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pallor or ischemia, and/or heart palpitations. 11 – 14 There are several existing reports in the literature of intravascular local anesthetic injection involving the inferior alveolar artery, 4 , 5 , 11 , 12 a few involving the posterior superior alveolar artery, 13 , 14 one report involving the superior palatine artery, 15 and one involving the buccal artery, 16 but none exist regarding direct injection into the facial artery. The aim of this clinical report is to present an accidental local anesthetic injection into the facial artery and to discuss its

pressure, tachypnea, tachycardia, skin pallor, sialorrhea, diaphoresis, and incontinence. Electrolyte imbalance, which can include hyperkalemia, hypernatremia, hypomagnesemia, and hypocalcemia, acute renal failure, arrhythmias, and rhabdomyolysis may ensue. In addition to the electrolyte imbalance, laboratory tests will likely show elevated creatine kinase. Extrapyramidal findings in NMS can include Parkinson-like symptoms, dystonia, dyskinesia, and akathisia. While there is no diagnostic testing for NMS, the above listed symptoms in association with trigger

sphygmomanometer, pulse oximeter, and electrocardiogram (ECG) because of the potential for intraoperative vital sign fluctuations. On the day of dental treatment, the patient's condition deteriorated immediately after her arrival on the premises, and she collapsed before undergoing any dental treatment. Although she was conscious, she had facial pallor and difficulty walking independently. Therefore, she was immediately transferred to the internal medicine department attached to our dental institution, where a sphygmomanometer, pulse oximeter, and ECG were quickly applied. At

epinephrine. Therefore, if epinephrine is administered intramuscularly and the symptoms do not improve, IM injections should be repeated every 5 to 15 minutes. 1 , 19 The transient adverse effects of IM epinephrine in adults were reported as pallor (25%; 13/52 injections), tremor (13%; 7/52 injections), heart palpitations (13%; 7/52 injections), headache (6%; 3/52 injections), and shivers and dizziness (2%; 1/52 injections) 5 ; those in children included tremor (94%; 16/17 injections), pallor (82%; 14/17 injections), headache (24%; 4/17 injections), tingling of

anesthesia may trigger cardiovascular events, and the well-informed provider should be familiar with their recognition and management. ABNORMALITIES IN ARTERIAL BLOOD PRESSURE Neurocardiogenic (Vasovagal) Syncope Syncope is a transient loss of consciousness due to reduced cerebral blood flow. It may occur unexpectedly but is often preceded by such signs and symptoms as pallor, lightheadedness, diaphoresis, and nausea. As brain tissues are deprived of oxygen, a brief period (ie, a few seconds) of convulsive motor activity is not