A 54-year-old man presented to the hospital with dyspnea after inhaling butane gas while melting a water pipe during winter. On physical examination, late inspiratory crackles were evident in both auscultated lower lung fields. His history showed no lidocaine allergy, allergic rhinitis, asthma, or allergies to other drugs. On examination, blood pressure was 125/75 mmHg, pulse was 65 beats per minute, oral temperature was 36.5℃, respiratory rate was 18 breaths per minute, oxygen saturation was 76.0%, pH was 7.27, PaO2 was 46.0 mmHg, and PaCO2 was 47.2 mmHg, as the patient breathed ambient air. Total IgE was 129 kU/L. An electrocardiogram revealed a normal sinus rhythm. A pulmonary function test revealed forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) of 78%, FVC of 2.24 L (60%), FEV1 of 1.75 L (62%), and a diffusing capacity for carbon momoxide of 15.1 mL/mmHg (71%) indicating a restrictive pattern. Chest radiographs revealed bilateral patchy opacities, more in the right lung than in the left lung. Computed tomography of the chest revealed multifocal consolidation and ground-glass opacities in all lobes of both lungs, indicating an acute inhalation lung injury (). The patient recovered after oxygen and supportive care. On the fifth day, we planned to conduct a bronchoscopy to diagnose an inhalational lung injury. We used lidocaine aerosol as local anesthesia for reducing the gag reflex. After administering the lidocaine anesthesia, the patient complained of dizziness without urticaria and angioedema and shortness of breath, which was associated with an increased respiratory rate and decreased oxygen saturation. Coarse expiratory wheezes were auscultated on a physical examination. Blood pressure subsequently dropped, and a radial pulse was not palpable. The patient was treated with nebulized salbutamol and systemic steroid. However, the patient did not recover, and blood pressure continued to decrease accompanied by an increase in respiratory rate and a decrease of oxygen saturation () followed by cardiorespiratory arrest. Cardiopulmonary resuscitation (CPR) with epinephrine, inotropics, and fluid therapy was performed immediately, and the patient was admitted to the intensive care unit under tracheal intubation and ventilator treatment. After 2 hours, his CPR tryptase level was 1.68 µg/L. He was extubated safely on the third post-CPR day.
A 41-year-old female patient received an injection of lidocaine containing epinephrine for root canal treatment, and then, about 30 min later, symptoms of dizziness and systemic urticaria appeared. The patient was determined to be hypersensitive to lidocaine and transferred to the department of allergy.\nSkin prick testing was performed using lidocaine, procaine, bupivacaine, mepivacaine, chirocaine (levobupivacaine), ropivacaine, and articaine, and the patient tested positive to lidocaine, ropivacaine, and articaine (). Among the drugs to which she had tested negative, lidocaine, procaine, mepivacaine, and bupivacaine were used for a skin test, in which a positive reaction was seen only with lidocaine.\nRestorative treatment was performed using procaine, to which the patient had tested negative in the skin test, but it was ineffective as a result of its shorter duration of activity than lidocaine, resulting in the appearance of adverse effects, such as increased anxiety in the patient. Subsequent treatments were performed using levobupivacaine, with which satisfactory treatment effects, in terms of pain reduction and duration, were achieved.