Type 1 antiarrhythmic: Decreases diastolic depolarization, decreasing automaticity of ventricular cells; increases ventricular fibrillation threshold.
· As antiarrhythmic: Management of acute ventricular arrhythmias during cardiac surgery and MI (IV use). Use IM when IV administration is not possible or when ECG monitoring is not available and the danger of ventricular arrhythmias is great (single-dose IM use, for example, by paramedics in a mobile coronary care unit)
· As anesthetic: Infiltration anesthesia, peripheral and sympathetic nerve blocks, central nerve blocks, spinal and caudal anesthesia, retrobulbar andtranstracheal injection; topical anesthetic for skin disorders and accessible mucous membranes
· Contraindicated with allergy to lidocaine or amide-type local anesthetics, CHF, cardiogenic shock, second- or third-degree heart block (if no artificial pacemaker), Wolff-Parkinson-White syndrome, Stokes-Adams syndrome.
· Use cautiously with hepatic or renal disease, inflammation or sepsis in the region of injection (local anesthetic), labor and delivery (epidural anesthesia may prolong the second stage of labor; monitor for fetal and neonatal CV and CNS toxicity), and lactation.
Direct injection—10, 20 mg/mL; IV injection (admixture) 40, 100, 200 mg/mL; IV infusion—2, 4, 8 mg/mL; topical liquid—2.5%, 5%; topical ointment—2.5%, 5%; topical cream—0.5%; topical gel—0.5%, 2.5%; topical spray—0.5%, 10%; topical solution—2%, 4%; topical jelly—2%; injection—0.5%, 1%, 1.5%, 2%, 4%, 5%; patch—varies
· Arrhythmia: Use only the 10% solution for IM injection. 300 mg in deltoid or thigh muscle. Switch to IV lidocaine or oral antiarrhythmic as soon as possible.
· Arrhythmia: Use only lidocaine injection labeled for IV use and without preservatives or catecholamines. Monitor ECG constantly. Give 50–100 mg at rate of 25–50 mg/min. One-third to one-half the initial dose may be given after 5 min if needed. Do not exceed 200–300 mg in 1 hr.
· Arrhythmia: Give 1–4 mg/min (or 20–50 mcg/kg/min). Titrate the dose down as soon as the cardiac rhythm stabilizes. Use lower doses in patients with CHF, liver disease, and in patients > 70 yr.
· Local anesthesia: Preparations containing preservatives should not be used for spinal or epidural anesthesia. Drug concentration and diluent should be appropriate to particular local anesthetic use: 5% solution with glucose is used for spinal anesthesia, 1.5% solution with dextrose for low spinal or "saddle block"; anesthesia. Dosage varies with the area to be anesthetized and the reason for the anesthesia; use the lowest dose possible to achieve results.
· Arrhythmia: Safety and efficacy have not been established. American Heart Association recommends bolus of 0.5–1 mg/kg IV, followed by 30 mcg/kg/min with caution. The IM auto-injector device is not recommended.
Preparation: Prepare solution for IV infusion as follows: 1–2 g lidocaine to 1 L 5% dextrose in water = 0.1%–0.2% solution; 1–2 mg lidocaine/mL. Stable for 24 hr after dilution.
Infusion: IV bolus: Give 50–100 mg at rate of 25–50 mg/min. An infusion rate of 1–4 mL/min of a 1 mg/mL solution will provide 1–4 mg lidocaine/min. Use only preparations of lidocaine specifically labeled for IV infusion.
· CNS: Dizziness or light-headedness, fatigue, drowsiness, unconsciousness, tremors, twitching, vision changes; may progress to seizures
· CNS: Headache, backache, septic meningitis, persistent sensory, motor, or autonomic deficit of lower spinal segments, sometimes with incomplete recovery
· Increased lidocaine levels with beta blockers (propranolol, metoprolol, nadolol, pindolol, atenolol), cimetidine, ranitidine
· History: Allergy to lidocaine or amide-type local anesthetics, CHF, cardiogenic shock, second- or third-degree heart block, Wolff-Parkinson-White syndrome, Stokes-Adams syndrome, hepatic or renal disease, inflammation or sepsis in region of injection, lactation, pregnancy
· Physical: T; skin color, rashes, lesions; orientation, speech, reflexes, sensation and movement (local anesthetic); P, BP, auscultation, continuous ECG monitoring during use as antiarrhythmic; edema; R, adventitious sounds; bowel sounds, liver evaluation; urine output; serum electrolytes, LFTs, renal function tests
· WARNING: Keep life-support equipment and vasopressors readily available in case severe adverse reaction (CNS, CV, or respiratory) occurs whenlidocaine is injected.
· WARNING: Establish safety precautions if CNS changes occur; have IV diazepam or short-acting barbiturate (thiopental, thiamylal) readily available in case of seizures.
· WARNING: Monitor for malignant hyperthermia (jaw muscle spasm, rigidity); have life-support equipment and IV dantrolene readily available.
· Reduce dosage when treating arrhythmias in CHF, digitalis toxicity with AV block, and geriatric patients.
· Monitor fluid load carefully; more concentrated solutions can be used to treat arrhythmias in patients on fluid restrictions.
· Have patients who have received lidocaine as a spinal anesthetic remain lying flat for 6–12 hr afterward, and ensure that they are adequately hydrated to minimize risk of headache.
· WARNING: Check lidocaine preparation carefully; epinephrine is added to solutions of lidocaine to retard the absorption of the local anesthetic from the injection site. Be sure that such solutions are used only to produce local anesthesia. These solutions should be injected cautiously in body areas supplied by end arteries and used cautiously in patients with peripheral vascular disease, hypertension, thyrotoxicosis, or diabetes.
· Use caution to prevent choking. Patient may have difficulty swallowing following use of oral topical anesthetic. Do not give food or drink for 1 hr after use of oral anesthetic.
· WARNING: Monitor for safe and effective serum drug concentrations (antiarrhythmic use: 1–5 mcg/mL). Doses > 6–10 mcg/mL are usually toxic.
· Oral lidocaine can cause numbness of the tongue, cheeks, and throat. Do not eat or drink for 1 hour after using oral lidocaine to prevent biting cheeks or tongue and choking.
· You may experience these side effects: Drowsiness, dizziness, numbness, double vision; nausea, vomiting; stinging, burning, local irritation (local anesthetic).
· Report difficulty speaking, thick tongue, numbness, tingling, difficulty breathing, pain or numbness at IV site, swelling, or pain at site of local anesthetic use.
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