Local Anaesthesia Toxicity in Dental Surgery

exp date isn't null, but text field is

CLINICAL DESCRIPTION

Local anesthetic systemic toxicity (LAST) is a life-threatening adverse event that may occur after the administration of local anesthetic drugs through a variety of routes. While generally safe, local anesthetic agents can be toxic if administered inappropriately, and in some cases may cause unintended reactions even when properly administered.

MILD LOCAL ANAESTHETIC TOXICITY

CLINICAL FEATURES

SIGNS AND SYMPTOMS

  • Talkativeness, anxiety, slurred speech, confusion, nausea, vomiting, constriction of pupils (miosis), drowsiness, lethargy, sedation, unconsciousness, coma.

TREATMENT

  • Stop administration of local anesthetic
  • Monitor vital signs
  • Observe for 1-hour

 

MODERATE LOCAL ANAESTHETIC TOXICITYSIGNS AND SYMPTOMS

  • Stuttering speech, nystagmus, tremors, headache, dizziness, blurred vision, drowsiness

TREATMENT

  • Place in supine position
  • Monitor vital signs
  • Administer oxygen
  • Observe for 1-hour

 

SEVERE LOCAL ANAESTHETIC TOXICITYSIGNS AND SYMPTOMS

  • Seizure, cardiac dysrhythmia, or cardiac arrest

TREATMENTNON-PHARMACOLOGICAL

  • Place in supine position
  • If seizures, protect from nearby objects,
  • Suction oral cavity if vomiting occurs
  • Transport to emergency care facility / intensive care unit
  • Notify EMS/ Summon for medical assistance
  • Monitor vital signs
    • If at any time the patient becomes unresponsive, no normal breathing, and no palpable pulse consider the diagnosis of cardiac arrest
    • Immediate CPR and defibrillation congruent with current recommendations 

PHARMACOLOGICAL

  • Administer Oxygen 4 to 6 L/min by nasal cannula
  • Give Diazepam 5-10 mg IV slowly as stat dose