Local Anesthetic Toxicity
Local Anesthetic Toxicity: Calculating Maximum Safe Dose
- Use ideal body weight (IBW). If IBW >70 kg, use 70 kg dosing.
- If multiple local anesthetics (LAs) are used, calculate maximum dose assuming LA with greatest toxicity is used alone.
- Identify administered LA under “Agent & Concentration”
- Draw a line between LA Agent & Concentration (left) to patient´s IBW (right).
- Where this line intersects “Max Volume” (center) is the maximum dose (mL) that can be safely administered to the patient.
These numbers assume that the toxic levels are:
Bupivacaine = 2 mg/kg
- Lidocaine = 3 mg/kg
- Lidocaine + “Ad”renaline (Epinephrine) = 6 mg/kg
Dosing of 20% INTRAVENOUS LIPID for local anesthetic toxicity
- Draw a vertical line downward from patient´s IBW.
- The intersection of this line with the 3 other axes indicate weight-based initial bolus volume, infusion rate, and total maximum dose of intralipid (20%).
- Williams DJ, Walker JD. A nomogram for calculating the maximum dose of local anaesthetic. Anaesthesia. 2014;69(8):847-53. [PubMed]