5/5/2018 Local Anesthetic Systemic Toxicity | Oxford Academic

Table 5.
Suggested Test Doses for Detecting Unintentional Intravascular Injection

Test Agent  Dose  Positive Findings  Limitations 

36
Epinephrine   • 15 µg  • HR increase >10 • Beta blockade may impact
40
beats/min sensitivity
• SBP increase of 15 mm • T-wave monitoring may
Hg require o line analysis of ECG
41
• T-wave increase of tracing  
25% amplitude 

Local • • Auditory disturbance • Premedication with

26,37
anesthetic   Chloroprocaine • Circumoral numbness benzodiazepines may a ect
or lidocaine 100 • Metallic taste  sensitivity
mg • Large doses neuraxially will
• Bupivacaine result in total spinal
25 mg anesthesia 
• Ropivacaine
60 mg 

38
Air   • 2 mL  • Audible response on • Availability of Doppler
precordial Doppler monitoring
monitoring  • Potential paradoxical air
embolism via patent foramen
ovale 

Opioid  • Fentanyl 100 • Drowsiness or • Respiratory depression

µg  sedation  • Requires awake,
participating patient 

39
Isoproterenol   • 3 µg  • HR increase >20 • Neurotoxicity unknown
beats/min  • Transient systolic
hypotension 

ECG, electrocardiogram; HR, heart rate; SBP, systolic blood pressure.

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