Bronchospasm and Anaphylactic Shock Following Lidocaine Aerosol Inhalation in a Patient with Butane Inhalation Lung Injury

Abstract

Allergic reactions to local anesthetics are very rare and represent <1% of all adverse local anesthetics reactions. A 54-year-old man was admitted to the hospital in the winter because of shortness of breath. The patient reportedly had an inhalation lung injury due to butane gas fuel. On the fifth day, he developed an asthmatic attack and anaphylactic shock immediately after lidocaine aerosol administration to prepare for bronchoscopy to confirm an acute inhalational lung injury diagnosis. Cardiopulmonary resuscitation was performed immediately after respiratory arrest, and the patient was admitted to the intensive care unit intubated and on a ventilator. He was extubated safely on the third post-cardiopulmonary resuscitation day. These observations suggest that aerosol lidocaine anesthesia may cause airway narrowing and anaphylactic shock. Practitioners should be aware of this potential complication. We report on this case with a brief review of the literature.

Emergency extraction of accidental impacted upper denture in the Association of American Anesthesiologist IV elderly patient: A case report and review of literature

“…Precaution must be taken considering the use of aerosolized LA agent because it may provoke asthmatic attack. [10] However, this may also be used in stopping bronchospasm when it does occur. Although under LA, emergency resuscitative medications and facilities such as oxygen, adrenalin, and steroid must be handy to intervene.…”

“…Although under LA, emergency resuscitative medications and facilities such as oxygen, adrenalin, and steroid must be handy to intervene. [10] It is of paramount importance to observe meticulously simple, salient, scientific, and safe details when handling this type of risky situation. The patient must be carried along with respect to explanation of the details of the procedure and attendant risk.…”

A Rare Cardiotoxicity: Butane Inhalation

“…Ani ölüm başta olmak üzere kardiyak etkilenmeler, akciğer problemleri, her tür metabolik bozukluk ve hatta birçok psikiyatrik sorunla karşılaşılmaktadır. 3,4,6 Örneğin yakın tarihli olgu sunumu şeklindeki 4 ayrı çalışma da propan ve/ veya bütan gazı kullanımı sonrası ventriküler fibrilasyon ve miyokard enfarktüsüne bağlı ani ölüm olguları literatürde bildirilmiştir. 2,5,7,8 Başka bir çalışmada ise bütan gazı inhalasyonuna bağlı olarak 16 yaşındaki bir hasta da miyokard enfarktüsünden bahsedilmektedir.…”

“…Literatürde bu maddenin kötüye kullanımının sonuçları ile ilgili çok sayıdaki makale incelendiğinde neden olduğu patolojilerin çok çeşitlilik gösterdiği görülmektedir. 3,4 Bu bağlamda çakmak gazı inhalasyonu sonrası ani kardiyak arrest gelişmiş olguyu güncel literatür bilgileri ışığında sunduk.…”

Local anesthetics allergy: who should be tested?

“…However, in asthma patients with no history of DHR, there is no clear association between the use of LAs and the development of hypersensitivity reactions. Only a few case reports indicated that local anesthetics, particularly in nebulized forms, may induce bronchospasm (17,18). In contrast to the bronchospasm effect of LAs, nebulized lidocaine has also been successfully used in the treatment of persistent cough (19).…”