title: Life threatening medullary injury following adenoidectomy and local anesthetic infiltration of the operative bed.
abstract: OBJECTIVE
  To draw attention to a rare, life threatening complication of a rather common procedure, namely medullary injury following adenoidectomy and local anesthetic infiltration of the operative bed.
  
  
  METHODS
  Case report.
  
  
  METHODS
  A tertiary pediatric critical care unit.
  
  
  METHODS
  A healthy 7-year-old girl underwent adenoidectomy and local anesthetic infiltration of the adenoid bed with lidocaine and adrenaline. In the recovery room, nystagmus, dysarthria, dyspnea, inability to cough and right hemiparesis were noticed. Because of her inability to remove secretions tracheal intubation was performed, followed by severe, life threatening respiratory failure.
  
  
  METHODS
  Tracheal intubation, hemodynamic support, prolonged mechanical ventilation, nitric oxide, and tracheostomy.
  
  
  CONCLUSIONS
  In children, local anesthetic infiltration of the adenoid bed may cause life-threatening medullary injury and its routine use should be re-considered.
authors.affiliation: Pediatric Intensive Care, Meyer Children's Hospital, Haifa, Israel. e_hershman@rambam.health.gov.il
authors.forename: Eli
authors.initials: E
authors.lastname: Hershman
authors.forename: Michael
authors.initials: M
authors.lastname: Halberthal
authors.forename: Dorit
authors.initials: D
authors.lastname: Goldsher
authors.forename: Avishai
authors.initials: A
authors.lastname: Golz
authors.forename: Gad
authors.initials: G
authors.lastname: Bar-Joseph
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002648:Child; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology; D007442:Intubation, Intratracheal; D008012:Lidocaine / Q000008:administration & dosage*; D008526:Medulla Oblongata / Q000293:injuries*; D010291:Paresis / Q000209:etiology; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine