Intravenous lidocaine as a possible cause of ventricular standstill during induction of anesthesia: A case report

Lidocaine is a widely used drug in anesthesiology and is commonly administered as an adjunct during intravenous propofol induction to mitigate the pain of propofol injection. We report an unusual case of a healthy male in his twenties who sustained two separate episodes of ventricular standstill (VS) while undergoing general anesthesia for uncomplicated procedures performed two years apart. On both occasions, VS occurred shortly after administering low-dose intravenous lidocaine (less than 0.5 mg/kg) given immediately prior to the injection of intravenous propofol. The events occurred prior to laryngoscopy and lasted approximately ten seconds before spontaneous recovery. Comprehensive cardiology evaluation, including electrocardiography, transthoracic echocardiogram, Holter monitoring, and cardiac magnetic resonance imaging revealed no underlying structural or conduction abnormalities. Alternative causes, including vagally mediated mechanisms, other anesthetic agents, liver derangements, acid-base and electrolyte disturbances were considered but deemed less likely. The temporal association between administration of intravenous lidocaine and the occurrence of VS suggests a possible increased sensitivity to lidocaine. This case highlights a rare but potentially life-threatening conduction abnormality associated with intravenous lidocaine and underscores the importance of vigilance and individualized risk assessment prior to anesthesia induction.