Lidocaine: Difference between revisions
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*[[Local Anesthetic Systemic Toxicity (LAST)]] | *[[Local Anesthetic Systemic Toxicity (LAST)]] | ||
=== | ===Systemic Toxicity=== | ||
*Rare during infiltration of local anesthetic | |||
*CNS toxicity | |||
**Metallic taste, tinnitus, tingling of lips, dizziness, anxiety, confusion, lethargy, loss of consciousness, seizures | |||
*Cardiovascular toxicity | |||
**Bradycardia, decreased myocardial contractility, atrioventricular block, vasodilation, ventricular arrhythmias, cardiac arrest | |||
==Pharmacology== | ==Pharmacology== | ||
Revision as of 01:37, 22 October 2018
See critical care quick reference for drug doses by weight.
General
- Type: Local anesthetics; Antiarrhythmics
- Dosage Forms:
- Common Trade Names:
Adult Dosing
Local Anesthetic
- Without epinepherine: 5mg/kg (max 300mg)
- With epinepherine: 7mg/kg (max 500mg)
Antiarrhythmic
- Loading dose = 1-1.5mg/kg
- Additional boluses of 0.5-0.75mg/kg q5-10min up to max of 3mg/kg
- If effective start infusion of 2mg/min
- Indications
- Treatment of ventricular arrhythmias and ectopy
- Considered 2nd-line to amiodarone for treatment of V-fib and pulseless v-tach
- Treatment of ventricular arrhythmias and ectopy
Pediatric Dosing
Local Anesthetic
- Without epinepherine: 5mg/kg (max 300mg)
- With epinepherine: 7mg/kg (max 500mg)
Antiarrhythmic
See critical care quick reference for drug doses by weight.
Special Populations
- Pregnancy Rating:
- Lactation:
- Renal Dosing
- Adult
- Pediatric
- Hepatic Dosing
- Adult
- Pediatric
Contraindications
- Allergy to class/drug
- High SA or AV block
Adverse Reactions
Serious
Systemic Toxicity
- Rare during infiltration of local anesthetic
- CNS toxicity
- Metallic taste, tinnitus, tingling of lips, dizziness, anxiety, confusion, lethargy, loss of consciousness, seizures
- Cardiovascular toxicity
- Bradycardia, decreased myocardial contractility, atrioventricular block, vasodilation, ventricular arrhythmias, cardiac arrest
Pharmacology
- Half-life:
- Onset of action = 45-90s
- Duration of action = 10-20min (antiarrythmic IV); 30-90 min (subcutaneous)
- Metabolism:
- Excretion:
- Mechanism of Action:
- Class Ib antiarrythmic
- 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
- Class Ib antiarrythmic
Comments
- For wounds, may use HCO3 (1cc to 10cc Lido) to decrease pain
- Inject through wound edges NOT intact skin