LAUSR

arrhythmias and cardiac arrest after LA administration. The patients which are at high risk for side effects of LAs are as follows: Patients with partial or complete heart block, patients with advanced liver disease or severe renal dysfunction, patients in the late stages of pregnancy, patients treated with antiarrhythmic drugs Class III (e.g., amiadarone), and the elderly patients. Our patient had no risk factor for side effects of LA. Although cardiovascular symptoms are primarily reported for bupivacaine toxicity, our patient presented with neurological symptoms. In our patient, bupivacaine was administered subcutaneously to the scalp, which has good vascularity, and hence, LAST developed more easily. We applied lipid rescue therapy in accordance with the international guidelines because he had status epilepticus and severe acidosis. Because of the long action time of LA, long-term toxicity cases have been reported in the literature. In our case, long-term toxicity did not occur. Personnel in HT centers or other clinics that commonly use LAs should be trained for basic life support and on the side effects of LAs. Emergency physicians should be aware of LAST and should not hesitate to apply lipid rescue therapy immediately. In addition, because of the frequent usage of LA in ED, a lipid emulsion solution should be kept in the ED. References 1. Wadlund DL. Local anesthetic systemic toxicity. AORN J 2017;106: 367–77. 2. Yaster M, Tobin. Local anesthetics. In: Schechter NL, Berde CB, Yaster M, editors. Pain in Infants, Children, and Adolescents (2nd ed). Philadelphia, PA: Lippincott, Williams & Wilkins; 2003; pp. 241. 3. Safety A. Committee of Japanese Society of Practical guide for the management of systemic toxicity caused by local anesthetics. J Anesth 2019;33:1–8. 4. Marwick PC, LevinAI, Coetzee AR. Recurrence of cardiotoxicity after lipid rescue from bupivacaine-induced cardiac arrest. Anesth Analg 2009;108:1344–6.