Lidocaine - IV

Question 1

What is the brand/trade name for lidocaine?

Answer 1

• Xylocaine

UpToDate - Lidocaine: Drug Information

Question 2

What is the pharmacologic category/class of lidocaine?

Answer 2

• Class Ib Antiarrhythmic agent
• Local Anesthetic (Amide)

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1

Nagelhout (7th ed.), p. 122 - Fig. 10.7

UpToDate - Lidocaine: Drug Information

Question 3

What is the mechanism of action of lidocaine?

Answer 3

Sodium channel blockade → prevents initiation and conduction of nerve impulses

• decreases SNS response to laryngoscopy/intubation
• suppresses automaticity of cardiac conduction tissue
• local anesthesia

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1

Apex Unit 5: Pharmacology 2; Local Anesthetics; Lesson 4. Mechanism of action

UpToDate - Lidocaine: Drug Information

Question 4

What is the adult dosing of lidocaine to prevent the SNS response to laryngoscopy/intubation?

Answer 4

• 1-1.5 mg/kg IV

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1

Dr. GooGoo

Stoelting’s Pharmacology (5th ed.), p. 483 - Fig. 19.6

Question 5

The antiarrhythmic dose of lidocaine is ____________; this is effective for which types of arrhythmias?

Answer 5

• 1-1.5 mg/kg IV;
  _{repeat doses of 0.5 mg/kg q 5-10 mins PRN}
• Lidocaine is effective for ventricular arrhythmias with the exception of those accompanied by bradycardia
  _{little to no effect on atrial tachyarrhythmias}

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1

UpToDate - Lidocaine: Drug Information

Stoelting’s Pharmacology (5th ed.), p. 523

Question 6

Lidocaine may be useful as a treatment to prevent stinging/burning from injection of propofol or etomidate - what is the dosing for this indication?

Answer 6

• 20-40 mg IV

_{should be administered PRIOR to irritating drugs in conjuction with venous occlusion (especially for hand veins)}

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1

Nagelhout (7th ed.), pp. 105, 108

Question 7

What is the onset of action for IV lidocaine?

Answer 7

• 45-90 seconds

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1

UpToDate - Lidocaine: Drug Information

Question 8

What is the duration of action for lidocaine following a single IV bolus dose?

Answer 8

• 10-20 minutes

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1

UpToDate - Lidocaine: Drug Information

Question 9

What organ(s) are responsible for lidocaine’s clearance (metabolism/elimination)?

Answer 9

• Metabolism: Liver (P450)
• Elimination: Kidneys

beware of active metabolites in liver or renal failure!

Half-life: ~1-2 hours

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1

UpToDate - Lidocaine: Drug Information

Question 10

When using IV lidocaine, administration should not exceed ___________/hr

Answer 10

300 mg

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1

UpToDate - Lidocaine: Drug Information

Question 11

BONUS

The mixture of lidocaine and propofol in the same syringe carries what risk that warrants precaution?

Answer 11

• Pulmonary embolism

the formation of fat globules/oil droplets may occlude microvasculature

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1

Stoelting’s Pharmacology (5th ed.), p. 160