[Cardiac arrest due to lidocaine]

A 65-year-old woman with height of 156 cm and weight of 54 kg, who had previously been healthy, was scheduled for resection of axillary abscess. She was not premedicated. After local infiltration of 1%-lidocaine 25 ml, operation was started under electrocardiographic monitoring. Blood pressure was 190/100 mmHg, heart rate being 80 bpm and EKG showed sinus rhythm. During next 25 minutes, 60 ml of 1%-lidocaine was used because of inadequate pain relief. Two minutes after the last injection of 1%-lidocaine 10 ml, the patient developed significant bradycardia followed by cardiac standstill. Resuscitation was started immediately. Within two minutes, EKG showed idioventricular rhythm followed by junctional escaped rhythm and then sinus rhythm at a rate of 42 bpm appeared. Bradycardia below 50 bpm continued for 9 minutes despite of intravenous administration of atropine. After the recovery of heart beat, the patient became responsive, alert, and oriented, and neither arrhythmia nor ST-T change was observed. Laboratory data showed no abnormality which might have predisposed her to the development of cardiac arrest. Because the cardiac arrest occurred soon after lidocaine injection and no drug other than lidocaine had been used, lidocaine was thought to be the cause of the cardiac arrest.