Local anaesthetic systemic toxicity
Agitation, tinnitus, perioral tingling, seizures or arrhythmia after LA.
Early signs: circumoral tingling, metallic taste, tinnitus, light-headedness, agitation, slurred speech. Late: seizures, loss of consciousness, bradycardia, arrhythmia, cardiac arrest.
- Stop injecting. Call for help / emergency services.
- Maintain airway, give oxygen 15 L/min.
- Seizures: treat as epileptic seizure (buccal midazolam).
- Cardiac arrest: start CPR — prolonged resuscitation may be needed.
- Hospital treatment includes 20% lipid emulsion IV. Prevention: aspirate before and during injection, inject slowly (≈ 1 cartridge/min), stay within the weight-based maximum dose (Doses tab).
Sources
- Association of Anaesthetists — Management of severe local anaesthetic toxicityUK
- Resuscitation Council UK — Medical emergencies in primary dental careUK
- BNF (British National Formulary)UK
Checked against these sources on 2026-10-22. Guidelines change — open the source to confirm.
Summarised from the sources above. Always verify against current local guidelines and the patient's medical history.
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