Lidocaine
Anesthetic
Precautions
- For wounds, may use HCO3 (1cc to 10cc Lido) to decr pain
- inject through wound edges NOT intact skin
Maximum Doses of Anesthetic Agents
Agent | Without Epinephrine | With Epinephrine | Duration | Notes |
Lidocaine | 5 mg/kg (max 300mg) | 7 mg/kg (max 500mg) | 30-90 min |
|
Mepivicaine | 7 mg/kg | 8 mg/kg | ||
Bupivicaine | 2.5 mg/kg (max 175mg) | 3 mg/kg (max 225mg) | 6-8 hr |
|
Ropivacaine | 3 mg/kg | |||
Prilocaine | 6 mg/kg | |||
Tetracaine | 1 mg/kg | 1.5 mg/kg | 3hrs (10hrs with epi) | |
Procaine | 7 mg/kg | 10 mg/kg | 30min (90min with epi) |
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
See Also
Toxicity
Diagnosis
Symptoms:
- CV
- (brady/arrest)
- Tx w/ epi per ACLS
- (brady/arrest)
- CNS
- lightheaded, ringing in ears
- Seizure
- Abrupt change in MS, drowsiness, confusion
See Also: Local Anesthetic Systemic Toxicity (LAST)