Acute respiratory distress syndrome after airway anesthesia with lidocaine

Adequate anesthesia of the upper and proximal lower airways is a critical prerequisite for a smooth and successful bronchoscopic procedure. Lidocaine is the most commonly used local anesthetic agent for flexible bronchoscopy. Adverse reactions to this agent have rarely been reported. Nevertheless, we recently observed a life-threatening reaction to airway lidocaine anesthesia in a 33-year-old man who was to undergo flexible bronchoscopy for the evaluation of an intrathoracic lymphadenopathy. Before the procedure, the patient developed noncardiogenic pulmonary edema. Only 2 such cases after airway anesthesia with nontoxic doses of lidocaine for a bronchoscopic procedure have been reported in the literature. Unlike in these cases, the episode was brief and self-limiting, with adverse reaction confined to the respiratory tract without development of shock or systemic involvement.