中耳手術時キシロカイン局所麻酔による心停止の1例

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This is a report of a 20-year-old female, suffering from right-sided chronic otitis media, who was operated on under local anesthesia. In the course of operation, the patient became irritable and epileptic. Cardiac arrest then ensued. These conditions appeared just after the local anesthesia was established with 14ml lidocaine. The patient was treated by our anestheologists and successfully resuscitated. No postoperative trouble has appeared to date.From the retrospective study of the patient history and literature, the following conclusions were drawn:1) The patient had a past history of psychomotor seizure. Lidocaine has a pharmacological property of inducing psychomotor seizure. It is therefore, concluded that the patient was hypersensitive to lidocaine.2) Pretreatment with diazepam is effective in preventing lidocaine-induced seizures. Before the onset of lidocaine-induced seizures in a nontreated patient, drowsiness, apprehension, or excitability usually appear. Prior administration of diazepam suppresses these symptoms. If seizures occur in the pretreated patients, it will be difficult to control them.3) During ordinary resuscitation, seizures are treated by barbiturates, and ventricular fibrillation by intravenous lidocaine. Diazepam is more effective than barbiturates. The ventricular fibrillation occurring under local anesthesia should be treated by lidocaine, because ventricular fibrillation usually results from the untoward effect of the epinephrine contained in local anesthetics as evidenced by the literature.Therefore, intravenous injection of diazepam and lidocaine is the first choice for convulsions and tachyarrhythmia. Lidocaine containing norepinephrine has no cardiac effect.For the purpose of making the blood vessels contract, norepinephrine is a better accompaniment to lidocaine because it has less cardiac effect than epinephrine.
耳鼻咽喉科臨床学会の論文

中耳手術時キシロカイン局所麻酔による心停止の1例

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