Case Report

A 60-year-old woman with invasive squamous cell carcinoma of the cervix underwent cold knife conization and endocervical curettage under general anesthesia with a laryngeal mask airway. The procedure was completed uneventfully with minimal blood loss. The patient was subsequently brought to the recovery room in good condition, alert and oriented. Post-operatively she complained of a sore throat. A verbal order was placed for lidocaine solution to be gargled. The recovery room nurse gave a 50 mL bottle of 4% lidocaine to the patient who promptly swallowed it all. Approximately 40 minutes later, the nurse called to inform the anesthesia team of this event. At this point, the patient was being prepared for discharge home and monitors had been removed. The patient was immediately evaluated and found to be drowsy with GCS 11 (E3V3M5). Monitors were reconnected and showed sinus tachycardia, but the patient was otherwise hemodynamically stable. Her mental status then altered relatively quickly; she became hyperactive, agitated, and combative. Intralipid 20% was rapidly bolused and midazolam 2 mg was administered for sedation while additional IV access was obtained. The patient’s agitation gradually resolved with return to baseline mental status over the next 3 hours. The patient’s family and surgical team were informed and the patient was admitted for overnight observation on telemetry. No further symptoms or complications were noted. Toxicology was consulted and the patient was cleared for discharge on postoperative day 1.