FROM DENTAL CHAIR TO ICU: A CASE OF LOCAL ANESTHETIC SYSTEMIC TOXICITY

Local Anesthetic Systemic Toxicity (LAST) is a rare but potentially life-threatening complication affecting the central nervous and cardiovascular systems. Despite the widespread use of local anesthetics in dental practice, severe adverse events may occur. A 50-year-old female presented with altered sensorium and severe respiratory distress six hours after a dental procedure. On arrival, she was tachycardic with gasping respirations and a Glasgow Coma Scale score of 7/15. Arterial blood gas analysis showed respiratory acidosis. Neuroimaging and cardiac evaluation were unremarkable. Laryngoscopy revealed airway edema, requiring urgent intubation and ventilatory support. The patient improved with supportive intensive care and was discharged without neurological deficits. A probable diagnosis of LAST was made based on temporal association and exclusion of other causes. This case highlights an atypical presentation of LAST with delayed onset, absence of seizures, and predominant respiratory failure. Early recognition and prompt management are crucial to improve outcomes.