Delayed cephalad spread of a lidocaine spinal anesthetic causing ventilatory failure.

Spinal anesthesia, irrespective of the local anesthetic used, is a time-proven anesthetic technique that provides ideal operating conditions for lower abdominal and lower extremity operations. Various local anesthetics can be used to inject into the subarachnoid space. Tetracaine and lidocaine are the two most extensively used local anesthetics. Moore suggests that lidocaine should not be used because of a possible tendency for delayed cephalad spread (1). However, this suggestion is not supported by case reports or investigations. A search of the literature failed to reveal articles describing delayed cephalad spread of lidocaine used for spinal anesthesia to the extent that respiration was impaired. We report such a case.