Lidocaine – how does it work?

Lidocaine is usually used as a neighborhood and regional anesthetic. Lidocaine, a Class Ib antiarrhythmic drug, can be approved by the Food and Drug Administration (FDA) for the treatment of ventricular arrhythmias occurring during cardiac manipulation (i.e., cardiac surgery) and life-threatening arrhythmias, resembling those of ventricular origin or occurring during an acute infarction heart muscle (Facts and comparisons, 2022). In this blog, we’ll concentrate on the usage of lidocaine within the treatment of cardiac arrhythmias. How it’s working?

Action mechanism

In a healthy heart, the ventricles contract in response to impulses from the sinoatrial (SA) node, the guts’s natural pacemaker. Normal heart muscle cells allow a limited amount of sodium ions to enter, resulting in controlled depolarization. Conversely, ischemic or damaged myocardial cells allow rapid infusion of sodium ions. This causes the cells to depolarize much faster than normal after which begin to fireside spontaneously, creating an ectopic pacemaker that may trigger a ventricular arrhythmia.
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Lidocaine acts on damaged or ischemic myocardial cells, slowing down the influx of sodium, raising the electrical stimulation threshold (EST) of cells and the His-Purkinje conduction system. Increased EST prolongs depolarization in ischemic cells, suppresses the automaticity of conducting tissue, and restores control to the SA node.

Adult Dosage (Facts & Comparisons, 2022)

The typical dosage of lidocaine is 50 to 100 mg, administered as an intravenous (IV) bolus at a rate of roughly 25 to 50 mg/minute. Monitor the patient’s electrocardiogram (ECG) closely. If the guts rhythm doesn’t reply to the initial injection of a dose of fifty to 100 mg, a second dose could also be repeated after 5 minutes. The maximum dose is 200 to 300 mg, administered over 1 hour.
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Lidocaine could also be administered (off-label) to treat sudden cardiac arrest because of ventricular fibrillation or pulseless ventricular tachycardia unresponsive to cardiopulmonary resuscitation, defibrillation, and epinephrine. The initial intravenous dose is a bolus of 1 to 1.5 mg/kg. For refractory ventricular fibrillation or pulseless ventricular tachycardia, repeat a bolus of 0.5 to 0.75 mg/kg every 5 to 10 minutes (maximum cumulative dose 3 mg/kg). Once perfusion is restored, a continuous infusion ought to be administered at a rate of 1 to 4 mg/min. Dosage ought to be adjusted in patients with hepatic or renal impairment.

Contraindications (Facts and comparisons, 2022)

Lidocaine is contraindicated in patients with a history of hypersensitivity to amide local anesthetics. Lidocaine hydrochloride injection shouldn’t be utilized in patients with Stokes-Adams syndrome, Wolff-Parkinson-White syndrome, or severe sinoatrial, atrioventricular, or intraventricular block without a man-made pacemaker.

Monitoring (Facts and comparisons, 2022)

In addition to ECG monitoring, laboratory tests should include tests for liver function and lidocaine levels. In patients requiring use of the drug for longer than 24 hours, it is strongly recommended to watch lidocaine concentrations.
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Full information may be present in the medication’s package leaflet or within the Nursing2022 Medicines Manual + medicines updates.

Facts and Comparisons (2022, June 23). Lidocaine injection. . https://fco.factsandcomparisons.com/lco/action/search?q=lidocaine%20injection&t=name&acs=false&acq=lidocaine%20injectionAND