An 18 yrs old woman in the active stage of labour requests an epidural anaesthesia for delivery. Immediately following the epidural injection of 12ml of 2% lidocaine, the pt complains of lip numbness and becomes apprehensive. What is presumptive diagnosis.

systemic toxicity of Local anesthetics Central nervous system toxicity is classically described as a two-stage process. An initial excitatory state is followed by a depressive phase. Early neurological features include perioral tingling, tinnitus, and slurred speech. Light headedness and tremor may also occur, as may a change in mental status with confusion or agitation. However, LAST can occur without these characteristic premonitory signs. The excitatory neurological phase culminates in generalized convulsions. This may lead to the depressive phase of coma and respiratory depression. Cardiovascular system toxicity is classically in three phases. The initial phase includes hypeension and tachycardia. The intermediate phase is associated with myocardial depression and hypotension. The terminal phase includes peripheral vasodilatation, severe hypotension, and a variety of arrhythmias such as sinus bradycardia, conduction blocks, ventricular tachyarrhythmias, and asystole.