I went over to GI the other day to do an EGD and a colonoscopy on a patient. Patient was healthy (in her 50s), mild asthma, no meds besides inhaler. 75kg - strong family history of colon CA and she has motility issues so she gets scoped regularly. Anesthesia officially requested for "severe anxiety."

EGD first. Patients states that she does not like being awake when the bite block goes in. The GI doc does not give any local (hurricane spray or lido swish and spit).

So, I push 100mg of lido and within 20 or 30 seconds the patient complains of loud ringing in the ears - "I've never felt this before." GI doc and the nurse look like they are about to freak about. Patient looks stunned. I quickly push 70mg of prop and she drifts off to sleep. No issues with sedation and she wakes up fine at the end of the procedure (about 30minutes later).

What do you guys think? I love giving lido and use it quite a bit for both MAC and GI cases, so this was alarming to me (signs of toxicity at what should have been a very safe dose).