Society for Pediatric Anesthesia
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A healthy 10-year-old, 33kg boy is brought to the operating room for an open reduction and internal fixation of a radial fracture. A single shot supraclavicular block with 0.2% ropivacaine is planned. After the injection, the patient demonstrates new seizure-like activity, and local anesthetic systemic toxicity (LAST) is suspected. What is the MOST appropriate next step in patient management?

A. The patient should be ventilated with 100% oxygen and a goal end tidal carbon dioxide less than 30 mm Hg
B.  The dose of lipid emulsion for this patient should not exceed 6 mL/kg
C.  The drug of choice for ventricular arrhythmias in LAST is amiodarone
D.  If epinephrine is used, an initial dose of 10 mcg/kg is preferred to avoid impaired pulmonary gas exchange and increased afterload

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