lidocaine (Xylocaine®)
Antidysrhythmic (Class I-B)
Suppresses automaticity in His-Purkinje system and by elevating electrical stimulation (fibrillation) threshold of ventricles during diastole. This occurs by blocking fast sodium channels and depressing pathogenic phase 4 diastolic depolarization.
30-90 seconds
2-4 hours
VF/VT
Wide-complex tachycardia of unknown origin
Significant ventricular ectopy in the setting of myocardial ischemia/infarction
Premedication prior to RSI in patients with closed head injury.
Hypersensitivity to other amide type anesthetics (NOT ester anesthetics like Novacain®)
Stokes-Adams syndrome
Second or Third degree AV Block without an artificial pacemaker
Lightheadedness
Confusion
CNS depression
Muscle twitching
Seizures
Blurred Vision
Hypotension
Cardiovascular collapse
Bradycardia
Metabolic clearance of lidocaine may be decreased in patients taking beta adrenergic blockers in patients with decreased cardiac output or liver dysfunction.
Apnea induced with succinycholine may be prolonged with large doses of lidocaine.
Cardiac depression may occur if lidocaine is given concomitantly with IV phenytoin.
Prefilled: 100 mg in 5 ml, 1 and 2 g additive syringes
Ampules: 100 mg in 5 ml, 1 and 2 g vials in 30 ml of solution. 5ml containing 100 mg/ml
IV: 1 - 1.5 mg/kg, repeat in 3 - 5 minutes to a max of 3 mg/kg.
ET: 2 - 3 mg/kg single bolus.
Maintenance infusion: 2-3 mg/min
IV/IO: 1 mg/kg, repeat in 3 -5 minutes to a max of 3 mg/kg
Maintenance infusion: 10 - 50 mcg/kg/min
Pregnancy Safety: Category B
A 75-100 mg bolus will maintain adequate blood levels for only 20 minutes.
If bradycardia occurs in conjunction with PVCs, always treat the bradycardia first.
Exceedingly high doses of lidocaine can result in coma or death.
Decrease infusion dose in the elderly and those with liver or renal dysfunction.
Avoid lidocaine for reperfusion dysrhythmias following thrombolytic therapy.