Cardiac arrest after intraurethral administration of lidocaine

We report a case of cardiac arrest immediately following intraurethral administration of lidocaine as topical anesthesia for cystourethroscopy in an 87-year-old man. Intraurethral mucosa lesions from previous attempts at Foley catheter insertion led to a rapid elevation in the blood concentration of lidocaine. In the presence of such factors as a urethral obstruction and a high lidocaine concentration, signs of cardiovascular toxicity can occur almost simultaneously with those of central nervous system toxicity. We, therefore, recommend that spinal or general anesthesia may be better for patients with intraurethral mucosa lesions undergoing urethral procedures.