Heart arrest lidocaine

Lidocaine is one of the least cardiotoxic of the currently used sodium channel blockers. Proarrhythmic effects, including sinoatrial node arrest, worsening of impaired conduction, and ventricular arrhythmias, are uncommon with lidocaine use. In large doses, especially in patients with preexisting heart failure, lidocaine may cause hypotension—partly by depressing myocardial contractility. 

Although serious adverse reactions to lidocaine are uncommon, high dosage by any route may produce cardiovascular depression, bradycardia, hypotension, arrhythmias, heart block, cardiovascular collapse, and cardiac arrest,... 

Lidocaine can cause dysrhythmias and hypotension. The dysrhythmias that have been reported include sinus bradycardia, supraventricular tachycardia (11), and rarely torsade de pointes (12). There have also been rare reports of cardiac arrest (2) and worsening heart failure (13). Lidocaine can also cause an increased risk of asystole after repeated attempts at defibrillation (14). Lidocaine may increase mortality after acute myocardial infarction, and it should be used only in patients with specific so-called warning dysrhythmias (that is frequent or multifocal ventricular extra beats, or salvos) (15). 

A synergistic interaction of intrathecal fentanyl 100 pg and morphine 0.5 mg, given before induction, with systemically administered lidocaine 200 mg 4 hours later for ventricular tachycardia, resulted in potentiation of opioid effects in a 74-year-old man with major heart disease after coronary artery bypass grafting during the 5 minutes after lidocaine he had a respiratory arrest with loss of consciousness and miotic pupils, all reversed by naloxone (80). The proposed mechanism was thought to be a reduction in calcium ion concentrations in opioid-sensitive CNS sites. 

Keidar S, Grenadier E, Palant A. Sinoatrial arrest due to lidocaine injection in sick sinus syndrome durii amiodarcxie administration. Am Heart J (1982) 104,1384-5. 

Sinoatrial arrest occurred in a man with heart block following a suspected myocardial infarction, after he received intravenous lidocaine 1 mg/kg over 1 minute, followed 3 minutes later by phenytoin 250 mg given over 5 minutes. The patient lost consciousness and his blood pressure could not be measured, but he responded to a 200-microgram dose of isoprenaline (isoproterenol). ... 

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