All about Lidocaine! Flashcards
What year was Lidocaine discovered?
1943
Who discovered Lidocaine?
Nils Lofgren
What list is lidocaine on?
the World Health Organization’s list of essential medications
What class is lidocaine in?
Amide local anesthetics
Is lidocaine an acid or a base?
weak base
What is the pKa of lidocaine?
slightly above physiologic pH
7.9
Is lidocaine fast or slow?
fast d/t less ionized drug at physiologic pH
Is lidocaine long or short acting?
short (fairly) 90-120min
What is the protein binding of lidocaine?
64-70%
Where is lidocaine metabolized?
in the liver
- it is an amide local anesthetic
What is the % of ionized lidocaine at physiologic pH?
76%
What is the duration of action of lidocaine?
90-120min
What formulation of lidocaine is used to “test dose”? and where is this test dose injected?
Lidocaine 1.5% with 1:200,000 epi
2cc into the spinal or epidural needle/catheter
What formulations of Lidocaine are available?
5 pure
2 with epi
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%
Lidocaine 1% is what concentration of medication?
10mg/mL
Lidocaine 2% is what concentration of medication?
20mg/mL
Lidocaine 0.5% is what concentration of medication?
5mg/mL
Lidocaine 4% is what concentration of medication?
40mg/mL
Lidocaine 5% is what concentration of medication?
50mg/mL
What is the maximum dose of lidocaine?
4mg/kg without epi
7mg/kg with epi
What is the maximum dose of lidocaine with epi?
7mg/kg
What are the 6 ways lidocaine can be administered/used?
- antiarrhythmic
- topical
- induction
- nebulized
- multimodal pain management
- regional anesthetic
How does lidocaine work as an antiarrhythmic?
Hint: what does it depress?
depresses myocardial automaticity
What class of antiarrhythmic agent is lidocaine?
Class 1b
In treatment of VF/VT what is the initial dosage of IV/IO lidocaine?
1-1.5mg/kg
When treating refractory VF/VT after initial dose of lidocaine, what are subsequent doses?
0.5-0.75mg/kg
What is the total max dose of IV/IO lidocaine when used as an antiarrhythmic (VF/VT)
3mg/kg
What is the maintenance infusion dose of lidocaine?
in mg/min & mcg/kg/min
1-4mg/min (30-50mcg/kg/min)
What is EMLA cream?
1:1 Lidocaine:Procaine
What are the 4 patients or locations EMLA is contraindicated in?
- open skin
- mucous membrane
- infants <1 month
- Hx methemoglobinemia
What are the 3 reasons lidocaine is administered during induction of anesthesia?
- decrease pain of propofol
- attenuate CV response to intubation (SNS response)
- attenuate any ↑ICP
Is lidocaine dosed on TBW or IBW?
IBW
How can lidocaine be administered to block pain of propofol injection?
tourniquet on the arm
give lidocaine
wait 60 seconds
remove tourniquet
What is the administration dose/onset of lidocaine for attenuation of the SNS response to DL?
1-1.5mg/kg 1-3 min prior to DL
What 2 pressures are effected by IV lidocaine administration pre-induction?
- hypertension
2. increased ICP
When used via ETT cuff, how is lidocaine administered/process/onset?
- use manometer & air to inflate cuff to 15-20mmHg
- remove air and note volume
- 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
What % lidocaine is used in nebulized airway block?
4%
What % lidocaine is used in a trans-tracheal block?
4%
When used in multimodal analgesia, what are the bolus and infusion does of lidocaine?
bolus: 1.5mg/kg
infusion: 2mg/kg/hr
What are the 2 possible target MOA of lidocaine as an analgesic?
- sodium channels
- blockage of the priming of polymorphonuclear granulocytes
What 3 drugs, used as part of a multimodal analgesia approach can cause ↓BP?
Mg/Lido/General anesthesia
How are exparel and lidocaine mixed?
THEY ARE NOT!!!
