Lidocaine induced seizure during dental procedure

[iwina]

My 4 1/2 year old daughter was to have a cavity filled.  After the lauging gas and in the process of receiving 2.0cc of 2% lidocaine(she weighs approx. 45 pounds), she had an immediate seizure.  According to the dental notes, her oxygen saturation were never under 97% and she took approx. 1 1/2 hours to become coherent.  She essentially slept through the ER visit (2 hours).  The ER doctor said that the seizure was caused by the lidocaine(no MRI or CAT) and she has had no discernable after effects. The dentist had never encountered this before, neither had her pediatrician.  The Pediatric neurologists' first words were, "Gee, never heard of this." Not helpful!  I understand about anatomic variations and fully believe this seizure was caused by lidocaine essentially hitting a vein and numbing my girls' brain and not her tooth; BUT, 1)This is apparently a 'rare' event, How often does it occur and does she have an increased (any?)chance of this event happening again? Or the same chance as everybody else? 2) Is she prone to seizures and this event "set her off"? 3) She still needs this lower molar filled, now what? Other drugs?

[Matthew Baron, D.M.D.]

I too have never heard of a lidocaine induced seizure.  It is called a local anesthetic because it does just that, remains in that local area. So i don't think it numbed your daughter's brain.   More likely is that there was or is some underlying predisposition for her to have a seizure and this traumatic event set off her episode.  Has she ever had dental work with a local before? or was this her first cavity?  I don't know if she is prone to seizures or what the chances of this happening again would be.  I will do some investigating and research to see what sort of rate of occurrence exists with seizures and local anesthetics.  Also, I believe that the nitrous oxide may have played a role, so i'll look into that avenue and see what i come up with.

[iwina]

Thank you for your quick response! And thank you for your further investigation.  To answer your question,this was her first filling with lidocaine.  She had another cavity filled 4 days later that wasn't deep and it was drilled and filled without anesthetic. Nothing remarkable happened (other than us being a nervous wreck)

[NickyIsHere123]

Hi, I am so sorry this happened and how frightened you must have been. I can't help but wonder if it is normal to do this at this age? She is so young. I don't think I would have even agreed to it in the first place. If I were you, I would wait it out next time and make sure she brushes her teeth. Prevention is always the best route. Again, I wish all of you well.

[caddylady]

I found this thread while researching something else. Two days ago I had a tooth extracted and had nitrous oxide. This was only the second time I've ever had the gas. It knocked me out cold within seconds and then (from what I'm told) I experienced a seizure. (The first time I had laughing gas I also passed out cold, but did not have a seizure). Apparently I do not require much gas to be affected by it. After researching the internet I cannot find that much relating seizures to nitrous oxide but there are a few documented cases. Your post is interesting to me because you mention that your daughter had nitrous oxide too. Perhaps that is where you need to be looking. I am so sorry for what you and your daughter had to go through. My daughter has epilepsy and I witnessed her have a grand mal seizure for the first time recently and it was most horrific. I will say a prayer for her.

[leahe]

i believe it had something to do with the nitrous.  i had a very traumatizing experience at the dentist getting my wisdom teeth removed almost 2 years ago and i blame the nitrous. i had never used nitrous before, i wish i would not have accepted it - i wasn't even nervous.
when they put the mask on and put the IV in my arm for the anesthesia, i immediate went out, but it was the most uncomfortable pressure in my head i ever felt, with the last image i saw repeating itself at a very fast pace, and the last sound i heard repeating itself as well. i was unconscious, but i was conscious of being unconscious. i wasn't aware of my body, but my mind was awake. i knew immediately something was wrong, but i didn't know what was happening just that it was bad. the feeling of intense pressure/pain lasted only a little while before i experienced what i can only describe as a brain orgasm. it was really terrifying, i thought i was dying, or that i had just died. i didn't feel the pain anymore and went into darkness. then i experienced what to me was a fight for my life, trying to get back into my body. i felt like i was doing mental sit-ups, hard to explain. but i'm sure my body was moving a lot during this. the whole experience was terrible and not something i would ever want someone to experience. hopefully it wasn't this bad for your daughter.
i finally came to, and the dentist was telling me to take a deep breath, and i was just glad to be alive and breathing.  my legs were still kicking for awhile, i felt like i had to, in order to hold on to my existance. i was also in a different position on the chair, i had to scoot back up. so i know i was moving around a lot, i believe i had a seizure.
i was in shock. the dentist said "i had too much nitrous" - i told him i thought i was dying. he said i'm not going go die, and it was just a bad dream. i didn't really have a chance to explain just how terrible it was, but i knew it was not a dream. they tried to calm me down quickly to continue with the procedure , i was still a little out of it, but they put in the IV back in my arm to put me under as soon as they could to start the surgery. this time it was normal and i just fell asleep and woke up with gauze in my mouth. there was no nitrous administered the second time.
so it was either nitrous, or the mix of nitrous and the anesthesia combined, at least for me.  my body was really sore the next day, stomach and leg muscles. i just know i will never go near nitrous again and wish i had never accepted it in the first place, it was the most horrifying experience of my life.

[caddylady]

Wow, I can totally relate to a lot of that. Did you have nightmares the night after the procedure? I had TERRIBLE nightmares. So bad that the next night I was scared to go to sleep. I had the same feeling of being aware but not able to do anything. I felt my body go into seizing motions. I couldn't stop it or do anything about it. I felt like I was going to die and if they didn't notice me and my struggle (for my life!) I was surely going to die. I wasn't struggling to free myself because I couldn't, BUT I remember wishing I could move on my own so I could grab the nitrous mask off my face. I remember feeling that it was the source of the distress and if it wasn't removed I was going to die of a nitrous overdose. At first when I was really awake, I couldn't figure out if I dreamed it all or if it was real. It took about 3 days before I felt like myself again. It really did a number on my cognitive thinking too. It was very frightening and like you I will NEVER go near nitrous again!!!

[shayjay]

I wonder if she is allergic to lidocaine. I am actually trying to find some stuff out about that. My mom had a reaction to this at her dentist; numb face and tongue and overall weird feeling. She is now lost for what to do since she needs work done. She was thinking about nitrous oxide but this sounds like it may not be a good option for her either! Any thoughts??

[turl]

Your childs seizure was almost definitely caused by the Lidocaine. Local anesthetics can cause seizures and is based on the total dose. Even a small dose of local anesthetic injected directly into an artery takes the local anesthetic directly to the brain and induces a seizure.  It is specifically for that reason that there are limits to the total amount of local anesthetic used at a time.  
    This can be altered by adding epinephrine to the lidocaine to decrease the uptake into the blood vessels (you can use a higher dose)
   In relation to the nitrous oxide, very unlikely to cause seizures.  You can have some myoclonic activity with this inhaled anesthetic, but very unlikely to have an actual seizure. Dysphoric effects can also commonly occur with nitrous oxide.