Neurologic toxicity of lidocaine during awake intubation in a patient with tongue base abscess. Case report

Giordano, Davide; Panini, Alessandro; Pernice, Carmine; Raso, Maria Gabriella; Barbieri, Verter

doi:10.1016/j.amjoto.2013.08.009

Cited by 34 publications

(15 citation statements)

References 14 publications

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“…35,38,40,41,54,55,58 In 7 cases, toxicity followed topical administration of LA without needle injection. 26,45,47,48,50,57,59 Finally, in 2 cases, LAST followed direct unintentional LA intravascular injection through a venous cannula. 14,42…”

Section: Setting Of Lastmentioning

confidence: 99%

“…[8][9][10][12][13][14][15][16][17][18][19][20][21][22]24,25,[27][28][29][31][32][33][34][36][37][38][40][41][42][43][51][52][53][54][55][56][57][58]60,61 Twelve percent of the cases developed in an office, 30,39,45,46,[48][49][50] whereas another 4% occurred in other locations, including the patient's home. Finally, 15% of the authors did not specify the hospital setting where the LA was administered.…”

Section: Setting Of Lastmentioning

confidence: 99%

See 1 more Smart Citation

A Review of Local Anesthetic Systemic Toxicity Cases Since Publication of the American Society of Regional Anesthesia Recommendations

Vasques

Behr

Weinberg

et al. 2015

Regional Anesthesia and Pain Medicine

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Local anesthetic systemic toxicity (LAST) occurrence may cross several medical specialties. In 2010, the American Society of Regional Anesthesia and Pain Medicine (ASRA) published the first algorithm on LAST management, introducing the use of lipid emulsion (ILE) treatment. In the present study, we retrieved the cases of LAST published between ASRA guidelines dissemination and March 2014. We analyzed the reported clinical manifestations of LAST, characteristics of affected patients, onset time of toxicity, and clinical setting. We also focused on the treatment measures that were applied in the different cases, especially on the use of ILE and adherence to ASRA recommendations. Despite the limits of a review of case reports, the present study calls attention to the insidious nature of LAST, especially its atypical manifestations, and shows that ILE may currently be underadministered in daily clinical practice, especially in nonanesthesiology practice.

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Section: Setting Of Lastmentioning

confidence: 99%

Section: Setting Of Lastmentioning

confidence: 99%

A Review of Local Anesthetic Systemic Toxicity Cases Since Publication of the American Society of Regional Anesthesia Recommendations

Vasques

Behr

Weinberg

et al. 2015

Regional Anesthesia and Pain Medicine

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“…Posterior tongue pathologies, because of their risk of airway obstruction, should be recognised quickly and evaluated as an emergency. The English literature reveals only a small number of cases of tongue‐base abscesses . The present case is the oldest patient reported with a tongue‐base abscess in the literature.…”

Section: Introductionmentioning

confidence: 68%

“…As in the present case, intubation may be very difficult, especially in elderly patients with tongue‐base abscesses; hence, surgeons should keep their tracheotomy equipment ready at all times and the anaesthesiologists should have a video laryngoscope or flexible bronchoscope on hand. Giordano et al reported an unusual case of a neurological toxicity of lidocaine during an awake intubation in a patient with a tongue‐base abscess who consequently underwent urgent nasotracheal fibre optic intubation. Corticosteroid therapy may be helpful to reduce oedema on the hypopharyngeal airway and to visualise larynx better.…”

Section: Discussionmentioning

confidence: 99%

Another cause of difficult airway in an elderly patient: Tongue‐base abscess

2018

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“…Topical anesthesia is relatively easy, effective and well tolerated, but not without risks. In a patient with a tongue base abscess, systemic local anesthetic toxicity has been reported after topical anesthesia with lidocaine for awake fiberoptic intubation 2 . In heavily sedated patients with unstable cervical fracture, insufficient topicalization led to laryngospasm with total upper airway obstruction as a result of fiberoptic pharyngeal mucosa stimulation 3 .…”

Section: Introductionmentioning

confidence: 99%

Upper Airway Blocks for Awake Difficult Airway Management

Pintarič

2016

ACC

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SUMMARY -Airway anesthesia is pivotal for successful awake intubation provided either topically or by blocks. Airway blocks are considered technically more difficult to perform and carry a higher risk of complications. However, in experienced hands, they can be useful as they provide excellent intubating conditions. For complete upper airway anesthesia, bilateral glossopharyngeal and superior laryngeal nerve blocks with translaryngeal injection are required. Superior laryngeal nerve block and translaryngeal injection can be performed easily, safely and with a high success rate in patients with normal anatomy. In those with difficult landmarks, ultrasound can be of assistance. For the superior laryngeal nerve block, other targets than the nerve itself must be established to make the technique consistently successful, easy to teach, learn and perform. The same applies to the translaryngeal injection, where the use of ultrasound is necessary for correct midline identification. Intraoral glossopharyngeal nerve block is also safe and easy to perform, but associated with long lasting discomfort. Bilateral extraoral peristyloid approach should be discouraged since inadvertent blocks of the closely adjacent vagus nerve cannot be prevented in this location. A safe and easy method of blocking the distal portions of the glossopharyngeal nerve for awake intubation is therefore required.

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Neurologic toxicity of lidocaine during awake intubation in a patient with tongue base abscess. Case report

Cited by 34 publications

References 14 publications

A Review of Local Anesthetic Systemic Toxicity Cases Since Publication of the American Society of Regional Anesthesia Recommendations

A Review of Local Anesthetic Systemic Toxicity Cases Since Publication of the American Society of Regional Anesthesia Recommendations

Another cause of difficult airway in an elderly patient: Tongue‐base abscess

Upper Airway Blocks for Awake Difficult Airway Management

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