Lidocaine injectable

IV Use only lidocaine injection without preservatives, clearly labeled for IV use. Monitor EGG constantly to avoid potential overdosage and toxicity. 

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. 

Garcfa-Vilanova-Comas A, Fuster-Diana C, Cubells-Parrilla M, Perez-Ferriols MD, P6rez-Valles A, Roig-Vila JV. Nicolau syndrome after lidocaine injection and cold application a rare complication of breast core needle biopsy. Int J Dermatol 2011 50(1) 78-80. 

Sharma R, Goel N, Kumar A, Panda A. Central nervous system toxicity with a 1 ml lidocaine injection in the aberrant carotid artery overlying the trachea. Acta Anaesthesiol Scand 2008 52(10) 1436. 

Central nervous system toxicity from local anesthetics has previously been described. Lidocaine is usually considered to be safe up to a total intravenous dose of 3 mg/kg. However, although the total dose of the local anesthetic is important, lidocaine injected directly into the arterial circulation close to the central nervous system can produce toxicity in small doses [77 ]. 

It appears that lidocaine injected into the carotid sinus may have accidentally entered the cerebral arterial circulation and caused the clinical seizure. 

Ventricular fibrillation should be terminated by electrical defibrillation. Alternatively, lidocaine can be injected intravenously. In cases with lower frequency, ventricular tachyarrhythmia class I diugs such as aj marine, flecainide or propafenone are more effective as a result of the use-dependence of lidocaine. For prophylaxis treatment, amiodarone or sotalol may be helpful or the implantation of a cardioverter-defibrillator system. Acute amiodarone (i.v. in higher doses) can also terminate ventricular tachyarrhythmias. This action, however, seems to be mediated by its INa-blocking side effects and not (or less) by its class III like effects. 

The amide local anaesthetic lidocaine may also be used as an antianhythmic for ventricular tachycardia and exra-systoles after injection into the blood circulation. Drugs with high lipid solubility such as bupivacaine cannot be used for these purposes because their prolonged binding to the channel may induce dysrhythmias or asystolic heart failure [3]. Systemically applied lidocaine has also been used successfully in some cases of neuropathic pain syndromes [4]. Here, electrical activity in the peripheral nervous system is reduced by used-dependent but incomplete sodium channel blockade. 

Lidocaine (112), xyloceiine, and dibucaine (113) have been formulated in homo- and copolymers of lactide and glycolide. The goal of these studies has been relatively short-term (24-hr) controlled release of the anesthetic. Injectable microcapsules of lidocaine hydrochloride were produced by an air suspension coating technique and administered i.m. to rabbits (112). Serum levels of Udocaine indicated an initial rise over the first 2 hr and then a gradual decline with clearance after about 8-10 hr. 

Several topically applied local anesthetics are routinely used by the eye care specialist in certain routine diagnostic procedures and for various relatively simple surgical procedures such as insertion of punctal plugs and surgical vision correction. The first of these to be used was cocaine, in concentrations ranging from 1 to 4% [30]. More modern local anesthetics, however, such as tetracaine hydrochloride and proparacaine hydrochloride, have replaced cocaine as drugs of choice in these procedures. For surgical procedures of a more complex nature, lidocaine hydrochloride and similar local anesthetics as retrobulbar injections have been used [31]. 

LIDOCAINE HYDROCHLORIDE INJECTION USP 10ML BOTTLE 5 PER PACKAGE 6505011065499 PG 15.76 ... 

LIDOCAINE HYDROCHLORIDE INJECTION USP 50ML VIAL 25 VIALS/PACKAGE 6505014478094 PG 12.16 ... 

LIDOCAINE HYDROCHLORIDE INJECTION USP 5MI SYRINGE-NEEDLE UNIT10S 6505011561797 PG 13.02 ... 

Schwartz, M.L., Meyer, M.B., Covino, B.G. and Narang, R.M. (1974). Antiarrhythmic effectiveness of intramuscular lidocaine Influence of different injection sites. J. Clin. Pharmacol. 14 77-83. 

Similar to Voltaren" Emulgel, oily droplets of an eutectic mixture of lidocaine and prilocaine are dispersed in a hydrogel to provide local anesthesia to the skin for injections and siugical treatment (Emla cream). A further possibility is the dermal administration of a liposome dispersion as a spray (Heparin PUR ratiopharm Spriih-gel "). After administration, water and isopropylic alcohol evaporate partially resulting in an increase of concentration and in a transition from the initial liposome dispersion into a lamellar liquid crystal [32]. The therapeutic effect appears to be influenced favorably by the presence of lecithins rather than by the degree of liposome dispersion. 

Bupivacaine is an anaesthetic with a slow onset but a long duration of action. It is indicated for continuous epidural analgesia in labour. Xylocoine is the proprietary preparation of lidocaine (lignocoine). Lidocoine injections ore used in dentistry. 

Extravasation Extravasation of IV hypertonic solutions of sodium bicarbonate may cause chemical cellulitis (because of their alkalinity), with tissue necrosis, ulceration, or sloughing at the site of infiltration. Prompt elevation of the part, warmth, and local injection of lidocaine or hyaluronidase are recommended to prevent sloughing. 

Replacement therapy-As soon as possible, change patient to IV lidocaine or to an oral antiarrhythmic preparation for maintenance therapy. However, if necessary, an additional IM injection may be administered after 60 to 90 minutes. 

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). 

IM administration Reconstitute cefepime with the following diluents Sterile Water for Injection, 0.9% Sodium Chloride, 5% Dextrose Injection, 0.5% or 1 % lidocaine hydrochloride, or Sterile Bacteriostatic Water for Injection with parabens or benzyl alcohol. 

Infiltration anaesthesia is applied fan-shaped, with as few needle punctures as possible, in close proximity of the wound or the skin area to be treated. An aspiration should always take place to avoid intravascular injection. Suitable alternatives are lidocaine (lignocaine) or prilocaine for injection 5-10 mg/ml, with or without adrenaline. When making an incision of an abscess it is sometimes difficult to use a local anaesthetic if there is a pronounced inflammatory reaction, since the effect of the anaesthetic is reduced due to an increased acidity level. While adrenaline reduces bleeding and delays dispersion of the anaesthetic, local anaesthetic/adrenaline combinations are contraindicated for local anaesthesia of digits, on the face or where the skin survival is at risk. 

Nerve block anaesthesia in general practice mostly concerns finger or toe blocks. Lidocaine or prilocaine, 10 mg/ml without adrenaline (norepinephrine), is used and is injected on each side of the finger or toe, in two portions by the four nerve branches. Injection of larger volumes than 1-2 ml/side carries a risk of ischaemia because of the firm tissue. The transport through the nerve sheath takes a few minutes, and for a satisfactory result one should wait 5-10 minutes before the planned intervention starts. 

The most commonly used vasoconstrictors, the sympathomimetic drugs, are often added to local anesthetics to delay absorption of the anesthetic from its injection site. By slowing absorption, these drugs reduce the anesthetic s systemic toxicity and keep it in contact with nerve fibers longer, thereby increasing the drug s duration of action. Administration of lidocaine 1% with epinephrine results in the same degree of blockade as that produced by lidocaine 2% without the vasoconstrictor. 

Answer Bupivacaine use for local anesthesia of this type is very safe and commonly done. However, SOMETIMES inadvertent vascular injection results in a large amount of anesthetic in the systemic circulation. Because the heart is beating, the excitable tissue in the heart is being depolarized repetitively. Local anesthetics bind to rapidly depolarizing tissues more than tissues at rest (frequency-dependent block). Also, bupivacaine has a long duration of action because of its long residence time at receptors (sodium channel). Thus, this combination of factors contributed to the catastrophic outcome of this case. Had the same case involved lidocaine, the resuscitation would have likely been successful. 

Intra-arterial injection of thiopentone is a serious complication as crystals of the thiobarbiturate can form in the arterioles and capillaries, causing intense pain, vasoconstriction, thrombosis, and even tissue necrosis. Accidental intra-arterial injections should be treated promptly with intra-arterial administration of a vasodilator (papaverine 20 mg) and lignocaine (lidocaine) Note leave the needle/cannula in the artery), as well as a regional anaesthesia-induced sympathectomy (stellate ganglion block, brachial plexus block) and anticoagulation with intravenous heparin. The risk of ischaemic damage is much higher with a 5% solution and the use of this concentration is not recommended. 

Pain on injection is more common (8-20%) than with thiopentone, especially if a small vein is used for administration but can be reduced by flushing the vein with lidocaine (lignocaine) prior to methohexitone administration. 

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