Download ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE

ANNE ARUNDEL MEDICAL CENTER
CRITICAL CARE MEDICATION MANUAL
DEPARTMENT OF NURSING AND PHARMACY
Guidelines for Use of Intravenous
Lidocaine
Major Indications
Acute management of ventricular arrhythmias (secondary to amiodarone in many patients presenting with
ventricular arrhythmias).
Mechanism of Action
Lidocaine suppresses ventricular arrhythmias by depressing automaticity of the His perkenjie system while raising
the excitability threshold of the ventricles.
Pharmacokinetics
IV
Onset of Effect
Peak Effects
Duration of Effects
1 - 2 minutes
5 - 7 minutes
0.5 - 1 hours*
*dependent on plasma concentration
Dosage & Administration
VF & Pulseless VT: 1-1.5 mg/kg IV bolus; repeat bolus only as guided by clinical situation (distribution
& metabolism of lidocaine in “code” situations are much reduced, thus levels generally remain therapeutic
without repeated bolus doses). Begin drip @ 2-4 mg/min when circulation returns.
VT with pulse or ventricular ectopy: 1-1.5 mg/kg bolus IVP over 2-3 mins, followed by an infusion of
2-4 mg/min. Repeat bolus of 0.5 mg/kg in 10 minutes. Further bolus doses of 0.5 mg/kg may be repeated
q 5-10 minutes as needed for persistent ectopy up to a maximum total bolus of 3 mg/kg.
*If patient has evidence of CHF, liver failure, or cardiogenic shock, repeat bolus should be eliminated and
infusion rate is decreased by 50%.
Monitoring
Continuous EKG
lidocain.dnp/page 1
12.97, reviewed 11/02
Cautions
Lidocaine should be used cautiously in patients with:
Renal failure
Liver failure
CHF
Marked hypoxia, hypovolemia, shock
Bradycardia, AV block
Adverse Effects
1.
2
3.
Cardiac: bradycardia, cardiac arrest, heart block.
CNS: Lethargy, lightheadedness, sedation, tinnitus, nausea, vomiting, numbness, confusion, seizure-like
activity.
Respiratory distress, respiratory arrest.
lidocain.dnp/page 2
12.97, reviewed 11/02
ANNE ARUNDEL MEDICAL CENTER
CRITICAL CARE MEDICATION MANUAL
DEPARTMENT OF NURSING AND PHARMACY
Lidocaine Maintenance Infusion Dosage Chart
2 gms Lidocaine in 500 ml
(concentration 4 mg/ml)
Dose in mg / min
0.8
0.9
1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
2
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.9
3
3.5
4
4.5
5
lidocain.dnp/page 3
12.97, reviewed 11/02
Pump Rate in ml/ hr
12
14
15
17
18
20
21
23
24
26
27
29
30
32
33
35
36
38
39
41
42
44
45
53
60
68
75