Local Anesthetic Systemic Toxicity Induced Cardiac Arrest After Topicalization for Transesophageal Echocardiography and Subsequent Treatment With Extracorporeal Cardiopulmonary Resuscitation.

TOPICAL ANESTHESIA with lidocaine is one of the cornerstones of performing a transesophageal echocardiography (TEE) exam in awake patients. There are a number of different techniques of oropharyngeal topicalization with lidocaine including the direct application of viscous lidocaine, lidocaine ointment, nebulization and/or atomization of lidocaine solution. Rapid administration of large doses of local anesthetics such as lidocaine are known to cause toxicity. Guidelines for the use of subcutaneous lidocaine suggest a maximum dose of 4.5 mg/kg but do not specify maximal doses for topical anesthesia with lidocaine. 1 Kouba D.J. LoPiccolo M.C. Alam M. et al. Guidelines for the use of local anesthesia in office-based dermatologic surgery. J Am Acad Dermatol. 2016; 74: 1201-1219 Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar Because the majority of the lidocaine dose administered during oropharyngeal topicalization is either swallowed or inhaled, the pharmacokinetics and potential for toxicity likely differ than that of intravenous or subcutaneous lidocaine, and maximum administered doses to prevent toxicity are unknown. The authors present a case of a patient who developed local anesthetic systemic toxicity (LAST) after oropharyngeal topical anesthesia with lidocaine prior to TEE and her subsequent treatment with extracorporeal life support (ECLS).