Lidocaine Hydrochloride

dr.joan

Lidocaine Hydrochloride:
Trade names: xylocaine ,Esracain

Class: Local anesthesia anti arrhythmic

Pregnancy: (Category

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 (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 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:
CNS: Dizziness/light-headedness, fatigue, drowsiness, unconsciousness, tremors, twitching, vision changes; may progress to seizures, convulsions
GI: Nausea, vomiting
CV: Cardiac arrhythmias, cardiac arrest, vasodilatation, hypotension
Respiratory: Respiratory depression and arrest
Hypersensitivity: Rash, anaphylactoid reactions
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.