Lidocaine HCL

Question 1

What is the trade names for lidocaine HCL?

Answer 1

Xylocaine; Synera (lidocaine / tetracaine)

Question 2

What is the drug classification for lidocaine HCL?

Answer 2

Anesthetic, antiarrhythmic (class IBVW)

Question 3

How is lidocaine HCL supplied?

Answer 3

Preload 100mg/5 ml (20mg/ml); 2% for injection

Some may also have epinephrine added

Question 4

Describe the pharmacodynamics of lidocaine HCL when used as a ventricular antiarrhythmic.

Answer 4

Suppresses automaticity of conduction tissue by increasing the electrical stimulation threshold of the ventricle and the His Purkinje system to prevent spontaneous depolarization of the ventricles during diastole.

Question 5

What are the indications for use of lidocaine HCL?

Answer 5

• Amiodarone alternative in cardiac arrest from VF/pVT
• Stable monomorphic VT with preserved ventricular function
• Stable polymorphic VT with normal baseline QT interval and preserved LV function when ischemia is treated and electrolyte balance is corrected
• Can be used for stable polymorphic VT with baseline QT-interval prolongation if torsade is suspected
• Procedural anesthetic
• IO infusion pain

Question 6

What is the dosing for lidocaine when used in cardiac arrest from VF / pVT?

Answer 6

Initial dose: 1 - 1.5 mg/kg IVP

If refractory VF may give additional 0.5 to 0.75 mg/kg IVP, repeat in 5 to 10 minutes; maximum 3 doses or total of 3 mg/kg

Pediatric- 1mg/kg IV/IO, q 5 minutes

Question 7

What is the dosing of lidocaine when treating a perfusing arrhythmia (VT/Torsades)?

Answer 7

Adult - 0.5 to 1 mg/kg SIVP, repeat in 5 to 10 minutes; maximum total of 3 mg/kg

Pediatric - 1mg/kg IV/IO, q 5 minutes

Question 8

What is the dose for lidocaine when used for local anesthesia (tetracaine)?

Answer 8

Adult/Pediatric - 1 to 2 drops of 0.5% solution (single dose); apply to affected areas as needed, local anesthetic dosage varies with procedure, degree of anesthesia, vascularity and duration

Question 9

What is the dosage of lidocaine for IO infusion pain?

Answer 9

20 - 40mg slow push (in 0.2mL increments) of preservative-free lidocaine 2%. Toxic dose is 3mg/kg.

Pediatric - 0.5mg/kg IO to a total maximum of 40 mg (2ml) delivered over 2 minutes

Question 10

What are the contraindications for lidocaine HCL?

Answer 10

• Hypersensitivity to lidocaine or amide-type local anesthetics
• Do NOT use prophylactically in AMI
• Do NOT use for Idioventricular rhythms

Question 11

What are some precautions to consider with lidocaine administration?

Answer 11

Hepatic disease, marked hypoxia, severe respirator depression, hypovolemia, incomplete heart, Hx of malignant hyperthermia, shock, elderly, heart Failure

Question 12

List the signs of lidocaine toxicity

Answer 12

Drowsiness; disorientation; seizures; cardiovascular depression; bradycardia; hypotension; heart block; cardiovascular collapse. If toxic effects develop, the drug should be stopped

Question 13

Describe the mechanism of action (pharmacodynamics) for lidocaine HCL when used as a local anesthetic.

Answer 13

Acts to block initiation and conduction of nerve impulses by decreasing the permeability of the nerve cell membrane to sodium ions.

Question 14

How would you set up a lidocaine maintenance infusion for a perfusing arrhythmia (VT/Torsade). Dose?

Answer 14

Mix 1 gm in 250 ml NS (concentration 4 mg/ml)

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

Pediatric - Infusion 20 to 50mcg/kg/min IV/IO (repeat bolus dose if infusion initiated > 15 minutes after initial bolus).