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Subjects/Anesthesia/Regional Anesthesia
Regional Anesthesia
hard
syringe Anesthesia

During an ultrasound-guided supraclavicular brachial plexus block, a patient suddenly complains of metallic taste, tinnitus, and develops perioral numbness. What is the most appropriate immediate next step in management?

A. A. Administer intravenous lipid emulsion (ILE) 20% bolus
B. B. Administer intravenous midazolam 2 mg
C. C. Increase oxygen flow to 100% via face mask
D. D. Check the patient's blood pressure and heart rate

Explanation

The symptoms described (metallic taste, tinnitus, and perioral numbness) are classic early signs of Local Anesthetic Systemic Toxicity (LAST), indicating systemic absorption of the local anesthetic. The immediate and specific treatment for LAST, especially with neurological symptoms, is the administration of intravenous lipid emulsion (ILE) 20% bolus. ILE acts as a 'lipid sink,' sequestering the local anesthetic from target organs. While increasing oxygen and monitoring vital signs (options C and D) are important supportive measures, and midazolam (option B) would be used for seizures (a later manifestation of LAST), the most appropriate and specific immediate intervention for these early signs of LAST is ILE.

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