Lidocaine

Question 1

Lidocaine (xylocaine)

Class

Answer 1

• Antiarrhythmic

Question 2

Lidocaine (xylocaine)

MOA

Answer 2

• Decrease automaticity by slowing the rate of phase 4 depolarization

Question 3

Lidocaine (xylocaine)

Indications

Answer 3

• Alternative to amiodarone in cardiac arrest, from:
  
  • VF
  • Pulseless VT
  • Stable monomorphic VT
  • Stable polymorphic VT with normal baseline QTi

Question 4

Lidocaine (xylocaine)

Contraindications

Answer 4

• Hypersensitivity
• 2nd & 3rd deg AV block in absence of artificial pacemaker
• Stokes-Adams syndrome
• Prophylactic use in AMI
• Wide-complex vent escape beats with bradycardia

Question 5

Lidocaine (xylocaine)

Adverse reactions

Answer 5

• SZ (with high doses)
• Altered mental status
• Confusion
• Slurred speech
• Light-headedness
• Blurred vision
• Bradycardia

Question 6

Lidocaine (xylocaine)

Drug Interactions

Answer 6

• Apnea induced with succinylcholine may be prolonged with high doses of lidocaine
• Cardiac depression may occur in conjunction with IV phenytoin (Dilantin)
• Procainamide exacerbates CNS effects
• Metabolic clearance is decreased in pts with liver disease or taking beta-blockers

Question 7

Lidocaine (xylocaine)

Adult Dosage

Answer 7

• Cardiac arrest from VF/pulseless VT;
  
  • Initial dose 1 - 1.5 mg/kg IV
    
    • Repeat dose in 5 - 10 min at 0.5 - 0.75 mg/kg
    • Max of 3 mg/kg
• Stable VT, Wide Complex Tach of uncertain type, significant ectopy:
  
  • From 0.5 - 0.75 mg/kg through 1 - 1.5mg/kg
    
    • Repeat 0.5 - 0.75mg/kg q 5-10min
    • Max of 3 mg/kg
• Maint. infuse: 1-4 mg/min (30-50 µg/kg/min) diluted

Question 8

Lidocaine (xylocaine)

Ped Dosage

Answer 8

Ped:

• Bolus dose:
  
  • 1mg/kg rapid IV push
  • Max 100mg
• Continuous infusion:
  
  • 20-50 µg/kg/min
  • Administer bolus dose when infusion initiated if bolus has not been given within previous 15 min

Question 9

Lidocaine (xylocaine)

Duration

Answer 9

• Onset: 1-3 min
• Peak: 5-10 min
• Duration: varies (15min - 2hrs)

Question 10

Lidocaine (xylocaine)

Special Considerations

Answer 10

• Preg Cat: B
• Reduce maintenance infusion by 50% if pt over 70 yo, has liver or renal disease, or is in CHF or shock
• A 75-100mg bolus maintains blood levels for only 20 min
• Exceedingly high levels can result in coma/death
• Not for reperfusion arrhythmias after fibrinolytic therapy
• Cross-reactivity with other forms of local anesthetics