What is the recommended lipid emulsion dosing for LAST therapy?

• A. 1.0 ml/kg IV bolus of 20% lipid emulsion, followed by 0.2 ml/kg/min infusion for 15 minutes
• B. 0.5 ml/kg IV bolus, with infusion 0.05 ml/kg/min for 5 minutes
• C. 2.0 ml/kg IV bolus, no infusion
• D. 1.5 ml/kg IV bolus of 20% lipid emulsion, followed by 0.25-0.5 ml/kg/min infusion for 10-30 minutes, max dose 10 ml/kg

Answer: (D)

Lipid emulsion therapy for LAST works by rapidly expanding the intravascular lipid phase to trap lipophilic local anesthetics, lowering their free plasma concentration and helping stabilize the patient.

The recommended dosing uses a 1.5 mL/kg bolus of 20% lipid emulsion given IV, followed by an infusion at 0.25-0.5 mL/kg/min for 10-30 minutes. The total amount should be limited to about 10 mL/kg in the first portion of treatment to avoid lipid overload. This combination provides a quick surge to create a lipid sink and a sustained infusion to maintain it and support perfusion.

Other regimens either underdose the initial bolus, omit the maintenance infusion, or use an impractically large bolus without infusion, which are not aligned with guideline-based LAST management.