Diagnostic findings after local anesthetic systemic toxicity with articaine: A case report

To review the diagnostic findings following local anesthetic systemic toxicity (LAST) with articaine and assess the prognosis given appropriate management. Articaine is widely used in the dental field due to its relatively safe profile, fast onset, and short half-life. We present a case of LAST following articaine administration. A 61-year-old female with a past medical history of essential hypertension, prediabetes, and nontoxic multinodular goiter presented with acute onset altered mental status and generalized tonic clonic seizure requiring intubation in the field from her dentist’s office following the administration of articaine for a root canal. Diagnostic studies, including MRI, echocardiography (ECHO), and electrocardiogram (EKG), were consistent with the suspected diagnosis of LAST. Notably, her left ventricular ejection fraction (LVEF) declined from 60-65% (per ECHO nine days prior) to 20-25% on the second day of hospitalization. Brain MRI demonstrated multifocal areas of gyriform cortical restricted diffusion seen in both cerebral hemispheres. She was successfully treated with lipid emulsion therapy with continued supportive care and subsequently discharged 10 days later to continue physical therapy and rehab after her LAST episode. LAST acutely presents with dramatic findings including cardiac and neurologic manifestations. Our patient presented with tonic clonic seizure, acute encephalopathy, Severe reduction in LVEF, and brain MRI showing multiple watershed lesions. Treatment with lipid emulsion therapy and supportive measures led to substantial recovery, with a near-complete return to baseline function within six months. • Early recognition of LAST related to following local anesthetic administration. • Symptomatic management, including airway protection, anticonvulsants, and cardiovascular support. • Lipid emulsion therapy as a potential treatment in severe LAST cases. • Close monitoring of cardiac, neurologic, and organ function. • Further research is needed to optimize LAST management strategies and improve patient outcomes.