Local anesthetic systemic toxicity is a systemic adverse reaction to the administration of a local anesthetic. Children are at particular risk for local anesthetic systemic toxicity given their smaller body weight. In cases of cardiac arrest from local anesthetic systemic toxicity, prolonged chest compressions or extracardiac membrane oxygenation may be indicated because cardiac toxicity may last for several hours. Under general anesthesia, some of the early central nervous system signs of local anesthetic systemic toxicity, such as altered consciousness and seizures, may be masked, and the first indicator of local anesthetic systemic toxicity may be hemodynamic instability or cardiac arrest. Nevertheless, in a multicenter database of more than 100,000 consecutive pediatric regional anesthetics, local anesthetic systemic toxicity did not occur more often in pediatric patients undergoing regional anesthesia under general anesthesia compared with patients undergoing regional anesthesia awake or under sedation, and was overall very rare (2.2/10,000 and 15.2/10,000, respectively). In cases of cardiac arrest from local anesthetic systemic toxicity, prolonged chest compressions or extracardiac membrane oxygenation (ECMO) may be required because toxicity may last for several hours or more. Aggressive resuscitation and early administration of intralipid are the most important steps.
