Around 2 weeks ago I had a very nervous patient enter the clinic for the extraction of a broken down LL8. The patient had not eaten all day so we provided them with a glucose drink pre-treatment. Although the patient was nervous (taking many deep breaths during initial examination), he said he was comfortable enough and happy to undergo the treatment. I administered the LA (Left ID block followed by a long buccal infiltration) and waited around 5-10 minutes for full anaesthesia to be achieved. Once the patient was fully numb and I was just about to perform the extraction, he suddenly experienced vasovagal syncope and lost consciousness for around 20 seconds. Thankfully this was spotted the second it happened and was managed immediately. The patient quickly recovered but still felt slightly uneasy and anxious for a good while after the incident. We therefore decided alongside the patient to postpone the treatment to another day and ensure he left with an escort. I know it is difficult to say, but is it likely that this event was caused by the local anaesthetic (there was no flashback on aspiration and the event occurred at least 10 minutes after the ID block) or was this more likely due to a combination of the stress, hot weather and lack of food pre-treatment?