title: Severe Respiratory Event Initially Thought to be Inadvertent Endobronchial Intubation: Possible Complications From Using of a Topical Metered-Dose of 8% Lidocaine Pump Spray.
abstract: BACKGROUND
  Pulmonary collapse after intubation is common, and it is caused by a variety of factors.
  
  
  METHODS
  A 21-year-old man presented at our operation room to undergo an appendectomy. Except for a history of cigarette smoking, his history was negative. Anesthesia was induced with 100% oxygen and sevoflurane, remifentanil infusion, and propofol. Neuromuscular block was obtained with rocuronium. The tip and cuff of a tracheal tube were lubricated with a topical metered-dose of 8% Lidocaine pump spray. After intubation, SPO2 suddenly decreased. The chest x-ray revealed right upper lobe atelectasis. Fiber optic bronchoscopy showed that a large amount of yellow sticky mucus had been secreted into the right main bronchus.
  
  
  CONCLUSIONS
  In Japan, 8% Lidocaine pump spray contains menthol and ethanol as additives. These additives, particularly menthol, might have led to excessive mucus production, although we did not analyze the mucus secretion.
authors.affiliation: Department of Surgery, Toki General Hospital, Gifu, Japan.
authors.forename: Young-Chang P
authors.initials: YC
authors.lastname: Arai
authors.affiliation: Department of Surgery, Toki General Hospital, Gifu, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Kawanishi
authors.affiliation: Department of Surgery, Toki General Hospital, Gifu, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Sakakima
authors.affiliation: Department of Surgery, Toki General Hospital, Gifu, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Ohmoto
authors.affiliation: Department of Surgery, Toki General Hospital, Gifu, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Ito
authors.affiliation: Department of Surgery, Toki General Hospital, Gifu, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Maruyama
authors.affiliation: Multidisciplinary Pain Centre, School of Medicine, Aichi Medical University, Aichi, Japan.
authors.forename: Tatsunori
authors.initials: T
authors.lastname: Ikemoto
keywords: 8% Lidocaine Pump Spray; Endobronchial Intubation; Severe Respiratory Event