All about Lidocaine!

Question 1

What year was Lidocaine discovered?

Answer 1

1943

Question 2

Who discovered Lidocaine?

Answer 2

Nils Lofgren

Question 3

What list is lidocaine on?

Answer 3

the World Health Organization’s list of essential medications

Question 4

What class is lidocaine in?

Answer 4

Amide local anesthetics

Question 5

Is lidocaine an acid or a base?

Answer 5

weak base

Question 6

What is the pKa of lidocaine?

Answer 6

slightly above physiologic pH

7.9

Question 7

Is lidocaine fast or slow?

Answer 7

fast d/t less ionized drug at physiologic pH

Question 8

Is lidocaine long or short acting?

Answer 8

short (fairly) 90-120min

Question 9

What is the protein binding of lidocaine?

Answer 9

64-70%

Question 10

Where is lidocaine metabolized?

Answer 10

in the liver

- it is an amide local anesthetic

Question 11

What is the % of ionized lidocaine at physiologic pH?

Answer 11

76%

Question 12

What is the duration of action of lidocaine?

Answer 12

90-120min

Question 13

What formulation of lidocaine is used to “test dose”? and where is this test dose injected?

Answer 13

Lidocaine 1.5% with 1:200,000 epi

2cc into the spinal or epidural needle/catheter

Question 14

What formulations of Lidocaine are available?
5 pure
2 with epi

Answer 14

Lidocaine 0.5%
Lidocaine 1%
Lidocaine 1.5% with 1:100,000 epi
Lidocaine 1.5% with 1:200,000 epi
Lidocaine 2%
Lidocaine 4%
Lidocaine 5%

Question 15

Lidocaine 1% is what concentration of medication?

Answer 15

10mg/mL

Question 16

Lidocaine 2% is what concentration of medication?

Answer 16

20mg/mL

Question 17

Lidocaine 0.5% is what concentration of medication?

Answer 17

5mg/mL

Question 18

Lidocaine 4% is what concentration of medication?

Answer 18

40mg/mL

Question 19

Lidocaine 5% is what concentration of medication?

Answer 19

50mg/mL

Question 20

What is the maximum dose of lidocaine?

Answer 20

4mg/kg without epi

7mg/kg with epi

Question 21

What is the maximum dose of lidocaine with epi?

Answer 21

7mg/kg

Question 22

What are the 6 ways lidocaine can be administered/used?

Answer 22

1. antiarrhythmic
2. topical
3. induction
4. nebulized
5. multimodal pain management
6. regional anesthetic

Question 23

How does lidocaine work as an antiarrhythmic?

Hint: what does it depress?

Answer 23

depresses myocardial automaticity

Question 24

What class of antiarrhythmic agent is lidocaine?

Answer 24

Class 1b

Question 25

In treatment of VF/VT what is the initial dosage of IV/IO lidocaine?

Answer 25

1-1.5mg/kg

Question 26

When treating refractory VF/VT after initial dose of lidocaine, what are subsequent doses?

Answer 26

0.5-0.75mg/kg

Question 27

What is the total max dose of IV/IO lidocaine when used as an antiarrhythmic (VF/VT)

Answer 27

3mg/kg

Question 28

What is the maintenance infusion dose of lidocaine? | in mg/min & mcg/kg/min

Answer 28

1-4mg/min (30-50mcg/kg/min)

Question 29

What is EMLA cream?

Answer 29

1:1 Lidocaine:Procaine

Question 30

What are the 4 patients or locations EMLA is contraindicated in?

Answer 30

1. open skin 2. mucous membrane 3. infants <1 month 4. Hx methemoglobinemia

Question 31

What are the 3 reasons lidocaine is administered during induction of anesthesia?

Answer 31

1. decrease pain of propofol 2. attenuate CV response to intubation (SNS response) 3. attenuate any ↑ICP

Question 32

Is lidocaine dosed on TBW or IBW?

Answer 32

IBW

Question 33

How can lidocaine be administered to block pain of propofol injection?

Answer 33

tourniquet on the arm give lidocaine wait 60 seconds remove tourniquet

Question 34

What is the administration dose/onset of lidocaine for attenuation of the SNS response to DL?

Answer 34

1-1.5mg/kg 1-3 min prior to DL

Question 35

What 2 pressures are effected by IV lidocaine administration pre-induction?

Answer 35

1. hypertension | 2. increased ICP

Question 36

When used via ETT cuff, how is lidocaine administered/process/onset?

Answer 36

1. use manometer & air to inflate cuff to 15-20mmHg 2. remove air and note volume 3. alkalized lidocaine Low dose 40mg Lido (2mL) 1-2mL sodium bicarb Use NS to get to target volume **needs at least 60 minutes to work

Question 37

What % lidocaine is used in nebulized airway block?

Answer 37

4%

Question 38

What % lidocaine is used in a trans-tracheal block?

Answer 38

4%

Question 39

When used in multimodal analgesia, what are the bolus and infusion does of lidocaine?

Answer 39

bolus: 1.5mg/kg infusion: 2mg/kg/hr

Question 40

What are the 2 possible target MOA of lidocaine as an analgesic?

Answer 40

- sodium channels | - blockage of the priming of polymorphonuclear granulocytes

Question 41

What 3 drugs, used as part of a multimodal analgesia approach can cause ↓BP?

Answer 41

Mg/Lido/General anesthesia

Question 42

How are exparel and lidocaine mixed?

Answer 42

THEY ARE NOT!!!