Lidocaine

Aka: Lidocaine

1. Mechanism
   1. Suppresses ventricular arrhythmias
      1. Decreases automaticity
      2. Increases Ventricular Fibrillation threshold
         1. Requires high plasma Lidocaine levels (6 ug/ml)
   2. Suppresses ventricular ectopy
      1. Local Anesthetic effect
      2. Post Myocardial Infarction
         1. Routine prophylactic Lidocaine use not recommended
   3. Terminates reentrant ventricular arrhythmia
2. Indications
   1. Ventricular Fibrillation
   2. Ventricular Tachycardia (Wide Complex Tachycardia)
      1. Use Lidocaine only if unknown etiology
      2. Not indicated for drug induced arrhythmia
      3. Not indicated for metabolic induced arrhythmia
   3. Post-Resuscitation for ventricular arrhythmia
      1. Myocarditis
      2. Structural heart disease
3. Contraindications
   1. Wide-complex ventricular escape rhythm
   2. Associated with Bradycardia
4. Pediatric Dosing
   1. Dose: 1 mg/kg IV/IO/ET
5. Adult Dosing
   1. Ventricular Fibrillation
      1. Dose: 1.0-1.5 mg/kg IV push
      2. May repeat in 3-5 min to max dose 3 mg/kg
   2. Ventricular Tachycardia (with a pulse)
      1. First: 1.0-1.5 mg/kg IV push
      2. Next: 0.5-0.75 mg/kg IV push (max total 3 mg/kg)
6. Infusion Dosing (Pediatric and Adult)
   1. Lidocaine 120 mg in 100 ml D5W
      1. Precede infusion with 1 mg/kg bolus loading dose
      2. Then 20-50 ug/kg/min (1-2.5 ml/kg/h) Infusion
   2. If hepatic blood flow is compromised (e.g. CHF)
      1. Decrease dose to under 20 ug/kg/min
7. Adverse Effects
   1. Myocardial depression of conduction and contractility
      1. Concurrent Antiarrhythmic therapy
      2. Sick Sinus Syndrome
      3. Left Ventricular Dysfunction
   2. Circulatory depression
   3. Neurologic changes
      1. Drowsiness or disorientation
      2. Decreased hearing acuity
      3. Paresthesia and muscle twitching
      4. Seizures
   4. Overdosage
      1. Third degree AV Heart Block
      2. Altered AV conduction
      3. Sinus node automaticity depressed