Perioperative: local anaesthetic toxicity: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Perioperative: local anaesthetic toxicity

Sample item

After an axillary brachial plexus block with bupivacaine, a patient has perioral numbness, tinnitus, then a seizure and ventricular arrhythmia. Which specific therapy should be given after airway and seizure control?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Intravenous 20% lipid emulsion

Local anaesthetic systemic toxicity starts with perioral tingling and tinnitus, progresses to seizures and may end in cardiovascular collapse, especially with bupivacaine. Intravenous 20% lipid emulsion acts as a sink that draws the drug from tissues and is the specific treatment. Airway management, seizure control with benzodiazepines and advanced life support are given as well. Propofol is not a substitute for lipid.

Option by option

  • A. Intravenous 20% lipid emulsion (correct)

    Lipid emulsion sequesters lipophilic local anaesthetic and reverses cardiotoxicity.

  • B. Intravenous flumazenil

    Flumazenil reverses benzodiazepines and could provoke seizures.

  • C. Intravenous calcium gluconate

    Calcium gluconate treats hypocalcaemia or hyperkalaemia and does not reverse sodium channel blockade.

  • D. Intravenous naloxone

    Naloxone reverses opioids, not local anaesthetics.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Intravenous 20% lipid emulsion. Local anaesthetic systemic toxicity starts with perioral tingling and tinnitus, progresses to seizures and may end in cardiovascular collapse, especially with bupivacaine.

Why is "Intravenous flumazenil" not the answer?

Flumazenil reverses benzodiazepines and could provoke seizures.

Why is "Intravenous calcium gluconate" not the answer?

Calcium gluconate treats hypocalcaemia or hyperkalaemia and does not reverse sodium channel blockade.

Why is "Intravenous naloxone" not the answer?

Naloxone reverses opioids, not local anaesthetics.

What concept does this question test?

It tests Perioperative: local anaesthetic toxicity in General Surgery. Intravenous 20% lipid emulsion acts as a sink that draws the drug from tissues and is the specific treatment. Airway management, seizure control with benzodiazepines and advanced life support are given as well. Propofol is not a substitute for lipid.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Perioperative: local anaesthetic toxicity?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.