Adverse Reactions

Excessive absorption results in paraesthesiae (face and tongue), anxiety, tremors and even convulsions. The latter are very dangerous, are followed by respiratory depression and may require diazepam or thiopental for control. Cardiovascular collapse and respiratory failure occur with higher plasma concentrations of the local anaesthetic and is caused by direct myocardial depression compounded by hypoxia associated with convulsions. Cardiopulmonary resuscitation must be started immediately.

Anaphylactoid reactions are very rare with amide local anaesthetics and some of those reported have been due to preservatives. Most reported reactions to amide local anaesthetics are due to coadministration of adrenaline (epinephrine), intravascular injection or psychological effects (vasovagal episodes). Reactions with ester local anaesthetics are more common.

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