What is the typical initial bolus dose of 20% lipid emulsion for local anesthetic systemic toxicity?

• A. 1.5 mL/kg
• B. 0.5 mL/kg
• C. 3 mL/kg
• D. 10 mL/kg

Answer: (A)

In local anesthetic systemic toxicity, the first move is to give a rapid bolus of lipid emulsion to create a intravascular lipid sink that pulls the lipophilic local anesthetic out of tissues like the heart and brain. The standard initial dose for a 20% lipid emulsion is 1.5 mL/kg given IV over about one minute. This quick dose helps reduce the free circulating drug and supports cardiac function. After the bolus, start a continuous infusion at 0.25 mL/kg/min to maintain the effect. If instability persists, you can repeat the bolus up to two more times while continuing the infusion and monitoring closely.