Fatal consequences of local anesthesia: report of five cases and a review of the literature.

The possible hazards of local anesthetic agents in either moderate or large doses are not always fully appreciated. The toxic side effects following rapid systemic absorption may be the unsuspected cause of death following the clinical use of these substances. Data on 15 deaths after the administration of local anesthetic substances are summarized. Five case histories involving lidocaine (lignocaine, Xylocaine) and cocaine are presented in detail, including the results of toxicologic analysis. The literature relevant to similar fatalities is reviewed but contains little information relating to blood and tissue concentrations in fatal cases. It is hoped that this paper may assist in clarifying the cause of death in some previously problematic situations.