Disappearance of wheezing during epidural lidocaine anesthesia in a patient with bronchial asthma

Background and Objectives. Local anesthetics in blood absorbed from the epi dural space attenuate bronchial hyperreactivity to chemical stimuli. Howeve r, it is not documented whether local anesthetics at clinically relevant co ncentrations improve active wheezing in patients with bronchial asthma. Cas e report. We managed a 60-year-old man with bronchial asthma and active whe ezing under continuous epidural anesthesia using plain lidocaine. The wheez ing gradually diminished 20 minutes after the epidural injection of 13 mt 2 % lidocaine and completely disappeared over 155 minutes during continuous e pidural injection of 2% lidocaine (6 mL/h). The plasma concentrations of li docaine in arterial blood during the epidural anesthesia ranged from 2.5 to 3.9 mu g/mL. Wheezing reappeared 55 minutes after termination of the conti nuous epidural injection of lidocaine. The plasma concentration of lidocain e at this time was 1.9 mu g/mL. Conclusions. At clinically relevant concent rations, lidocaine in the blood absorbed from the epidural space may improv e bronchospasm in patients with bronchial asthma.