LIDOCAINE (XYLOCAINE)

Class

Antiarrhythmic

Pharmacology and Actions

1. Cardiovascular
   1. Increased ventricular fibrillation threshold
   2. Decreased conduction rate and myocontractility (at toxic levels)
2. CNS
   1. Stimulation
   2. Decreased cough reflex

Indications

1. Pediatric cardiac arrest from VT/VF
2. Sustained VT with a pulse
3. Prior to intubation in head trauma (suspected increased intracranial pressure)

Contraindications

1. Known hypersensitivity to lidocaine

Precautions

1. High grade AV block is a relative contraindication.  Do not treat ventricular escape beats or accelerated idioventricular rhythm with lidocaine.
2. Lidocaine is metabolized in the liver, elderly patients and those with liver disease or poor liver perfusion secondary to shock or CHF are more likely to experience side effects.
3. Side effects include drowsiness, confusion, convulsion, hypotension, bradycardia, and tachycardia.
4. Head trauma requires careful airway management. If endotracheal intubation is appropriate, pretreatment with lidocane may help avoid further ICP.

Administration

1. Pediatric cardiac Arrest from VF/VT
   1. Initial dose of 1.0 mg/kg IV/IO
2. Adults:  Sustained ventricular tachycardia with a pulse
   1. 0.5 mg/kg IV/IO over 2 minutes and may be repeated in 5 – 10 minutes
3. Pediatrics:  Sustained ventricular tachycardia with a pulse
   1. 1 mg/kg IV/IO over 2 minutes
4. Head Trauma
   1. 1.0 mg/kg IV/IO bolus: no additional bolus is required

Side Effects and Special Notes

1. PVCs should not be treated with lidocaine.  Hypoxia can generate PVCs and lidocaine will not help; treat the cause.  Patients with PVCs and active chest pain should have their pain treated aggressively with oxygen, aspirin, and pain medications.
2. Best available evidence currently indicates that prophylactic lidocaine (in the setting of MI without PVCs) may actually increase mortality.