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AAGBI Safety Guideline Management of Severe Local Anaesthetic Toxicity 1 Recognition 2 Immediate management 3 Treatment Signs of severe toxicity: • Sudden alteration in mental status, severe agitation or loss of consciousness, with or without tonic-clonic convulsions • Cardiovascular collapse: sinus bradycardia, conduction blocks, asystole and ventricular tachyarrhythmias may all occur • Local anaesthetic (LA) toxicity may occur some time after an initial injection • Stop injecting the LA • Call for help • Maintain the airway and, if necessary, secure it with a tracheal tube • Give 100% oxygen and ensure adequate lung ventilation (hyperventilation may help by increasing plasma pH in the presence of metabolic acidosis) • Confirm or establish intravenous access • Control seizures: give a benzodiazepine, thiopental or propofol in small incremental doses • Assess cardiovascular status throughout • Consider drawing blood for analysis, but do not delay definitive treatment to do this In circulatory arrest • Start cardiopulmonary resuscitation (CPR) using standard protocols • Manage arrhythmias using the same protocols, recognising that arrhythmias may be very refractory to treatment • Consider the use of cardiopulmonary bypass if available Without circulatory arrest Use conventional therapies to treat: • hypotension, • bradycardia, • tachyarrhythmia Give intravenous lipid emulsion (following the regimen overleaf) • Continue CPR throughout treatment with lipid emulsion • Recovery from LA-induced cardiac arrest may take >1 h • Propofol is not a suitable substitute for lipid emulsion • Lidocaine should not be used as an anti-arrhythmic therapy Consider intravenous lipid emulsion (following the regimen overleaf) • Propofol is not a suitable substitute for lipid emulsion • Lidocaine should not be used as an anti-arrhythmic therapy 4 Follow-up • Arrange safe transfer to a clinical area with appropriate equipment and suitable staff until sustained recovery is achieved • Exclude pancreatitis by regular clinical review, including daily amylase or lipase assays for two days • Report cases as follows: in the United Kingdom to the National Patient Safety Agency (via www.npsa.nhs.uk) in the Republic of Ireland to the Irish Medicines Board (via www.imb.ie) If Lipid has been given, please also report its use to the international registry at www.lipidregistry.org. Details may also be posted at www.lipidrescue.org Your nearest bag of Lipid Emulsion is kept This guideline is not a standard of medical care. The ultimate judgement with regard to a particular clinical procedure or treatment plan must be made by the clinician in the light of the clinical data presented and the diagnostic and treatment options available. © The Association of Anaesthetists of Great Britain & Ireland 2010
Immediately Give an initial intravenous bolus injection of 20% lipid emulsion 1.5 ml.kg –1 over 1 min and Start an intravenous infusion of 20% lipid emulsion at 15 ml.kg –1 .h –1 after 5 min Give a maximum of two repeat boluses (same dose) if: • cardiovascular stability has not been restored or • an adequate circulation deteriorates Leave 5 min between boluses A maximum of three boluses can be given (including the initial bolus) and Continue infusion at same rate, but: Double the rate to 30 ml.kg –1 .h –1 at any time after 5 min, if: • cardiovascular stability has not been restored or • an adequate circulation deteriorates Continue infusion until stable and adequate circulation restored or maximum dose of lipid emulsion given Do not exceed a maximum cumulative dose of 12 ml.kg –1 An approximate dose regimen for a 70-kg patient would be as follows: Immediately Give an initial intravenous bolus injection of 20% lipid emulsion 100 ml over 1 min and Start an intravenous infusion of 20% lipid emulsion at 1000 ml.h –1 after 5 min Give a maximum of two repeat boluses of 100 ml and Continue infusion at same rate but double rate to 2000 ml.h –1 if indicated at any time Do not exceed a maximum cumulative dose of 840 ml This AAGBI Safety Guideline was produced by a Working Party that comprised: Grant Cave, Will Harrop-Griffiths (Chair), Martyn Harvey, Tim Meek, John Picard, Tim Short and Guy Weinberg. This Safety Guideline is endorsed by the Australian and New Zealand College of Anaesthetists (ANZCA). © The Association of Anaesthetists of Great Britain & Ireland 2010
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Recommendations for the Safe Transf
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CONTENTS Section I Summary and Reco
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SECTION II - BACKGROUND In 1996 the
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SECTION IV - ORGANISATION AND COMMU
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SECTION V - STAFFING REQUIREMENTS A
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A p p ropriate re s p i ra t o ry s
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SECTION VII - THE TRANSFER The tran
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SECTION VIII - EQUIPMENT AND DRUGS
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SECTION IX - EDUCATION AND TRAINING
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SECTION X - RESOURCE IMPLICATIONS F
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APPENDIX I INDICATIONS FOR INTUBATI
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APPENDIX III ADDITIONAL INFORMATION
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AAGBI SAFETY GUIDELINE Suspected An
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GUIDELINES Suspected Anaphylactic R
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Suspected anaphylactic reactions as
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Storage of Drugs in Anaesthetic Roo
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Storage of Drugs in Anaesthetic Roo
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This guideline was originally publi
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Anaesthesia 2015 Checketts et al. |
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Anaesthesia 2016, 71, 1503 Correcti
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Membership of the working party Dr
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1. Summary 1.1 Safety, quality and
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3. Responsibility of anaesthetists
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3.4 The Trust - Medical Devices Man
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4. Standards 4.1 Medical Devices Di
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5. Responsibility of manufacturers
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6. Choosing and trialling equipment
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equipment officer is encouraged to
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EU procurement thresholds Threshold
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When negotiating a purchasing agree
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9. Shared equipment Many types of e
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Third party servicing is another op
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11. Replacement 11.1 Planned equipm
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number of re-uses (e.g. re-usable L
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Where new equipment is purchased th
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14. Incident reporting and investig
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available from www.hse.gov.uk 14.4
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DB DoH EBME EC EU FRCA HN HSE IEC I
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8. OPSI. Statutory Instrument 2006
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Eire Tel: 00353 1 676 4971 Website:
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Peri-operative management of the ob
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Guidelines Peri-operative managemen
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Recommendations 1 Every hospital sh
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35 30 25 Prevalance (%) 20 15 10 5
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is an increased incidence of prolon
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Figure 2 Relationship between total
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techniques, and when used with neur
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Table 5 The STOP-BANG screening que
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Intra-operative care Preparation of
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Figure 3 Ramping position for obese
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eturn of airway reflexes with desfl
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Table 6 Dosing schedule for thrombo
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A review and meta-analysis by the S
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numbers of staff are needed to roll
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Table 7 Equipment for managing obes
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11. Schneider HJ, Glaesmer H, Klots
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44. Edholm D, Kullberg J, Haenni A,
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75. McKay RE, Malhotra A, Cakmakkay
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Out of Hours Activity (Anaesthesia)
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Considerations for anaesthetists Th
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OAA / AAGBI Guidelines for Obstetri
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Contents 1. Key recommendations 2 2
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2. Introduction This is the third v
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Recommendations Medical staff The t
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appointed directly from other count
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Peripartum care Pre-operative asses
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Intravenous patient-controlled opio
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depression. In the absence of contr
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of clinical deterioration, as recom
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5. Training and education Each obst
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The Royal College of Anaesthetists
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Contents ❚ Foreword 4 Introductio
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Introduction ❚ The Good Anaesthet
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Related guidelines and sources of i
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Domain A: knowledge, skills and per
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Domain B: safety and quality Attrib
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Domain C: communication, partnershi
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Domain D: maintaining trust Attribu
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Day Case and Short Stay Surgery 2 P
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GUIDELINES Day case and short stay
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Guidelines: Day case and short stay
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