16/09/2026
“That dental injection looks routine… until local anaesthetic toxicity turns it into an emergency.” 🚨
Local Anaesthetic Systemic Toxicity (LAST) — a rare but potentially life-threatening complication every clinician should know how to recognize.
🚨 How to recognise LAST
Early CNS signs:
* Perioral/tongue numbness or tingling
* Metallic taste
* Tinnitus
* Dizziness or visual disturbance
* Agitation, confusion, slurred speech
Progression:
* Muscle twitching
* Seizures
* Reduced consciousness
* Respiratory depression/apnoea
Cardiovascular signs:
* Hypotension
* Bradycardia or conduction abnormalities
* Arrhythmias
* Cardiovascular collapse/cardiac arrest
⚠️ Important: LAST can sometimes present predominantly with cardiovascular symptoms, without obvious preceding CNS symptoms.
🔔 Maximum recommended dose:
Drug:-
🚨 Lidocaine with epinephrine. 7 mg/kg (max
500 mg)
🚨 Lidocaine without epinephrine. 4.5 mg/kg
🚨 Articaine. 7 mg/kg
🚨 Bupivacaine. 2 mg/kg
🚨 Mepivacaine 6.6 mg/kg
If you suspect LAST :-
🔔 Immediate Management of LA Toxicity
✅ Step 1: Stop the Procedure Immediately
* Stop injecting LA
* Remove all instruments from mouth
✅ Step 2: Call for Help- Activate emergency response.
✅ Step 3: Position the Patient
* Supine position
* Legs slightly elevated if hypotensive
✅ Step 4: Maintain Airway, Breathing,
Circulation (ABC)
Airway- Ensure airway patency
Breathing- Give 100% oxygen
‼️ Use bag-mask ventilation if needed
Circulation- Monitor pulse and blood pressure
