LOCAL
ANAESTHETICS
Drug Highest dose Highest dose
without Adrenaline with Adrenaline
Lidocaine 4 mg/kg 7 mg/kg
Mepivacaine 4 mg/kg 7 mg/kg
Bupivacaine 2 mg/kg 2,5 mg/kg
Warning signals of toxic reactions in the central nervous system (CNS):
Lips and tongue feel numb
Metallic taste in mouth
Drowsiness
Tinnitus
Slurring speech
Muscular tremor
Nystagmus
Dysopia
Cardiovascular symptoms:
Fall in blood pressure
Sinus tachycardia, later sinus bradycardia
Ventricular tachyarrhythmia, AV-Block, QRS-widening
ST-segment changes (Bupivacaine)
Ventricular fibrillation and asystole
Therapy for the LA incident:
Symptomatic !
Stop injecting
100 % oxygen, ask the patient to hyperventilate
Give Benzodiazepine or Thiopental slowly (Attention: Cardiovascular System)
If convulsions : Benzodiazepine
Assist breathing, consider intubation
If dysrthymia : (usually Bupivacaine), Amrinone (Inocor) 1-4 mg/kg or. Bretylium 20 mg/kg
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