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Lidocaine

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  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

Lidocaine (C0023660)

Definition (MSH)A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine.
Definition (CSP)drug having anesthetic, sedative, analgesic, anticonvulsant and cardiac depressant activities, used as a local anesthetic; applied topically to the skin and mucous membranes.
Definition (PDQ)A synthetic aminoethylamide with local anesthetic and antiarrhythmic properties. Lidocaine stabilizes the neuronal membrane by binding to and inhibiting voltage-gated sodium channels, thereby inhibiting the ionic fluxes required for the initiation and conduction of impulses and effecting local anesthesia. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39607&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39607&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C614" NCI Thesaurus)
Definition (NCI)A synthetic aminoethylamide with local anesthetic and antiarrhythmic properties. Lidocaine stabilizes the neuronal membrane by binding to and inhibiting voltage-gated sodium channels, thereby inhibiting the ionic fluxes required for the initiation and conduction of impulses and effecting local anesthesia.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD008012
English2 2EtN 2MePhAcN, 2-2EtN-2MePhAcN, Lidocaine, LIDOCAINE PREPARATION, Lignocaine
Spanishlidocaina, lignocaina
Parent ConceptsAcetaminophen (C0000970), Local Anesthetics (C0002934), phenylamide (C0597215), Acetanilides (C0000974), Anesthetics (C0002932), [DE700] LOCAL ANESTHETICS, TOPICAL (C0973528), [NT300] ANESTHETICS, MUCOSAL (C0973582), Class Ib antiarrhythmic drug (C0304504), Amide type local anesthetic (C0360090), Dermatological Anesthetics (C1579272), Antiarrhythmics - Classes IA, B, and C (C1579436)
SourcesAOD, CSP, LNC, MSH, MTH, MTHFDA, MTHSPL, NCI, NDFRT, PDQ, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)



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