During LAST management, which approach best addresses seizures?

During LAST management, which approach best addresses seizures?

• A. Administer high-dose opioids.
• B. Use benzodiazepines.
• C. Administer lidocaine only.
• D. Administer diuretics.

Answer: (B)

When seizures occur during LAST, the priority is rapidly suppressing CNS excitability with a fast-acting anticonvulsant that minimizes additional cardiovascular risk. Benzodiazepines are the best choice because they enhance GABA-A receptor activity, increasing chloride influx to dampen neuronal firing and abort seizures quickly. This mechanism directly counters the CNS hyperexcitability caused by high local anesthetic levels, providing effective seizure control with a relatively favorable safety profile in the toxic setting. Other options don’t address the seizure activity—opioids won’t stop seizures and can worsen respiratory depression, lidocaine would not treat and may worsen the toxicity, and diuretics have no role in controlling seizures or LAST. If seizures persist after benzodiazepines, clinicians may escalate with other agents, but benzodiazepines remain the initial, best approach.

When seizures occur during LAST, the priority is rapidly suppressing CNS excitability with a fast-acting anticonvulsant that minimizes additional cardiovascular risk. Benzodiazepines are the best choice because they enhance GABA-A receptor activity, increasing chloride influx to dampen neuronal firing and abort seizures quickly. This mechanism directly counters the CNS hyperexcitability caused by high local anesthetic levels, providing effective seizure control with a relatively favorable safety profile in the toxic setting. Other options don’t address the seizure activity—opioids won’t stop seizures and can worsen respiratory depression, lidocaine would not treat and may worsen the toxicity, and diuretics have no role in controlling seizures or LAST. If seizures persist after benzodiazepines, clinicians may escalate with other agents, but benzodiazepines remain the initial, best approach.