Toxic reaction related to high dose lidocaine secondary to intravenous regional anesthesia

Abstract

Lidocaine can be seen systemic intoxication, central nervous system (CNS) and cardiovascular toxicities, due to its common usage and broad safety margin. Lidocaine overdose has been reported with convulsion, cardiac collapse and coma. In present case, a patient underwent surgical excision of wrist mass who erroneously received 1200 mg 10% lidocaine instead of 225 mg 2% dose. Interestingly, the case shows only some mild CNS side effects without any serious adverse effect.

Keywords

• Lidocaine, intoxication, intravenous, regional anesthesia, side effect

Damariçi bölgesel anestezi uygulaması sonrası gelişen, yüksek doz lidokaine bağlı toksik reaksiyon

Öz

Lidokain, yaygın kullanımı ve geniş güvenlik aralığı nedeniyle sistemik entoksikasyon, santral sinir sistemi ve kardiyovasküler sistem toksisitesi karşımıza çıkabilmektedir. Lidokain aşırı doz uygulamasında hastalarda konvülziyon, kardiyak kollaps ve koma görüldüğü rapor edilmiştir. Bu yazıda el bileğinde kitle çıkarılması için intravenöz rejyonel anestezi uygulaması amacıyla toplam 225 mg %2\'lik lidokain uygulanması gerekirken, ambalajına dikkat edilemediği için, yanlışlıkla aynı hacimde ve benzer ampül formunda olan %10\'luk lidokain\'den toplam 1200 mg verildiği halde sadece hafif santral sinir sistemi bulguları gözlenen bir olgu sunulmuştur.

Anahtar Kelimeler

• Lidokain, intoksikasyon, intravenöz, rejyonel anestezi, yan etki

References

1. Morgan GE. Mikhail .Clinical anesthesiology. Third Edition. McGraw-Hill Companies ; 2002, 297-8.
2. Choyce A, Peng P. A systematic review of adjuncts for intra- venous regional anesthesia for surgical procedures. Can J Anaesth 2002;49:32-45.
3. Luire SD, Reuben SS, Gibson CS, DELuca PA, Maciolek HA. Effect of clonidine on upper extremity tourniquet pain in healthy volunteers. Reg Anesth Pain Med 2000;25:502-5.
4. Gentili M, Bernard JM, Bonnet F. Adding clonidine to li- docaine for intravenous regional anesthesia prevents tourniguet pain. Anesth Analg 1999;88:1327-30.
5. Bigger JT, Hoffman DF. Antiarrhythmic drugs.in: Gillman AG, Rall TW,Nies AS. Goodman and Gillman: The phar- macological basis of therapeutics 8th ed. Newyork: Perga- mon Pres ; 1990.P.857-61.
6. Miller RD. Local anaesthetics. Anesthesia. Fourth edition. Churchill Livingstone 1994;510-6.
7. Crews JC, Rothman TE. Seizure after levobupivacaine for interscalene brachial plexus block. Anesth Analg 2003;96:1188-90.
8. Alfano SN, Leicht MJ. Lidocaine toxicity following subcuta- neous administration. Ann Emerg Med 1984 ;13:465-7.

9. Kudo K,Nishida N, Kiyoshima A, Ikeda N. A fatal case of poisoning by lidocaine over dosage-analysis of lidocaine in formalin-fixed tissues: a case report. Med Sci Law 2004;44: 266-71.
10. Zuberi BF, Shaikh MR, Jatoi NU, Shaikh WM. Lidocaine toxicity in a student undergoing upper gastrointestinal en- doscopy. Gut 2000;46: 435.
11. Sawyer RJ, von Schroeder H. Temporary bilateral blind- ness after acute lidocaine toxicity. Anesth Analg 2002; 95:224-6.
12. Blendon RJ, DesRoches CM, Brodie M, et al. Views of practicing physicians and the public on medical errors. N Engl J Med 2002;347:1933-40.