Lidocaine HCI (Xylocaine)

Question 1

Classification

Answer 1

Antidysrhythmic, Class IB

Question 2

Mechanism of Action

Answer 2

• Blocks sodium channels
• Increases the recovery period after re-polarization
• Suppresses automaticity of the His-Purkinje system & ventricular depolarization

Question 3

Indications

Answer 3

• Ventricular arrythmias when amiodarone is not available
• Cardiac arrest from VF/VT
• Stable monomorphic VT with preserved ventricular function
• Stable polymorphic VT with normal baseline QT interval & preserved left ventricular function (when ischemia & electrolyte imbalance are treated)
• Stable polymorphic VT with baseline QT prolongation suggestive of torsades de pointes

Question 4

Contraindications

Answer 4

• AV block
• Bleeding
• Thrombocytopenia
• Known sensitivity to lidocaine, sulfite, or paraben

Question 5

Adverse Effects

Answer 5

• Toxicity (signs may include euphoria, apprehension, nervousness, anxiety)
• Seizures without warning
• Cardiac arrythmias
• Hypotension
• Cardiac arrest

Question 6

Administration

Answer 6

• Pulseless V-Tach and V-Fib
  
  • Adult IV/IO: 1-1.5 mg/kg, may repeat at half the original dose every 5-10 minutes to a max of 3 mg/kg. Maintenance dose of 1-4 mg/min
  • Peds IV/IO: 1 mg/kg (max 100 mg). Maintenance infusion is 20-50 mcg/kg/min
  • Peds ETT: 2-3 mg/kg ETT, followed by 5 mL flush of NSS
• Perfusing Ventricular Rythms:
  
  • Adult: 0.5-0.75 mg/kg IV/IO (up to 1-1.5 mg/kg). Repeat every 5-10 minutes to a max of 3 mg/kg. Maintenance infusion of 1-4 mg/min.
  • Pediatrics: 1 mg/kg IV/IO. May repeat every 5-10 minutes to a max of 3 mg/kg. Maintenance infusion of 20-50 mcg/kg/min.

Question 7

Special Considerations

Answer 7

• Use with caution in:
  
  • Bradycardia
  • Hypovolemia
  • Cardiogenic shock
  • Adams-Stokes syndrome
  • Wolff-Parkinson-White syndrome
• Half life is approximetaly 90 minutes