Neonatal Intensive Care UnitChildren's Hospital


Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.



  • main use as an antiarrhythmic agent is for the short term control of ventricular dysrhythmias (premature beats, tachycardias and digoxin induced ventricular arrhythmias)
  • lidocaine is also used as a local anaesthetic


  • lidocaine is a Class 1b antiarrhythmic agent
  • majority of activity believed to be related to blockage of fast sodium channels resulting in suppression of
    1. automaticity in the His-Purkinje system and,
    2. spontaneous ventricular depolarization during diastole
  • therapeutic plasma level is 4.5 to 21.5 micromol/L
  • plasma half-life in neonates is about 3 h, compared with 1.8 h in adults
  • local anesthetics reversibly block nerve conduction near their site of action; they are believed to block conduction of nerve impulses by reducing permeability of the nerve cell membrane to sodium ions

Side Effects

  • generally involve the CNS and are usually of short duration and are dose related: drowsiness, tremulousness, agitation, muscle twitching, tremors, seizures and cardiorespiratory arrest may also occur


  • continuous ECG is necessary during IV administration



    Use 1% (10 mg/mL) solution: dilute 1:1 with normal saline


    IV PUSH:

  • lidocaine should be diluted in 5% dextrose to a concentration of 0.5-1.0 mg (500-1000 mcg) per mL
  • 1 mg (1000 mcg)/kg given IV push by a physician (may be given by a certified R.N. under the supervision of a physician) while the heart rate and rhythm are monitored. This dose may be repeated every 5 to 10 minutes as necessary, to a maximum total dose of 5 mg/kg
  • to dilute the 1% (10mg/mL solution) to 1mg/mL:
    1. Add 1mL of the 10mg/mL solution to an empty 20mL syringe
    2. Add 9mL of 5% dextrose to the 20mL syringe
    3. Concentration is now 10 mg/10mL = 1mg/mL


  • 10 to 50 mcg/kg/min


  • 1.0% (10 mg/mL) vial


  1. McEvoy G K (ed): AHFS Drug Information, American Society of Hospital Pharmacists, 1991.
  2. Cloherty JP and Stark AR (eds): Manual of Neonatal Intensive Care, Little, Brown and Company, 1991.
  3. Roberts, RJ: Drug Therapy in Infants, W.B. Saunders, Toronto, 1984.
  4. Gomella TL (Ed): Neonatology - Management, Procedures, On-Call Problems, Diseases, Drugs, 1992, Appleton and Lange, Norwalk, Connecticut.

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