Lidocaine infusion

Unlabeled uses In pediatric patients with cardiac arrest, less than 10% develop ventricular fibrillation, and others develop ventricular tachycardia the hemodynamically compromised child may develop ventricular couplets or frequent premature ventricular beats. In these cases, administer 1 mg/kg lidocaine by the IV, intraosseous, or endotracheal route. A second 1 mg/kg dose may be given in 10 to 15 minutes. Start a lidocaine infusion if the second dose is required a third bolus may be needed in 10 to 15 minutes to maintain therapeutic levels. 

When transferring from lidocaine to mexiletine, stop the lidocaine infusion when the... 

Kastrup, J., Petersen, P., Dejgard, A., Angelo, H., Hilsted, J. Intravenous lidocaine infusion - a new treatment of chronic painful diabetic neuropathy Pain 1987, 28, 69-75. 

Wallace, M.S., Dyck, J.B., Rossi, S.S., Yaksh, T.L. Computer-controlled lidocaine infusion for evaluation of neuropathic pain after peripheral nerve injury, Pain 1996, 66, 69-77. 

Jelliffe, R. Rodman, J. Kolb, E. "Clinical Studies with Computer-Assisted Lidocaine Infusion Regimens," Circulation, 1976, 54, 11-211. 

Rimback G, Cassuto J, Tollesson P O 1990 Treatment of postoperative paralytic ileus by intravenous lidocaine infusion. Anesthesia and Analgesia 70 414-419 Ringger N C, Lester G D, Neuwirth L et al 1996 Effect of bethanechol or erythromycin on gastric emptying in horses. American Journal of Veterinary Research 57 1771-1775... 

Ventricular tachycardia R Lidocaine infusion 20-50 (ig/min per kg or 0.25-0.5 mg/kg slow i.v. every lOmin magnesium sulfate 1-2.5g/min over 10 min for a 450 kg horse, maximum dose 25g/450kg... 

FIG. 1. The effects of successive intravenous lidocaine infusions at increasing concentrations on ipsilateral allodynia in rats ( = 8). Beginning on postoperative day 5, five infusions were administered at 48 h intervals which correspond to plasma concentrations of l.ll(d5), 1.60 (d7), 2.07 (d9), 2.56 (d 11) and 3.03 (d 13) zg/ml. Open squares show mean paw withdrawal thresholds 5 min before administering the corresponding infusion. Filled squares show the mean paw withdrawal threshold value at the end of the infusion , pre-infusion threshold values on days 11, 13, 15, and 17 were significantly different from pre-infusion thresholds on day 5 (P < 0.02) , post-infusion threshold values were significantly different from pre-infusion threshold values on this day (P <0.02). (From Sinnott et al 1999, with permission.)... 

L Hernandez, NA Guzman, BG Hoebel. Differential dopaminergic potency of cocaine, procaine and lidocaine infused locally in the nucleus accumbens in vivo with calibration by capillary electrophoresis in vitro. NIDA Res. Monogr 105 355-356, 1991. 

It is necessary to know the target, or desired, concentration and the current dose to make a modification in therapy. This approach can be used for lidocaine infusion, or for slow release theophylline, for digoxin, phenobarbital, and procainamide. 

IV. Diagnosis is based on a history of local anesthetic use and typical clinical features. Abrupt onset of confusion, slurred speech, or convulsions in a patient receiving lidocaine infusion for arrhythmias should suggest lidocaine toxicity. 

A matched study in 51 cardiac patients taking a variety of beta blockers (including propranolol, metoprolol, timolol, pindolol) found no significant differences in either total or free concentrations of lidocaine during a lidocaine infusion, but there was a trend towards an increase in the adverse effects of lidocaine (bradycardias) with concurrent beta blocker treatment. ... 

Lidocaine 0.5-0.75 mg/kg IV bolus Repeat every 5-10 minutes to a total of 3 mg/kg 1-4 mg/minute continuous infusion... 

Alternatively, a continuous magnesium infusion may be initiated after the first bolus, at a rate of 0.5 to 1 g/hour. Alternative treatments include transvenous insertion of a temporary pacemaker for overdrive pacing, which shortens the QT interval and may terminate torsades de pointes intravenous isoproterenol 2 to 10 mcg/minute, to increase the heart rate and shorten the QT interval intravenous lidocaine, which may shorten the duration of ventricular repolarization or intravenous phenytoin, which may also shorten the duration of ventricular repolarization, administered at a dose of 10 to 15 mg/kg infused at a rate of 25 to 50 mg/minute. 

Fig. 5 Mean blood levels of lidocaine hydrochloride in live beagles after exponential IV infusion through a peripheral vein ( ) and in the portal vein ( ). Vertical bars represent standard errors of the mean. (From Ref. 13.)...

A3. Ahmad, K., and Medzihradsky, F., Distribution of lidocaine in blood and tissues after single doses and steady infusion. Res. Commun. Chem. Pathol. Pharmacol. 2, 813-828 (1971). 

Absorption/Distribution - Lidocaine is ineffective orally it is most commonly administered IV with an immediate onset (within minutes) and brief duration (10 to 20 minutes) of action following a bolus dose. Continuous IV infusion of lidocaine (1 to 4 mg/min) is necessary to maintain antiarrhythmic effects. Following IM administration, therapeutic serum levels are achieved in 5 to 15 minutes and may persist for up to 2 hours. Higher and more rapid serum levels are achieved by injection into the deltoid muscle. Therapeutic serum levels are 1.5 to 6 mcg/mL serum levels greater than 6 to 10 mcg/mL are usually toxic. Lidocaine is approximately 50% protein bound (concentration-dependent). 

Unlabeled uses Bretylium is a second-line agent following lidocaine in the protocol for advanced cardiac life support during CPR. For resistant VF and VT (after lidocaine, defibrillation, and procainamide failures), give bretylium 5 to 10 mg/kg IV repeat as needed up to 30 mg/kg use a bolus every 15 to 30 minutes, infusion 1 to 2 mg/min. For life-threatening arrhythmia use an undiluted infusion of 1 g/250 mL. 

Physically compatible up to 48 hours - Ascorbic acid benztropine cytarabine dexamethasone sodium phosphate diphenhydramine doxorubicin heparin sodium hydrocortisone sodium phosphate lidocaine magnesium sulfate multivitamin infusion (must be refrigerated) vitamin B complex with ascorbic acid. 

A patient with heart failure developed a serious abnormal heart rhythm, ventricular tachycardia, and it was decided to treat this with lig-nocaine (also known as lidocaine) by the intravenous route. He was given a loading dose designed to raise the plasma concentration to an effective 2 mg/1, and then given a constant-rate intravenous infusion aimed at maintaining that concentration. In about an hour he was observed to be tremulous and then had a brief generalized convulsion (a fit). The plasma lig-nocaine concentration was found to be 8 mg/1 (desired therapeutic range 1 - no more than 5 mg/1). 

Procainamide and lidocaine are two of the primary drugs for treating cardiac arrhythmias. Since lidocaine has a short duration of action, it is common to administer it by continuous infusion. Procainamide, because of its amide linkage, has longer action than does its precursor, procaine. Orally active analogues of local anesthetics (e.g., mexiletine) also are used as antiarrhyth-mics (see Chapter 16). 

Of all the local anaesthetics available, levobupivacaine and ropivacaine have the most favourable pharmacological characteristics for use in obstetrics. They have the lowest potential for cardiotoxicity and, unlike lidocaine and prilocaine, there is little risk of cumulation when they are administered by epidural infusion at effective doses. Elimination of all amides is prolonged in the neonate, exceeding 20 h in the case of bupivacaine. 

Lidocaine is also a class Ib anti-arrhythmic drug and is used to treat ventricular arrhythmias. Administered by intravenous infusion it has also been found to have a useful role in the management of acute pain and chronic pain syndromes. 

This is a class IB drug used primarily for the emergency treatment of ventricular arrhythmias. It has little effect on sinus node automaticity but depresses normal and abnormal forms of automaticity in Purkinje fibres. It is generally ineffective against supraventricular and accessory pathway-induced (e.g. WPW syndrome) arrhythmias. Lidocaine is relatively safe and free from adverse cardiovascular side effects. It causes minimal cardiodepression, although high doses can cause heart block. The most common side effect is a dose-related CNS toxicity. It is given intravenously as a bolus of 1 mg-kg-1 followed by an infusion of 20-50 pg-kg-l-min-1. 

In patients with heart failure, lidocaine s volume of distribution and total body clearance may both be decreased. Thus, both loading and maintenance doses should be decreased. Since these effects counterbalance each other, the half-life may not be increased as much as predicted from clearance changes alone. In patients with liver disease, plasma clearance is markedly reduced and the volume of distribution is often increased the elimination half-life in such cases may be increased threefold or more. In liver disease, the maintenance dose should be decreased, but usual loading doses can be given. Elimination half-life determines the time to steady state. Thus, although steady-state concentrations may be achieved in 8-10 hours in normal patients and patients with heart failure, 24-36 hours may be required in those with liver disease. Drugs that decrease liver blood flow (eg, propranolol, cimetidine) reduce lidocaine clearance and so increase the risk of toxicity unless infusion rates are decreased. With infusions lasting more than 24 hours, clearance falls and plasma concentrations rise. Renal disease has no major effect on lidocaine disposition. 

Linchitz RM, Raheb JC. Subcutaneous infusion of lidocaine provides effective pain relief for CRPS patients. Clin J Pain. 1999 15 67-72. 

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