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Assessing Changes in Volatile General Anesthetic Sensitivity of Mice after Local or Systemic Pharmacological Intervention
Published on: October 16, 2013
Delayed awakening due to lidocaine overdose
J H Douglas1, J D Ross, D L Bruce
1Department of Anesthesiology, University of Mississippi Medical Center, Jackson 39216.
Journal of Clinical Anesthesia
|March 1, 1990
Summary
An elderly patient on intravenous lidocaine for arrhythmia experienced delayed awakening from anesthesia due to an overdose. This lidocaine toxicity resulted from calculation errors and underestimating patient factors affecting drug metabolism.
Area of Science:
- Anesthesiology
- Pharmacology
- Geriatrics
Background:
- Intravenous (IV) lidocaine is used for antiarrhythmic treatment.
- General anesthesia can affect drug metabolism.
- Elderly patients and those with cardiac disease may have altered drug biotransformation rates.
Observation:
- An 86-year-old male on IV lidocaine infusion experienced prolonged emergence from general anesthesia.
- Lidocaine concentration in blood was 15.6 micrograms/ml, significantly exceeding the therapeutic range.
Findings:
- The patient's lidocaine overdose was attributed to a miscalculated infusion rate.
- Underestimation of age, cardiac disease, and general anesthesia's impact on lidocaine biotransformation contributed to the toxicity.
Implications:
- Accurate dosage calculation is critical for IV drug infusions during and after general anesthesia.
- Clinical condition and patient-specific factors (age, comorbidities) must be considered to prevent drug toxicity.
- Careful monitoring is essential when administering medications like lidocaine in vulnerable patient populations.
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