Critical Care Trauma Centre

LIDOCAINE(Xylocaine)

 

Name: LIDOCAINE(XylocaineR)
Classification: antiarrhythmic
  • ventricular antiarrhythmic
  • may be used as an adjuct for pain control
Dose:
  • Loading Dose:
    • 1mg/kg, up to 1.5 mg/kg over 1 min, may repeat X 1 to a maximum total dose of 3.0 mg/kg
  • Maintenance Infusion:
    • 1 - 4 mg/min
  • Circulatory Failure:
    • 50 mg, then 1 mg/min as continuous infusion
  • Pre-suctioning with raised ICP:
    • 1.5 mg/kg (max 100 mg) 1 - 2 minutes prior to suctioning; maximum dose per hour 4.5 mg/kg

    •  
  • dose must be decreased in hepatic or renal failure.
  • infusion beyond 36 hours may necessitate a reduction in dose 
Administration:
  • Bolus dose:
    • rate 50 mg/min
  • IV Infusion:
    • 2 g/500 mL dextrose 5%, sodium chloride 0.9%, Ringer's Lactate
  • underlying causes for ventricular ectopy, such as low potassium or magnesium, hypoxemia, ischemia should be corrected concurrently with initation of therapy

Lidocaine ANTIDOTE:  for cardiorespiratory collapse/arrest induced by local anaesthetic agents or other lipid soluble cardiotoxic drugs:

LIPID RESCUE PROTOCOL:

  • Administer 20% Lipids:
  • Initial dose: 100 mL IV push over 1 minute
  • Infusion: start immediately after bolus and administer 400 mL over 30 minutes
  • Spike bag with regular IV administration set and run wide open (DO NOT USE AN IN-LINE FILTER OR TPN SET during Lipid Rescue)
  • Continue chest compressions if cardiac arrest to ensure lipids circulate
  • May repeat until blood pressure restored to a maximum of 8 mL/kg
Adverse Effects: Cardiac:
  • hypotension
  • bradyarrythmias
  • heart block
  • decreased cardiac output
  • reports of cardiac arrest ollowing IV administration
CNS:
  • disorientation
  • agitation
  • parasthesia
  • seizures
  • coma

 

Contraindication:
  • in complete heart block or type II second degree heart block unless functional pacemaker in place (can suppress a ventricular escape rhythm)

 

Drug Interactions:
  • lidocaine + cimetidine = increased lidocaine toxicity
  • lidocaine + propranolol = increased lidocaine toxicity
  • lidocaine + procainamide = increased lidocaine toxicity
  • lidocaine + amiodarone = severe sinus bradycardia (especially in sick sinus syndrome)
  • lidocaine + neuromuscular blockers = increased neuromuscular blockade
Monitoring Therapy:
  • continuous heart rate and rhythm
  • blood pressure
  • neurological status
  • seizure activity
  • tinnitus
  • perioral numbness
  • electrolytes: potassium, magnesium, phosphate 
  • pain
Adult Critical Care Protocol:
  • May be administed IV direct or by IV infusion by a nurse in Adult Critical Care
  • May be titrated by a nurse in Adult Critical Care
  • Continuous infusions must be administered by infusion device with pump library enabled.


Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: September 20, 2018