- Class IB antiarrhythmic
- Local anaesthetic
- Use-dependant Na channel blocker (i.e. Tends to work fairly specifically on more rapidly depolarizing ectopic foci).
- Decreases the duration of the action potential by shortening repolarization.
- Onset - 2 minutes
- Peak - Unknown
- Half-life - Biphasic 8 minutes, 1 to 2 hours
- Duration - 20minutes
- Treatment of hemodynamically significant ventricular ectopy.
- Closely coupled ventricular beats (R on T phenomenon), or multiform PVCs.
- Bursts of 3 or more ventricular beats at a rate > 100 (short runs of VT).
- Sustained VT with a pulse.
- Pulseless ventricular tachycardia or ventricular fibrillation.
- Allergy or hypersensitivity to lidocaine.
- 3rd degree AV block.
- Ventricular escape rhythms.
- Wolf Parkinson White syndrome.
Note: Although 2nd degree AV blk is also indicated as a contraindication in several texts, it is essentially a supraventricular rhythm. If it were to appear as a post arrest rhythm, the benefit of administering Lidocaine to prevent recurrence of VF or VT would outweigh the theoretical risks.
- CHF, cardiogenic shock (consult with the EP).
- Lidocaine may be used in the setting of ventricular ectopy/VT secondary to cocaine ingestion, however there is an increased risk of seizure due to the synergistic toxic affects of these two agents.
- Hepatic or renal failure.
Drug to Drug
- Increased risk of Lidocaine toxicity when given to patients taking cimetidine, ranitidine or beta blockers - Cimetidine inhibits the metabolism of several drugs.
- Giving Lidocaine to patients on Disopyramide may cause bradycardia or cardiac arrest.
- Dizziness, light headedness, drowsiness, slurred speech
- Respiratory arrest – rare
- Hypotension, cardiac arrhythmias, cardiac arrest
- Muscle twitching, paraesthesia (tingling in the lips, fingers)
- “ringing in the ears”
- Nausea or vomiting, rash, anaphylactoid reaction seizures secondary to lidocaine toxicity.
- 1.0 - 1.5 mg/kg IV bolus or 2.0 mg/kg via ETT if IV not available in the arrested patient
- Followed by 0.5 - 1.0 mg/kg bolus repeat prn to max of 3 mg/kg
- Same as adult.
- See BCEHS Pediatric Dosage (BCEHS Peds Dosages) recommendations for age and weight-appropriate dosing information.
- Always treat the underlying cause of ventricular ectopy first. e.g. cardiac ischemia, electrolyte imbalance, hypoxemia, hypovolemia, etc.