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Systemic toxic effects of local anesthetics are related to blood concentrations as absorption varies considerably according to the site of action. Furthermore, most cases of severe toxicity did not result from over dosage but from inadvertent intravascular injection or too rapid injection. The most serious effects of lidocaine intoxication are on the CNS and cardiovascular system and overdose can result in severe hypotension, bradycardia, arrhythmia and cardiac arrest, seizures. In severe cases apnea may occur.
Treatment of acute toxicity: If signs of acute systemic toxicity appear, injection of the local anaesthetic should be stopped immediately and CNS symptoms (convulsion, CNS depression) must promptly be treated with appropriate airway/respiratory support and the administration of anticonvulsant drugs such as benzodiazepines (diazepam). If circulatory arrest should occur, immediate cardiopulmonary resuscitation should be instituted. Optimal oxygenation and ventilation and the circulation should be maintained with infusion of intravenous fluids. Vasopressors should not be given to patients receiving oxytocic drug.
