Lidocaine induced convulsion in airway superficial anesthesia:a case report and review of literature

Abstract

Objective To increase the knowledge of airway topical anesthesia in lidocaine.Methods We analyzed a lymphoma patient which was induced convulsion by lidoeaine for topical anesthesia in airway,and retrospectively analyses the side-effect and clinical application and pharmacokinetics on the basis of the relevant documents.Results The patient,female,1 9 years old,was in hospital for progressive dyspnea during a month.For right trachelophyma she had accepted right cervical thyroid and superior mediastinum resection a month ago,and postoperatively pathology prompted diffuse large B-cell lymphoma in sub-cervical and anterosuperior mediastinum,lymphocytic thyroiditis.After hospitalization we considered that dyspnea was caused by the lymphoma which relapsed and oppressed the trachea.To establish the diagnosis and assessment the airway's condition the bronchoscopy was been done bedside the support of the high frequency jet ventilator.The liver and renal function were normal inspected by plasma biochemistry preoperative,and the method of airway topical anesthesia was instilling 2%lidocaine.The inferior segment of trachea about 40 mm from eminence was external pressure narrow,and the ITlueous membrane was asperity,and the extreme narrow segment was lip-like which caliber was 4×10 mm that the bronchoscopes could pass it by force.The right and left main bronchus opening was external pressure narrow and the distant part was unobstructed no neoplasm,The whole dosage of lidocaine was 300 mg.The operative procedure was successful and no short breath aggravated,and the SPO2 was above 92%.When the tracheal stent was repaired (about 10 min after the first drip of lidocaine) the patient was obnubilation and tonic seizure.After oral trachea cannula by bronchoscope guidance and assisted ventilation by compressing saccule and diazepam 10 mg IV,the convulsion stopped and the mind was clear 5 min later.The electrocardio-detection prompted that the heart rhythm was sinus rhythm and the HR was 150 times/min during the whole process.After the convulsion stopped the femoral artery plasma concentration of lidocaine was 7.76 mg/L which showed poisoning by lidocaine.Conclusions Lidocaine has been the most frequently used medicine for local anesthesia in flexible bronchoscopy.However,its severe side effects have been reported in clinical application.The primary reason of side effect is extra local absorption of lidocaine.It is the important intervention to increase the safety of bronchoscope which inhibits the local absorption of lidocaine. Key words: Bronchoscope; Lidocaine; Topical anesthesia ; Side effect