• Braden Waters, Ryan R Kroll, John Muscedere, Lysa Boissé Lomax, and Jessica E Burjorjee.
• From the *Department of Critical Care Medicine, McMaster University, Hamilton, Ontario, Canada; †Department of Internal Medicine, ‡Department of Critical Care Medicine, §Department of Medicine, Division of Neurology, and Division of Respirology, and ‖Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
• A A Case Rep. 2017 Nov 15; 9 (10): 277-279.

AbstractIatrogenic cranial nerve palsies can rarely complicate neurosurgical, oral maxillofacial, and otolaryngological procedures. Among the most serious complications of cranial nerve palsy is upper airway obstruction, which is life threatening. We present a case of multiple cranial nerve palsies evolving rapidly in a rostrocaudal stepwise fashion after infiltration of lidocaine to repair a cerebrospinal fluid leak in a patient postoccipital craniectomy. This led to hypoxic respiratory failure requiring mechanical ventilation before resolving spontaneously. This is the first known case of accidental brainstem anesthesia secondary to lidocaine infiltration at an occipital craniectomy site and serves to caution clinicians who manage similar patients.

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