Recognition of Local Anesthetic Systemic Toxicity During Dental Implant Surgery With Sedation

Babun H., Oluş F.

ANESTHESIA PROGRESS, cilt.26, sa.16, ss.148-154, 2026 (Scopus)

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 26 Sayı: 16
  • Basım Tarihi: 2026
  • Doi Numarası: 10.2344/anpr-26-0016
  • Dergi Adı: ANESTHESIA PROGRESS
  • Derginin Tarandığı İndeksler: Scopus, MEDLINE, PubMed
  • Sayfa Sayıları: ss.148-154
  • Akdeniz Üniversitesi Adresli: Evet

Özet

Objective

Local anesthetic systemic toxicity (LAST) is a potentially serious complication associated with local anesthetic administration during dental implant surgery. Sedation-related neurologic effects may overlap with early manifestations of LAST, potentially complicating clinical recognition. This study evaluated the incidence and characteristics of suspected LAST-compatible events during full-mouth implant surgery performed with or without moderate sedation.

Methods

In this retrospective observational study, 258 adults undergoing full-mouth dental implant surgery received either local anesthesia alone or local anesthesia combined with moderate sedation using midazolam and fentanyl. Demographic variables, total and weight-adjusted articaine doses, perioperative events, and clinical response to flumazenil were analyzed. Neurologic events were categorized as flumazenil-responsive (sedation-related) or nonresponsive, suspected LAST-compatible events.

Results

Among 92 sedated patients, 7 (7.6%) developed neurologic findings. Four cases resolved promptly after flumazenil and were classified as sedation-related reactions. Three patients (3.3% of the sedation group; 1.2% overall) exhibited persistent neurologic signs and symptoms despite reversal and were categorized as nonresponsive, suspected LAST-compatible events. Mean (SD) weight-adjusted articaine exposure was markedly higher in nonresponsive cases (9.55 [2.13] mg/kg vs 4.15 [1.57] mg/kg), and all nonresponsive events occurred in patients whose cumulative dose exceeded 7 mg/kg. No neurologic events were documented among 166 patients treated with local anesthesia alone. The absence of capnography and structured sedation-depth assessment limited differentiation between oversedation, hypoventilation, and evolving toxicity.

Conclusions

Suspected LAST-compatible events were observed only in sedated patients in this cohort; however, this pattern likely reflects increased diagnostic complexity rather than a direct pharmacologic interaction. Flumazenil response served as a pragmatic adjunct for distinguishing benzodiazepine-related oversedation from persistent neurologic findings. Individualized weight-adjusted dosing, incremental injection techniques, and enhanced physiologic monitoring—including capnography—may reduce diagnostic uncertainty and improve safety during sedated implant procedures.