Local Anesthetic Overdose/Toxicity
Signs and symptoms#
Early (1-5 minutes after injection)
- light headedness
- dizziness
- disorientation
- drowsiness
- visual and auditory disturbances (tinnitus, difficulty focusing)
- metallic taste
Late
- muscle twitching
- convulsions
- unconsciousness
- coma
- respiratory distress and arrest
- cardiovascular depression and collapse
Action#
- stop injection immediately
- provide supplemental oxygen
- attention to impending airway compromise, if so alert emergency medical services (EMS)
- attention to significant hypotension, dysrhythmias, and seizures
- manage specific symptoms
- arrange for escort home
Causes#
- excess dose of local anesthetic
- inadvertent intravascular injection of local anesthetic
References/Websites#
- References
- Greenwood M, et al. General medicine and surgery for dental practitioners: part 2. Medical emergencies in dental practice: the drug box, equipment and basic principles of management. BDJ. 2014;216(11):633-637.
- Greenwood M. General medicine and surgery for dental practitioners: part 3. Management of specific medical emergencies in dental practice. BDJ. 2014;217(1):21-26.
- Haas DA. Preparing dental office staff members for emergencies. Developing a basic action plan JADA. 2010;141(5 suppl):8S-13S.
- Rosenberg M. Preparing for medical emergencies. The essential drugs and equipment for the dental office. JADA. 2010;141(5 suppl):14S-19S.
- Jevon P. Medical emergencies in the dental practice poster: revised and updated. BDJ. 2020;229(2):97-104.