[Local anesthetic systemic toxicity-Part 2: treat and prevent : Acute management including lipid rescue and preventive strategies].

In cases of local anesthetic systemic toxicity (LAST) early recognition, the immediate establishment of adequate oxygenation and hemodynamic stability and adherence to specific considerations regarding resuscitation are of critical importance. Intravenous lipid emulsion treatment remains a central component of therapeutic management in this context. Preventive measures aimed at avoiding LAST rely less on isolated interventions than on an integrative, multimodal concept that encompasses both human factors and procedure-specific risk reduction strategies. These measures include, among others, the selection and dosing of the local anesthetic, the consistent use of ultrasound guidance (where the procedure permits), fractionated injection and repeated aspiration as well as the availability of standardized emergency algorithms alongside regular team training. Only through the interplay of these measures can effective prevention and successful management of LAST be achieved in daily clinical practice.