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Lidocaine HCL 2%
Trade Name
- Dalcaine
- Dilocaine
- Lidoject
- Octocain
- Xylocaine
- Xylocaine-MPF
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Lidocaine HCL 2%
Class
Antidysrhythmic
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Lidocaine HCL 2%
Mechanism of Action
Decreases automaticity by slowing the rate of spontaneous Phase 4 depolarization
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Lidocaine HCL 2%
Indications
- Suppression of ventricular dysrhythmias (VT, VF)
- Suppression of PVCs
- Prophylaxis against recurrence after conversion from VT, VF
- To ease pain pressure that is caused by fluid and/or medications that have been administered IO
- Prior to intubation of patients with a head injury to counter the rise of ICP (mechanism unknown)
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Lidocaine HCL 2%
Contraindications
- Second degree and third degree blocks in absence of artificial pacemaker.
- Hypotension
- Stokes Adams Syndrome
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Lidocaine HCL 2%
Adverse Reactions
- Slurred speech
- Seizures
- Altered mental status
- Confusion
- Lightheadedness
- Blurred vision
- Bradycardia
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Lidocaine HCL 2%
Drug Interactions
- Apnea induced with succinylcholine may be prolonged with high doses of Lidocaine
- Cardiac depression may occur in conjunction with IV Dilantin
- Procainamide may exacerbate the CNS effects
- Metabolic clearance decreased in patients with liver disease or those patients taking beta-blockers
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Lidocaine HCL 2%
How Supplied
- 100 mg in 5 ml solution prefilled syringes
- 1 and 2 gram additive syringes
- 100 mg in 5 ml solution ampules
- 1 and 2 gram vials in 30 ml of solution
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Lidocaine HCL 2%
Dosage and Administration
Adult
- Cardiac arrest VT/ VF: 1.5 mg / kg IV push; repeat q 3-5 minutes to maximum dose of 3 mg/kg.
- After conversion to NSR, begin drip at 2-4 mg / min (mix 1g in 250cc NS to create infusion)
- VT with pulse: 1-1.5 mg / kg IV Push; then 0.50-0.75 mg / kg q 5-10 min to max of 3 mg/kg Start drip at 2-4 mg/min ASAP
- PVCs with pulse: 0.5-1.5 mg/kg IV Push; additional boluses of 0.5-1.5 mg/kg q 5-10 min to max of 3 mg/kg. Start drip at 2-4 mg/ min ASAP
- VF prophylaxis: 0.5 mg/kg IV Push; additional boluses 0.5 mg/kg in 8-10 minutes up to 2mg/kg Start drip at 2-4 mg/min ASAP (mix 1g in 250cc NS to create infusion)
- IO Pain/Pressure Management: 20mg IO slow bolus wait 30 sec. then flush w/ 30cc NS
- Prior to Intubation (Head Trauma): 75-100 mg IV, IO
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Lidocaine HCL 2%
Dosage and Administration
Pediatric
- VF or Pulseless V-tach: 1 mg/kg IV / IO per dose.
- Infusion: 20-50 mcg/kg/min
- PVCs with pulse: 1 mg/kg IV / IO per dose.
- Infusion: 20-50 mcg/kg/min
- IO Pain/Pressure Management: .5mg/kg max 20mg IO slow bolus wait 30 sec. then flush w/ 30cc NS
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Lidocaine HCL 2%
Duration of Action
- Onset: 1-5 minutes
- Peak Effect: 5-10 minutes
- Duration: Variable. (15 min. -2 hours)
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Lidocaine HCL 2%
Special Considerations
- Pregnancy safety: Category B
- Lidocaine has been replaced by Amiodarone for issues surrounding Dysrythmias
- Reduce maintenance infusions by 50% if patient is over 70 years of age, has liver disease, or is in CHF or shock
- A 75-100 mg bolus maintains levels for only 20 minutes
- If bradycardia occurs with PVCs, always treat the bradycardia with atropine, Isoproterenol or both
- Exceedingly high doses of Lidocainecan result in coma or death
- Avoid Lidocaine for reperfusion dysrhythmias after thrombolytic therapy
- Cross-reactivity with other forms of local anesthetics
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