Lidocaine drug class?
Class Ib antiarrhythmic
Lidocaine action on cardiovascular system; What does it suppress and how?
-suppresses automaticity of conduction tissue, by increasing electrical stimulation threshold of ventricle, His-Purkinje system, and spontaneous depolarization of the ventricles during diastole by a direct action on the tissues
Lidocaine action of the nervous system
blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane’s permeability to sodium –> nhibition of depolarization thus blockade of conduction.
Lidocaine metabolism
Metabolism: 90% hepatic via CYP1A2 and CYP3A4
What are the Active metabolites of Lidocaine? What does accumulation of metabolites lead to?
monoethylglycinexylidide (MEGX) and glycinexylidide (GX) can accumulate and may cause CNS toxicity
Lidocaine use in ACLS
To treat Ventricular tachycardia, hemodynamically stable, sustained monomorphic: Acute treatment of ventricular arrhythmias (eg, due to acute myocardial infarction [MI] or during cardiac manipulation [eg, cardiac surgery]).
For Lidocaine use for Epidural and spinal anesthesia: what is the type of solution use ?
**Preservative free solutions. **Do not use solutions containing preservatives.
Ventricular arrhythmias: lidocaine dosing (typical, max dose for 1hr?)
Bolus dose: typical dose 50-100mg
maximum cumulative dose: 3 mg/kg or up to 300 mg within 1 hour (Ref).
List ALL 3 contraindications to lidocaine (besides allergy to amide LA)
1.Adam-Stokes syndrome
2.Wolff-Parkinson-White syndrome
3. severe degrees of SA, AV, or intraventricular heart block (except in patients with a functioning artificial pacemaker)
What is the use of lidocaine for induction? Dose? How long before intubation to administer lidocaine?
Lidocaine (eg, 1 to 1.5 mg/kg IV given two minutes prior to intubation) is administered to
- blunt the sympathetic response to laryngoscopy
- suppress the cough reflex
LTA considerations: (topical lidocaine in airway)
aspiration precautions are necessary since residual vocal cord paralysis may last two to four hours after topical anesthesia with lidocaine. Thus, postoperative patients should remain “nil per os” (ie, NPO) until paralysis has resolved.
Key roles of lidocaine during induction (4)
Suppresses airway reflexes to prevent coughing during laryngoscopy and intubation
Reduces airway responsiveness to noxious stimuli; reduces airway responsiveness to drugs that cause bronchospasm
Minimizes pain caused by IV injection of induction agent
Supplements sedation and reduces dose requirement of IV induction agent
Potential adverse effects of lidocaine in patients with Atrial fibrillation?
Increases ventricular rate in patients with atrial fibrillation (avoid in patients with Wolff-Parkinson-White syndrome or high-grade heart block)
Remifentanil for RSI induction: How ?
Administration of propofol 2 to 2.5 mg/kg –> remifentanil 3 to 5 mcg/kg, have been described for rapid sequence intubation. Ephedrine 10 mg IV is also administered to avoid bradycardia and hypotension.
In what situation is Remifentanil use for RSI inductionM (Instead of paralytics)?
When succinylcholine is contraindicated and the prolonged duration of a nondepolarizing neuromuscular blocking agent is undesirable.
