Diagnosis

May have:

Give 100% O₂, evaluate ventilation, stop N₂O and volatiles
Stop local anesthetic
- What was given? Drug, dose, site? Does this = a crisis or not?
- If crisis, request intralipid
  - Bolus Intralipid 20% 1.5 mL/kg IV over 1 min.
  - Further dosing
- Bolus Intralipid 20% 1.5 mL/kg IV over 1 minute. Repeat every 3-5 minutes, until hemodynamically stable
- Start infusion 0.25 mL/kg/min, increase as needed to 0.5 mL/kg/min
- Continue infusion for at least 10 min after hemodynamic stability is restored.
- Max dose of intralipid 20% is 10 mL/kg over first 30 min. If not responding, reconsider if other diagnosis or inadequate resuscitation
Ensure adequate IV access, monitoring of continuous ECG, BP, and SaO₂
Avoid propofol, vasopressin, calcium channel blockers and beta blockers
To suppress seizures: give midazolam 0.05-0.1 mg/kg IV
- 0.05-0.1 mg/kg IV
To treat hypotension: give Epinephrine 1 MICROgram/kg IV/IO, as needed, may need infusion 0.02-0.2 MICROgrams/kg/min
- 1 MICROgram/kg IV/IO
- May need infusion 0.02-0.2 MICROgrams/kg/min
To treat acidosis: Draw serial ABGs, consider a-line
HYPERKALEMIA
Monitor for recurrence for 4-6 hours following the event
Consider DDx
Crisis Management (If Severe)
Notify surgeon, call for help and code cart
Call for Transesophageal Echocardiography
Start chest compressions
Give epinephrine 10 MICROgrams/kg IV/IO
- 1 MICROgram/kg IV/IO
- May need infusion 0.02-0.2 MICROgrams/kg/min
If cardiac arrest, go to CARDIAC ARREST
Consider ECMO

May have:

Give 100% O₂, evaluate ventilation, stop N₂O and volatiles
Stop local anesthetic
- What was given? Drug, dose, site? Does this = a crisis or not?
- If crisis, request intralipid
  - Bolus Intralipid 20% 1.5 mL/kg IV over 1 min.
  - Further dosing
Ensure adequate IV access, monitoring of continuous ECG, BP, and SaO₂
Avoid propofol, vasopressin, calcium channel blockers and beta blockers
To suppress seizures: give midazolam 0.05-0.1 mg/kg IV
To treat hypotension: give Epinephrine 1 MICROgram/kg IV/IO, as needed, may need infusion 0.02-0.2 MICROgrams/kg/min
To treat acidosis: Draw serial ABGs, consider a-line
HYPERKALEMIA
Monitor for recurrence for 4-6 hours following the event
Consider DDx
Crisis Management (If Severe)
Notify surgeon, call for help and code cart
Call for Transesophageal Echocardiography
Start chest compressions
Give epinephrine 10 MICROgrams/kg IV/IO
If cardiac arrest, go to CARDIAC ARREST
Consider ECMO

Drugs

Epinephrine	1 MICROgram/kg IV/IO
Epinephrine	May need infusion 0.02-0.2 MICROgrams/kg/min
Midazolam	0.05-0.1 mg/kg IV
Intralipid	Bolus Intralipid 20% 1.5 mL/kg IV over 1 minute. Repeat every 3-5 minutes, until hemodynamically stable
Intralipid	Start infusion 0.25 mL/kg/min, increase as needed to 0.5 mL/kg/min
Intralipid	Continue infusion for at least 10 min after hemodynamic stability is restored.
Intralipid	Max dose of intralipid 20% is 10 mL/kg over first 30 min. If not responding, reconsider if other diagnosis or inadequate resuscitation