Abstract
Introduction
Systemic reactions from local tetracaine use are often an anomaly – not only is tetracaine
short-acting and quickly metabolized by the pseudocholinesterase system leading to
very limited systemic uptake, but most adverse reactions are usually associated with
dental or spinal anesthesia. Furthermore, reactions to local anesthetics manifest
in standard allergy-type reactions. When local anesthetics lead to nervous or cardiac
system abnormalities, it is termed a local anesthetic systemic toxicity – an event
with an incidence currently estimated to be 0.03%.
Case presentation
We present a case of a 56-year-old female who experienced a systemic reaction to tetracaine
1% while undergoing a fine needle biopsy of a thyroid nodule. The patient had previous
allergic reactions to lidocaine. Upon conclusion of the procedure, the patient began
convulsing and became rigid and non-verbal. She was able to move all extremities,
had no respiratory distress, no swelling, hives, or redness, and was swallowing without
difficulty. After about 5 min, the patient began to improve and experienced reversal
of all previous symptoms. Her physical exam and labs were otherwise normal, she returned
to her baseline functioning, and was discharged without any medical interventions.
Discussion
This case illustrates a case of LAST in a patient with previous Lidocaine allergy
without any other obvious risk factors. There have been no cases of cross-reaction
between lidocaine and tetracaine so it explores the possibility of patients having
cross reaction to those two different kinds of local anesthetic.
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Article Info
Publication History
Published online: May 15, 2020
Accepted:
May 8,
2020
Received in revised form:
May 8,
2020
Received:
April 11,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
