LIDOCAINE(Xylocaine)

Name:	LIDOCAINE(Xylocaine^R)
Classification:	*antiarrhythmic* ventricular antiarrhythmic may be used as an adjunct for pain control may be used as an adjunct for treatment of certain medication overdoses
Dose:	TREATMENT OF VENTRICULAR ARRHYTHMIAS 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. Usual initial bolus dose is 100 mg IV direct. Maintenance Infusion: 1 - 4 mg/min Circulatory Failure: 50 mg, then 1 mg/min as continuous infusion MANAGEMENT OF PAIN Loading Dose (optional): 1 mg/kg to maximum of 100 mg (bolus dose maybe administered from the maintenance infusion bag via the infusion pump) Maintenance Infusion: 1 - 4 mg/minute 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 + 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 administered IV direct or by IV infusion by a nurse in Adult Critical Care May be titrated when used for ventricular arrhythmias by a nurse in Adult Critical Care Continuous infusions must be administered by infusion device with pump library enabled.