title: [Delayed convulsion after lidocaine instillation for bronchoscopy].
abstract: BACKGROUND
  Lidocaine toxicity usually appears rapidly and is directly correlated with plasma concentrations of the drug.
  
  
  METHODS
  We report a case of a late neurologic toxicity occurring after instillation of lidocaine during fibre-optic bronchoscopy. A patient with bronchiolitis obliterans underwent a diagnostic bronchoscopy. She received multiples instillations of Xylocaine(®) 2% (lidocaine). Three and a half hours later, she had a tonic-clonic seizure. Seven hours later, this recurred. Lidocaine plasma levels were in the toxic range at the time of the first seizure (18.32μg/mL) with a significant decrease in the concentration noted 24hours later.
  
  
  CONCLUSIONS
  The slow absorption of lidocaine into the blood from the bronchial tree explains the delayed neurologic toxicity. Our observation is a reminder that complications can occur due to high doses of lidocaïne administrated by instillation. Thus, if the recommended dose of lidocaine is exceeded, it is essential to monitor patients closely for a prolonged period, especially those with fibrosing lung disease in order to avoid possible late toxicity.
authors.affiliation: Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de pharmacologie clinique, centre national de pharmacovigilance de Tunis, 9, avenue Dr. Zouheir Essafi, 1006 Tunis, Tunisie. Electronic address: gaiesemna@yahoo.fr.
authors.forename: E
authors.initials: E
authors.lastname: Gaïes
authors.affiliation: Service de pharmacologie clinique, centre national de pharmacovigilance de Tunis, 9, avenue Dr. Zouheir Essafi, 1006 Tunis, Tunisie.
authors.forename: N
authors.initials: N
authors.lastname: Jebabli
authors.affiliation: Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de pharmacologie clinique, centre national de pharmacovigilance de Tunis, 9, avenue Dr. Zouheir Essafi, 1006 Tunis, Tunisie.
authors.forename: M
authors.initials: M
authors.lastname: Lakhal
authors.affiliation: Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de pharmacologie clinique, centre national de pharmacovigilance de Tunis, 9, avenue Dr. Zouheir Essafi, 1006 Tunis, Tunisie.
authors.forename: A
authors.initials: A
authors.lastname: Klouz
authors.affiliation: Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de pharmacologie clinique, centre national de pharmacovigilance de Tunis, 9, avenue Dr. Zouheir Essafi, 1006 Tunis, Tunisie.
authors.forename: I
authors.initials: I
authors.lastname: Salouage
authors.affiliation: Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de pharmacologie clinique, centre national de pharmacovigilance de Tunis, 9, avenue Dr. Zouheir Essafi, 1006 Tunis, Tunisie.
authors.forename: S
authors.initials: S
authors.lastname: Trabelsi
mesh_terms: D000368:Aged; D000772:Anesthesia, Local / Q000009:adverse effects; D001989:Bronchiolitis Obliterans / Q000601:surgery; D001999:Bronchoscopy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007322:Instillation, Drug; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects*; D012640:Seizures / Q000139:chemically induced*; D013997:Time Factors
chemical_list: D008012:Lidocaine
keywords: Bronchiolite oblitérante; Bronchiolitis obliterans; Convulsion; Dosage plasmatique; Lidocaine; Lidocaïne; Plasma drug monitoring; Seizure; Toxicity; Toxicité