Lidocaine
Hydrochloride
Trade names: xylocaine ,Esracain
Class:
Local anesthesia anti arrhythmic
Pregnancy:
(Category B) Action:
• Type 1 antiarrhythmic: decreases
diastolic depolarization, decreasing automaticity of ventricular cells;
increases ventricular fibrillation threshold.
• Local anesthetic: blocks the
generation and conduction of action potentials in sensory nerves by reducing
sodium permeability, reducing height and rate of rise of the action potential,
increasing excitation threshold, and slowing conduction velocity.
Uses:
• 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 (singledose 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 and
transtracheal injection;
topical anesthetic
for skin disorders and accessible mucous membranes Dose:
by intravenous injection, in patients without gross
circulatory impairment, 100 mg as a bolus over a few
minutes (50 mg in lighter patients or those whose circulation is
severely impaired), followed immediately by infusion of 4 mg/minute for 30 minutes, 2 mg/minute for 2 hours, then 1 mg/minute;
reduce concentration further if infusion continued beyond 24 hours (ECG
monitoring and specialist advice for infusion)
N.B
Following
intravenous injection lidocaine has a short duration of action (lasting for
15–20 minutes). If an intravenous infusion is not immediately available the
initial intravenous injection of 50–100 mg can be repeated if necessary once or
twice at intervals of not less than 10 minutes Contraindications:
allergy to lidocaine or
amide-type local anesthetics, CHF, cardiogenic shock, second- or third-degree
heart block.
Side effects:
ý CNS: Dizziness/light-headedness,
fatigue, drowsiness, unconsciousness, tremors, twitching, vision changes; may
progress to seizures, convulsions
ý GI: Nausea, vomiting
ý CV: Cardiac arrhythmias, cardiac
arrest, vasodilatation, hypotension
ý Respiratory: Respiratory
depression and arrest
ý Hypersensitivity: Rash,
anaphylactoid reactions
ý Other: Malignant hyperthermia Nursing considerations:
Don’t add lidocain to blood transfusion
assembly.
Make certain that vials state “for cardiac
arrhythmias”.
Use 5% dextrose solution to prepare drug
(stable for 24 hours).
Assess for history of hypersensitivity. Use electronic infusion device to regulate the
infusion of the drug. Obtain B.P., Pulse, Resp. rate to use as
baseline data to evaluate response to treatment.
Drug should be given in a monitored
environment. Assess B.P. frequently during administration. Assess for respiratory depression.
If Adverse reactions occur, discontinue
infusion & prepare for emergency management.
