title: Delayed awakening due to lidocaine overdose.
abstract: An 86-year-old man receiving antiarrhythmic treatment with an intravenous (IV) lidocaine infusion experienced a prolonged emergence from general anesthesia. A venous blood sample was sent for determination of the lidocaine concentration, the infusion was stopped, and the patient awakened 15 minutes later. The circulating lidocaine concentration was 15.6 micrograms/ml, three times the upper limit of therapeutic range for arrhythmia treatment. The overdose was the result of a miscalculated infusion rate, plus an underestimation of effects of age, cardiac disease, and general anesthesia on the rate of lidocaine biotransformation. Infusion of any drug during and after general anesthesia requires scrupulous attention to dosage determination and to the clinical condition of the patient receiving the infusion.
authors.affiliation: Department of Anesthesiology, University of Mississippi Medical Center, Jackson 39216.
authors.forename: J H
authors.initials: JH
authors.lastname: Douglas
authors.forename: J D
authors.initials: JD
authors.lastname: Ross
authors.forename: D L
authors.initials: DL
authors.lastname: Bruce
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000768:Anesthesia, General; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000188:drug therapy*; D001711:Biotransformation; D062787:Drug Overdose; D006801:Humans; D007262:Infusions, Intravenous; D007431:Intraoperative Complications; D007866:Leg / Q000601:surgery; D008012:Lidocaine / Q000378:metabolism / Q000506:poisoning*; D008297:Male; D008508:Medication Errors; D013997:Time Factors; D014474:Unconsciousness / Q000139:chemically induced*
chemical_list: D008012:Lidocaine