Not recognizing early local anesthetic systemic toxicity (LAST)
What it is
Missing the early warning signs of local anesthetic systemic toxicity (LAST) — so treatment is delayed until the patient progresses to seizures, respiratory arrest, or cardiovascular collapse. LAST most often follows intravascular injection, overdose, or rapid absorption from vascular tissues, and can evolve quickly.
Why it happens
• The early presentation can be subtle, variable, or atypical — classic "prodromal" symptoms aren't always present • Clinicians may attribute early symptoms to anxiety/panic, "epinephrine rush," or stress — especially in the dental chair (AAPD notes early subjective CNS toxicity symptoms like dizziness, anxiety, confusion) • Not expecting toxicity because the dose "seems small," forgetting that a single inadvertent intravascular injection can cause high blood levels • No team "pattern recognition" or checklist in place → the first minutes are wasted
The full clinical mistake entry includes
- How to avoid it — the prevention protocol
- The clinical tip experienced clinicians use
- The documented reference behind the mistake
More clinical mistakes
Dentalverse is an educational resource for dental students and dentists. This page is a study reference — it is not medical advice and does not replace clinical judgment. Always follow your institution's protocols and your supervisor's guidance.