A note on LAST

A note on Local anesthetic systemic toxicity (LAST) 

Topical lidocaine is frequently used in ICU for various procedures. The risk of toxicity is higher if it is applied to mucosal membranes, particularly either repeatedly or in high doses. This could be a classic situation after prolonged bronchoscopy. In such situations, they could be either absorbed through mucous membranes or swallowed via the gastrointestinal (GI) tract. It can also be absorbed after applying to the skin. It may lead to neuro or cardio toxicities manifesting as seizures, arrhythmia, or cardiac arrest.

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References:

1. Labedzki L, Ochs HR, Abernethy DR, Greenblatt DJ. Potentially toxic serum lidocaine concentrations following spray anesthesia for bronchoscopy. Klin Wochenschr 1983; 61:379. 

2. Nath MP, Baruah R, Choudhury D, Chakrabarty A. Lignocaine toxicity after anterior nasal packing. Indian J Anaesth 2011; 55:427. 

3. Horáček M, Vymazal T. Lidocaine not so innocent: Cardiotoxicity after topical anaesthesia for bronchoscopy. Indian J Anaesth 2012; 56:95. 

4. Oni G, Brown S, Burrus C, et al. Effect of 4% topical lidocaine applied to the face on the serum levels of lidocaine and its metabolite, monoethylglycinexylidide. Aesthet Surg J 2010; 30:853.