![]() The high incidence of complications of lidocaine, which is comparative safe, could be due to its high frequency of use. Lidocaine, the most commonly used anesthetic in dentistry, accounted for approximately 25% of complications reported. The order of incidence of complications from highest to lowest according to the local anesthetics used is bupivacaine, lidocaine, ropivacaine, mixture local anesthetics, levobupivacaine, chloroprocaine, and articaine. This is followed by local infiltration, which is commonly used in dentistry. ![]() Penile blocks are most commonly associated with complications, because of the large distribution of blood vessels. To elaborate, the order of incidence of complications from highest to lowest based on the type of block is penile, local infiltration, neuraxial, upper extremity, paravertebral, lower extremity, head and neck, topical, transversus abdominis plane, and intravenous block. LAST is a life-threatening complication and reportedly occurs in 0.03% people (0.27/1,000). LAST refers to the complication particularly affecting the central nervous system (CNS) and cardiovascular system (CVS) due to the overdose of local anesthetics. Lipid emulsion is mainly used as parenteral nutrition for patients in intensive care units, but it has recently been widely used as a non-specific antidote in various types of drug toxicity, including that of local anesthesia. In this article, we have focused on local anesthetic systemic toxicity (LAST), which refers to systemic toxicity rather than local reactions due to local anesthetics, and the usage of lipid emulsion for treatment of LAST. Absorption of the local anesthetics include local reaction, idiosyncrasy, toxicity, and allergy or anaphylactic reaction. ![]() Another complications associated with the needle include syncope, hematoma, pain, edema, infection, paresthesia, nerve paralysis, and breakdown of needle or cartridge. Complications associated with the added vasoconstrictor include elevated blood pressure and increased heart rate. Complications due to local anesthesia can be divided into three major areas complications associated with vasoconstrictor, needle, and absorption of local anesthetics. Another one of the important qualifications is that there should be no adverse effect, neither local nor systemic. Furthermore, it should have rapid onset action, suitable duration of effect, and good tissue penetration. Keywords: Dental Anesthesia, Lipid Emulsions, Local Anesthetic Systemic ToxicityĪn ideal local anesthetics should be potent, reversible, low cost, stable, and easy to metabolize and emit. Furthermore, we introduced lipid emulsion that has recently been in the spotlight as the therapeutic strategy for LAST. We reviewed the incidence, mechanism, prevention, and treatment guidelines, and a serious complication of LAST occurring due to dental anesthesia. However, caution must be observed for >1000 mL of injection, which is the maximum dose. After bolus injection, 15 mL/kg/h of lipid emulsion is to be continuously injected for LAST. According to the recently published guidelines, 20% lipid emulsion is to be intravenously injected at 1.5 mL/kg. Although lipid emulsion is commonly used for parenteral nutrition, it has recently been widely used as a non-specific antidote for various types of drug toxicity, such as LAST treatment. According to the treatment guidelines for LAST, immediate application of lipid emulsion plays an important role. To prevent the LAST, it is necessary to recognize the risk factors for each patient, choose a safe drug and dose of local anesthesia, use vasoconstrictor, confirm aspiration and use incremental injection techniques. ![]() Predisposing factors of LAST include extremes of age, pregnancy, renal disease, cardiac disease, hepatic dysfunction, and drug-associated factors. Its reported prevalence is 0.27/1000, and the representative symptoms range from dizziness to unconsciousness in the CNS and from arrhythmias to cardiac arrest in the CVS. Local anesthetic systemic toxicity (LAST) refers to the complication affecting the central nervous system (CNS) and cardiovascular system (CVS) due to the overdose of local anesthesia. ![]()
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