Lignocaine is widely used as a local anaesthetic and antiarrhythmic drug. It should only be administered by, or under the direct supervision of, personnel experienced in their use, with adequate training in anaesthesia and airway management, and should not be administered parenterally unless adequate resuscitation equipment is available.
- Class Ib antiarrhythmic agent
- Hydrolysed in the gut and extensively metabolized in the first pass through the liver so only given IV
- Ventricular tachycardia, Ventricular fibrillation
- NOT for use in SVT
- NOT recommenced for non sustained VT or ventricular ectopics as treatment generally not advised
- Toxicity - Bradycardia and hypotension, asystolic arrest
- Nausea, vomiting, paraesthesia, Seizures, coma
- CPR: (when amiodarone is not available or contraindicated): usually Lidocaine 1-2 mg/kg, do not exceed 3 mg/kg over the first hour. Generally Lidocaine 50-100 mg iv over 2-5 mins (1 mg/kg) which may be followed by additional doses up to 200 mg within the first 30 minutes and then by an infusion.
- Ventricular Arrhythmias: Lidocaine 100 mg IV bolus dose over a few minutes. Follow by IV infusion 4 mg/minute for 30 minutes, then by IV infusion) 2 mg/minute for 2 hours, then (by IV infusion) 1 mg/minute, reduce concentration further if infusion continued beyond 24 hours (ECG monitoring and specialist advice for infusion), following IV injection lidocaine has a short duration of action (lasting for 15–20 minutes). If an IV infusion is not immediately available the initial IV injection of 100 mg can be repeated if necessary once or twice at intervals of not less than 10 minutes.