Reactions to Local Anesthetics

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Abstract
Local anesthetics are used widely by practically all physicians, most of whom are not fully aware of the lethal potential of local anesthetics and the swiftness with which they may precipitate a catastrophe. The perineural concentration of a local anesthetic necessary to interrupt conduction in a nerve fiber is many times greater than that which a patient will tolerate if that drug is circulating in the plasma. The majority of clinically useful local anesthetics are tertiary amines and are, therefore, basic substances.1They form aqueous solutions that are alkaline in reaction. The bases are poorly soluble in water, but they readily form water soluble salts with acids. The bases are less stable than the salts. The salts, by virtue of their greater solubility and stability, are used for injection and topical application. Although aqueous solutions of the salts are acid in reaction, when injected they are converted to the

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