Lidocaine Flashcards
Lidocaine Name
Lidocaine HCl
Lidocaine Class
Antiarrythmic, local anesthetic
Lidocaine MOA
Decreases automaticity by slowing the rate of spontaneous phase 4 depolarization. Terminates re-entry by decreasing conduction in re-entrant pathways (by slowing conduction in ischemic tissue, equalizes conduction speed among fibers). Increases ventricular fibrillation threshold.
Lidocaine Indications and Field Use
- Suppression of ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation, PVC’s).
- Prophylaxis against recurrence after conversion from ventricular tachycardia or ventricular fibrillation.
- Pain management after IO insertion in conscious patients.
Lidocaine Contraindications
• Known hypersensitivity/allergy.
• Use extreme caution in patients with conduction disturbance (second or third degree
block).
• Do not treat ectopic beats if heart rate is < 60. They are probably compensating for the
bradycardia; instead, treat the bradycardia.
Lidocaine Adverse Reactions
CV: May also cause SA nodal depression or conduction problems and hypotension in large doses, or if given too rapidly. Excessive doses in pediatric patient may produce myocardial and circulatory depression.
CNS: In large doses drowsiness, disorientation, paresthesias, decreased hearing acuity, muscle twitching, agitation, focal or generalized seizures.
Lidocaine Incompatibilities/Drug Interactions
None known
Lidocaine Adult Dosage
Pulseless VF/VT: Initial bolus of 1.0-1.5 mg/kg IV PUSH every 3-5 minutes to a total of 3 mg/kg. An initial bolus of 1.5 mg/kg should be given for cardiac arrest situations. Following the return of a spontaneous rhythm, initiate a drip at 2-4 mg/min. See: Maintenance Infusion below.
Antidysrhythmic or rhythms with a pulse: Initial boluses can be given as 0.5-0.75 mg/kg, up to 1.0-1.5 mg/kg, IV PUSH and additional boluses can be given as 0.5-0.75 mg/kg every 5-10 minutes to a total dose of 3 mg/kg. Following the return of a spontaneous rhythm, initiate a drip at 2-4 mg/min; see below.
Maintenance Infusion: Started after return of spontaneous rhythm for either indication above. Add 1 gm - 2 gms to a 250 ml NS or 5 % dextrose solution or use premixed solution (2 gm in 500 ml) and initiate a drip at 2-4 mg/min according to concentration. Patients > 70 years or with hepatic, renal disease or poor perfusion state, reduce maintenance infusion by half.
IO pain management 20-40 mg, very slow IO push.
Lidocaine Pediatric Dosage
Initial Bolus doses: 1 mg/kg, may repeat 1 time in 3-5 minutes for VF/Pulseless VT or in 15 minutes if used for refractory dysrhythmias with a pulse (VT with pulse, significant ventricular ectopy).
Infusion with return of spontaneous rhythm, optional: 20-50 mcg/kg/min; prepared by adding 120 mg (3mL) of 1 Gm/25 ml (40 mg/ml) solution to 97 ml of NS, yielding 1200 mcg/ml.
1 ml/kg/hr delivers 20 mcg/kg/min. 2.5 ml/kg/hr delivers 50 mcg/kg/min. Reduce to < 20 mcg/kg/min for children with low cardiac output, severe CHF or compromised hepatic blood flow. Infusion should be avoided unless infusion pump available.
IO pain management, 0.1 mg/kg, not to exceed adult dosage.
Lidocaine Routes
IV bolus, followed by IV infusion. IO. ET
Lidocaine Onset
1-5 minutes
Lidocaine Peak Effects
5-10 minutes
Lidocaine Duration
Bolus only - 20 minutes
Lidocaine AZ Drug Box Minimum
3 pre-filled syringes, total 300 mg
1 g vial or premixed infusion, total 2 g