Lidocaine

Anesthetic

Precautions

• For wounds, may use HCO3 (1cc to 10cc Lido) to decr pain
• inject through wound edges NOT intact skin

Theraputic Doses

MAX DOSE (mg/kg)

Agent	With Epi	Without Epi
Lidocaine	7	3-5
Mevipicaine	8	7
Bupivicaine	3	1.5

Antiarrhythmic

Adult Dosing

• Loading dose = 1-1.5 mg/kg
  • Additional boluses of 0.5-0.75 mg/kg q5-10min up to max of 3mg/kg
  • If effective start infusion of 2mg/min

Contraindications

• High SA or AV block

Indications

• Treatment of ventricular arrhythmias and ectopy
  • Considered 2nd-line to amiodarone for tx of V-fib and pulseless v-tach

Mechanism of Action

• Class Ib
  • Binds to fast Na channels in inactive state thereby inhibiting recovery after repolarization
  • Acts preferentially on ischemic tissue
    • Elevates V-fib threshold
    • Suppresses ventricular ectopy
• Little effect on vascular tone, contractility or cardiac output

Kinetics

• Onset of action = 45-90s
• Duration of action = 10-20min

Toxicity

Diagnosis

Symptoms:

1. CV
   1. (brady/arrest)
      1. Tx w/ epi per ACLS
2. CNS
   1. lightheaded, ringing in ears
   2. Seizure
   3. Abrupt change in MS, drowsiness, confusion

See Also: Local Anesthetic Systemic Toxicity (LAST)

See Also

• Antiarrhythmics
• Incision and Drainage