Sudden quadriparesis after non-overdose local anesthesia

Wei-Chen Chen; Hsien-Yi Chen; Te-I Weng; Chun-Kuei Chen

doi:10.1186/s12245-022-00423-7

Sudden quadriparesis after non-overdose local anesthesia

Int J Emerg Med. 2022 May 17;15(1):19. doi: 10.1186/s12245-022-00423-7.

Authors

Wei-Chen Chen¹, Hsien-Yi Chen^{1

2}, Te-I Weng^{3

4

5}, Chun-Kuei Chen^{6

7}

Affiliations

¹ Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
² College of Medicine, Chang Gung University, Taoyuan, Taiwan.
³ Department of Emergency Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
⁴ Forensic and Clinical Toxicology Center, College of Medicine, National Taiwan University Hospital, National. Taiwan University, Taipei, Taiwan.
⁵ Institute of Forensic Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁶ Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan. master198012@gmail.com.
⁷ College of Medicine, Chang Gung University, Taoyuan, Taiwan. master198012@gmail.com.

Abstract

Background: A well-known anesthetic, lidocaine is the most widely used local anesthetic. Local anesthetic systemic toxicity (LAST) is a life-threatening event with common and prominent presentations of central nervous system (CNS) toxicity and cardiovascular toxicity. The most frequent and prominent early warning signs and symptoms of LAST are central nervous system symptoms. While rare, cases quadriparesis after the administration of lidocaine has been reported.

Case presentation: In this paper, we report a very rare case of quadriparesis after local anesthesia administration for vocal cord cyst-removal surgery, which dramatically improved after treatment. LAST can occur during various routes of lidocaine administration, such as local spray. A possible mechanism of our case could be the local diffusion of lidocaine to the spinal cord, which caused the symptoms to mimic anterior cord syndrome.

Conclusions: Our case presented a favorable outcome following the administration of intravenous lipid emulsion (ILE) for non-over dose local anesthetic drug induced spinal cord inhibition symptoms. These findings highlight the need for further research on the use of ILE to reverse LAST and other adverse effects of local anesthetics.

Keywords: Lipid emulsion; Local anesthetic systemic toxicity; Quadriparesis; Vocal cord cyst-removal surgery.