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Lidocaine Max With Adrenaline — FRCA Primary MCQ

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HardPharmacology - AnalgesicsLidocaine Max With AdrenalineFRCA Primary

During cardiac arrest from suspected bupivacaine toxicity, which departure from standard adult ALS is specifically recommended by current Resuscitation Council UK guidance?

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Correct answer: D — Use adrenaline boluses ≤1 microgram kg−1 with lipid emulsion

The best answer is “Use adrenaline boluses ≤1 microgram kg−1 with lipid emulsion”. Local-anaesthetic systemic toxicity requires modified resuscitation: use 20% lipid emulsion promptly and restrict adrenaline boluses to no more than 1 microgram kg−1 because large catecholamine doses may worsen local-anaesthetic cardiotoxicity. Additional lidocaine is inappropriate, lipid should not wait for ROSC, and ventilation should prevent hypoxia, hypercarbia and acidosis rather than intensify them.

Reference: Resuscitation Council UK 2025 Special circumstances guidelines: local anaesthetic systemic toxicity: https://www.resus.org.uk/professional-library/2025-resuscitation-guidelines/special-circumstances-guidelines; Royal College of Anaesthetists, Primary FRCA syllabus v2.2: https://www.rcoa.ac.uk/sites/default/files/documents/2026-01/Primary-FRCA-Syllabus.pdf