ANESTHESIOLOGY Daily News
ANESTHESIOLOGY Daily NewsANESTHESIOLOGY Daily News
  • Friday
  • Saturday
  • Sunday
  • Monday
  • Tuesday
Resources
  • Meeting Info
  • Sessions
  • Claim CME
  • Archive
By Day
  • Friday
  • Saturday
  • Sunday
  • Monday
  • Tuesday
Facebook iconTwitter iconLinkedIn iconInstagram icon
Oct 25th, 2022

Guy L. Weinberg, MD, to deliver Severinghaus Lecture

The surprising path to resolving LAST


Guy L. Weinberg, MD
Guy L. Weinberg, MD

SPE03 - John W. Severinghaus Lecture: Local Anesthetic Systemic Toxicity - A Path to Innovation and Discovery
Tuesday, October 25 | 11 a.m.-12 p.m.
The Great Hall A/D

Older anesthesiologists likely remember local anesthetic systemic toxicity, or LAST, as a dreaded complication of regional anesthesia: Unpredictable, no established risk factors, and sometimes fatal despite heroic efforts.

“The only occasionally effective treatment for severe LAST was to put patients on cardiopulmonary bypass or other forms of extracorporeal support,” said Guy L. Weinberg, MD, Professor of Anesthesiology at the University of Illinois College of Medicine in Chicago. “It was uncommon, but when it occurred, it could be devastating. And then, in the late 1990s, I came across lab findings that indicated a possible antidote – the rapid infusion of an off-the-shelf lipid emulsion which, to that point, had only been used for total parenteral nutrition. Twenty-five years later, lipid resuscitation is a recommended and accepted treatment for LAST.”

This afternoon, Dr. Weinberg will deliver the “John W. Severinghaus Lecture: Local Anesthetic Systemic Toxicity – A Path to Innovation and Discovery.” That chance finding of a potential treatment for LAST lured him back into the lab after a 15-year hiatus and set him on a path leading to other innovations and discoveries, all unexpected and none seemingly related.

Dr. Weinberg said he became an “accidental tourist,” bouncing through resuscitation, statistics, causality, behavioral economics, and other apparently unrelated fields.

“When you see a presentation on the progression of scientific discovery, it looks like you went from A to B, from beginning to endpoint, a logical progression of one step to the next,” he said. “The reality is that discovery is more like Brownian motion; you go in all sorts of different directions, all of them completely unexpected. For instance, along the way, I found that adrenaline doesn’t really work very well for resuscitation, something that was known more than 100 years ago – but we keep forgetting, and it has to be rediscovered by every generation. The observation that you could reverse severe LAST by infusing a lipid emulsion was totally unexpected. We all talk about rare, seemingly impossible events as the black swan. I’ve accumulated a small flock of black swans in the past two decades.”

The unexpected journey started with laboratory findings from an index case and were first reported in 1998. It wasn’t until 2006 that the first two case reports of effective reversal of LAST were published. Both patients had failed to respond to standard resuscitation but recovered quickly after receiving a lipid emulsion that had been commercially available since the 1960s. One case occurred in Germany and the other in New York, Dr. Weinberg said; they were reported in different journals and have become canonical. 

Dozens of similarly dramatic resuscitations have been reported over the years, leading to lipid emulsion being included in guidelines from the American Society of Regional Anesthesia and Pain Medicine, the Association for Anaesthetists of Britain and Ireland, and other global bodies. Although Dr. Weinberg and others have documented the mechanisms of action behind lipid resuscitation, there has never been a randomized clinical trial for its use in LAST. However, recent small-scale RCTs show potential efficacy for lipid resuscitation in treating overdoses caused by pesticides, antipsychotics, trazodone, and metoprolol.

“You clearly cannot do randomized controlled trials with toxic doses of local anesthetic toxicity,” he said. “But recently reported trials of lipid emulsion for the treatment of overdoses caused by other, non-local anesthetic agents show they potentially respond in similar ways. This is what translational research is all about, from bench to bedside to bench and back again; a grand circle you could never foresee from that one index case.”

Visit Annual Meeting Daily News for more articles.

From The ASA Monitor
LEGISLATIVE CONFERENCE 2022 Returns to Washington, DC
LEGISLATIVE CONFERENCE 2022 Returns to Washington, DC
Advocacy: The Key to Protecting Patients and the Future of Anesthesiology
Advocacy: The Key to Protecting Patients and the Future of Anesthesiology
Steven H. Rose, MD, Recipient of the 2022 ASA Excellence in Education Award
Steven H. Rose, MD, Recipient of the 2022 ASA Excellence in Education Award
Commercial Fees Paid for Anesthesia Services – 2022
Commercial Fees Paid for Anesthesia Services – 2022
Catching Up With Jesse Ehrenfeld, MD, MPH, FASA
Catching Up With Jesse Ehrenfeld, MD, MPH, FASA
Improving Care and Outcomes for the Older Adult: A Holistic Model
Improving Care and Outcomes for the Older Adult: A Holistic Model
More Content
Claude Brunson, MD, FASA
Featured Lecture
Anesthesiology must lead in diversity, equity, and inclusion
Oct 25th, 2022
Michael S. Avidan, MBBCh, FCA SA
Featured Lecture
FAER-Helrich Lecture to focus on the importance of patient perspectives
Oct 23rd, 2022
Keynote Speaker Mick Ebeling, Founder and CEO of Not Impossible Labs
Featured Lecture
Making the impossible possible
Oct 23rd, 2022
Left to right: Michael W. Champeau, MD, FASA and Frank G. Opelka, MD, FACS
Featured Lecture
ASA, ACS partner for equitable payment models
Oct 23rd, 2022
Left to right: Randall M. Clark, MD, FASA and Jesse M. Ehrenfeld, MD, MPH
Featured Lecture
ASA President, AMA President-Elect fireside chat to explore big issues facing specialty
Oct 22nd, 2022
Karen B. Domino, MD, MPH
Featured Lecture
Ellison Pierce Lecture to examine racial, ethnic disparities in perioperative medicine
Oct 22nd, 2022
ANESTHESIOLOGY 2022 Keynote Speaker Mick Ebeling
Featured Lecture
From absurdity to solution
Oct 21st, 2022
Sean Runnels, MD
Featured Lecture
ASA brings popular session to NOLA
Oct 21st, 2022
Left to right: Deborah J. Culley, MD, Andrew J. Davidson, MD, MBBS, FANZCA, FAHMS, and Jamie Sleigh, MBChB, FFARCS, FANZCA, FJFICM, MD.
Featured Lecture
New findings in postop delirium underscore need for new practices
Oct 21st, 2022
Left to right: Claude Brunson, MD, FASA and Guy Weinberg, MD
Featured Lecture
Featured and Plenary Lectures
Sep 21st, 2022
ANESTHESIOLOGY Daily News
© 2022 American Society of Anesthesiologists (ASA)
1061 American Lane | Schaumburg, IL 60173