Lidocaine HCL

Question 1

Generic Name:

Answer 1

Lidocane HCL

Question 2

Trade Name:

Answer 2

Xylocaine

Question 3

Supplied:

Answer 3

100mg/5mL of 2% solution pre-filled syringe

Question 4

Class:

Answer 4

Antiarrhythmic, local anesthetic

Question 5

Mechanism of Action:

Answer 5

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.

Question 6

Indications and Field Use:

Answer 6

• 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

Question 7

Contraindications:

Answer 7

• 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.

Question 8

Adverse Reactions:

Answer 8

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.

Question 9

Incompatibilities/Drug Interactions:

Answer 9

None known

Question 10

Adult Dosage: Pulseless VF/VT:

Answer 10

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.

Question 11

Adult Dosage: Antidysrhythmic or rhythms with a pulse:

Answer 11

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.

Question 12

Adult Dosage: Maintenance Infusion:

Answer 12

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.

Question 13

Adult Dosage: IO pain management:

Answer 13

20-40mg, very slow IO push

Question 14

Pediatric Dosage: Initial Bolus Doses:

Answer 14

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).

Question 15

Pediatric Dosage: Infusion with return of spontaneous rhythm, optional:

Answer 15

• 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.

Question 16

Pediatric Dosage: IO pain management:

Answer 16

0.1 mg/kg, not to exceed adult dosage.

Question 17

Routes of Administration:

Answer 17

• IV bolus, followed by IV infusion
• May be given ET if IV access is delayed
• IO

Question 18

Onset of Action:

Answer 18

1 to 5 minutes

Question 19

Peak Effects:

Answer 19

5 to 10 minutes

Question 20

Duration of Action:

Answer 20

Bolus only - 20 minutes

Question 21

Arizona Drug Box Minimum Supply:

Answer 21

• 3 pre-filled syringes, total 300 mg

- 1g vial or premixed infusion, total 2g

Question 22

Special Notes:

Answer 22

- Decrease maintenance infusion by 50% in cases of congestive heart failure, shock, liver disease.
- Cross-allergenicity between local anesthetic “caine” drugs is controversial.
- Consider increased dose for ET administration.
- Infusions: Infusion pump is required for interfacility transports. A minimum of microdrip tubing is required for field use. Lidocaine drip rates established in field should be monitored carefully.