg.
• B. 1.5 mL/kg of 20% lipid emulsion IV, followed by infusion.
• C. 3 mL/kg.
• D. No lipid emulsion.

Answer: (B)

Treat LAST with lipid rescue therapy. The initial move is to administer a rapid bolus of lipid emulsion to create an intravascular lipid phase that traps the lipophilic local anesthetic, reducing its concentration in heart and brain—the lipid sink effect. The standard choice is 1.5 mL/kg of 20% lipid emulsion given IV as a bolus, then start a continuous infusion to maintain the lipid phase. This approach provides the prompt, robust uptake needed to counteract the toxicity; a smaller bolus won’t achieve the rapid sink, while a larger 3 mL/kg bolus is generally reserved for refractory cardiac arrest scenarios. Not giving lipid emulsion would miss the primary therapy for LAST.

Treat LAST with lipid rescue therapy. The initial move is to administer a rapid bolus of lipid emulsion to create an intravascular lipid phase that traps the lipophilic local anesthetic, reducing its concentration in heart and brain—the lipid sink effect. The standard choice is 1.5 mL/kg of 20% lipid emulsion given IV as a bolus, then start a continuous infusion to maintain the lipid phase. This approach provides the prompt, robust uptake needed to counteract the toxicity; a smaller bolus won’t achieve the rapid sink, while a larger 3 mL/kg bolus is generally reserved for refractory cardiac arrest scenarios. Not giving lipid emulsion would miss the primary therapy for LAST.