Abstract
During epidural anesthesia for a caesarean section, symptomes considered to be an acute toxic reaction of the local anesthetic (lidocaine) were observed inadvertently. The effects of the local anesthetic concentration in arterial blood and the electro-encephalogram (EEG) were studied. An epidural puncture was performed at the 2nd/3rd intervertebral space and the catheter was inserted 3-4 centimeters toward the head. A local anesthetic of 2% lidocaine solution 12ml (including test dose 2 ml) was injected at the rate of 5 ml/min. Three minutes after the injection (the concentration of the lidocaine in blood was estimated to be 4-5 microgram/ml according to the values examined), a descent in consciousness, loss of eye rash reflex and an elevation of blood pressure were observed. Five minutes after the injection (the concentration of lidocaine in blood was 3.81microgram/ml), an EEGwas recorded showing dominancy of the slow wave.When the umbilical cord was ligated, the lidocaine concentration in the umbilical vein was 1.21 microgram/ml. The apgar score of the newborn was 8 points at one minute after birth. We discussed the relationship between the lidocaine concentration in blood and the clinical symptomes that were observed.
