Update on the use of lipid emulsions in local anesthetic systemic toxicity: a focus on differential efficacy and lipid emulsion as part of advanced cardiac life support.

Local anesthetic systemic toxicity (LAST), including cardiovascular (CV) and central nervous system (CNS) complications, is a rare but devastating complication of regional anesthesia. Soon after the first successful use of cocaine as a local anesthetic (LA) in the late 19th century, there were case reports describing systemic toxicity and recommendations for its prevention. Arguably, LAST has been the major impetus for the development of newer (and safer) LA agents throughout the 20th century. Until the last decade, there were few options for treatment of LAST beyond a prolonged cardiopulmonary resuscitation (CPR). However, the recent successful use of intravenous lipid emulsions in severe LAST has dramatically changed the clinical management of this dreaded complication.