In this episode of My Favorite Learners, host Chloe Gomez, DNP, CRNA sits down with Dr. Richard Wilson, DNAP, CRNA, FAANA to explore one of anesthesia’s most urgent crisis scenarios: Local Anesthetic Systemic Toxicity (LAST).
Together, they break down:
How LAST progresses from early CNS warning signs (tinnitus, metallic taste, agitation) to cardiovascular collapse
The mechanism of sodium-channel blockade and why high-risk populations (pregnancy, extremes of age, hepatic/renal disease) need extra vigilance
Prevention strategies: test doses, incremental injection, ultrasound guidance, and crisis checklists
The history and pharmacology behind lipid emulsion therapy (lipid rescue) and the latest simplified dosing updates
Adjustments to ACLS protocols specific to LAST (small-dose epinephrine, avoiding vasopressin)
Practical insights from both OB anesthesia and regional anesthesia practice
Dr. Wilson also shares his journey from practicing CRNA to academic leader, faculty, and mentor through CRNA School Prep Academy, along with timeless advice for anesthesia learners: “The days are long, but the weeks are short.”
Whether you’re a SRNA preparing for boards, a CRNA in clinical practice, or an educator teaching crisis management, this episode will leave you more confident in recognizing, preventing, and treating LAST.
Don’t forget to subscribe, share with your anesthesia colleagues, and check out the ASRA LAST checklist for your own practice setting.