E Gaïes1, N Jebabli2, M Lakhal3, A Klouz3, I Salouage3, S Trabelsi3. 1. Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de pharmacologie clinique, centre national de pharmacovigilance de Tunis, 9, avenue Dr. Zouheir Essafi, 1006 Tunis, Tunisie. Electronic address: gaiesemna@yahoo.fr. 2. Service de pharmacologie clinique, centre national de pharmacovigilance de Tunis, 9, avenue Dr. Zouheir Essafi, 1006 Tunis, Tunisie. 3. Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de pharmacologie clinique, centre national de pharmacovigilance de Tunis, 9, avenue Dr. Zouheir Essafi, 1006 Tunis, Tunisie.
Abstract
INTRODUCTION: Lidocaine toxicity usually appears rapidly and is directly correlated with plasma concentrations of the drug. CASE REPORT: We report a case of a late neurologic toxicity occurring after instillation of lidocaine during fibre-optic bronchoscopy. A patient with bronchiolitis obliterans underwent a diagnostic bronchoscopy. She received multiples instillations of Xylocaine(®) 2% (lidocaine). Three and a half hours later, she had a tonic-clonic seizure. Seven hours later, this recurred. Lidocaine plasma levels were in the toxic range at the time of the first seizure (18.32μg/mL) with a significant decrease in the concentration noted 24hours later. CONCLUSION: The slow absorption of lidocaine into the blood from the bronchial tree explains the delayed neurologic toxicity. Our observation is a reminder that complications can occur due to high doses of lidocaïne administrated by instillation. Thus, if the recommended dose of lidocaine is exceeded, it is essential to monitor patients closely for a prolonged period, especially those with fibrosing lung disease in order to avoid possible late toxicity.
INTRODUCTION:Lidocainetoxicity usually appears rapidly and is directly correlated with plasma concentrations of the drug. CASE REPORT: We report a case of a late neurologic toxicity occurring after instillation of lidocaine during fibre-optic bronchoscopy. A patient with bronchiolitis obliterans underwent a diagnostic bronchoscopy. She received multiples instillations of Xylocaine(®) 2% (lidocaine). Three and a half hours later, she had a tonic-clonic seizure. Seven hours later, this recurred. Lidocaine plasma levels were in the toxic range at the time of the first seizure (18.32μg/mL) with a significant decrease in the concentration noted 24hours later. CONCLUSION: The slow absorption of lidocaine into the blood from the bronchial tree explains the delayed neurologic toxicity. Our observation is a reminder that complications can occur due to high doses of lidocaïne administrated by instillation. Thus, if the recommended dose of lidocaine is exceeded, it is essential to monitor patients closely for a prolonged period, especially those with fibrosing lung disease in order to avoid possible late toxicity.