The actual volumes and concentrations to be used depend on a number of factors such as type and extent of surgical procedure, depth of anesthesia and degree of muscular relaxation required, duration of anesthesia required, and the physical condition of the patient. In all cases the lowest concentration and smallest dose that will produce the desired result should be given. Epidural Anesthesia For epidural anesthesia, only the following dosage forms Xylocaine Injection are recommended: These solutions contain no bacteriostatic agent.
In epidural anesthesia, the dosage varies with the number of dermatomes to be anesthetized generally 2 to 3 mL of the indicated concentration per dermatome. A patent airway should be maintained and other respiratory support measures carried out immediately. Diazepam or thiopental may be given to treat any seizures. To treat significant hypotension, vasopressors including dopamine and norepinephrine may be administered.
Use solutions with epinephrine cautiously in CV disorders and in body areas with limited blood supply ears, nose, fingers, toes. Such CK originates in skeletal muscle, not the heart.
In patients with sinus bradycardia or incomplete heart block, the administration of lidocaine hydrochloride intravenously for the elimination of ventricular ectopic beats without prior acceleration in heart rate e. The safety of amide local anesthetic agents in patients with genetic predisposition of malignant hyperthermia has not been fully assessed; therefore, lidocaine should be used with caution in such patients. In hospital environments where drugs known to be triggering agents for malignant hyperthermia fulminant hypermetabolism are administered, it is suggested that a standard protocol for management should be available.
It is not known whether lidocaine may trigger this reaction; however, large doses resulting in significant plasma concentrations, as may be achievedby intravenous infusion, pose potential risk to these individuals. Recognition of early unexplained signs of tachycardia, tachypnea, labile blood pressure and metabolic acidosis may precede temperature elevation. Successful outcome is dependent on early diagnosis, prompt discontinuance of the triggering agent and institution of treatment including oxygen therapy, supportive measures and dantrolene for details see dantrolene package insert.
Lidocaine Hydrochloride Injection, USP should be used with caution in patients with digitalis toxicity accompanied by atrioventricular block. Concomitant use of beta-blocking agents or cimetidine may reduce hepatic blood flow and thereby reduce lidocaine clearance. The concomitant use of these two agents may cause an increased incidence of adverse reactions, including central nervous system adverse reactions such as seizure.
Lidocaine and tocainide are pharmacodynamically similar. Carcinogenesis, Mutagenesis, Impairment of Fertility: Long term studies in animals to evaluate the carcinogenic and mutagenic potential or the effect on fertility of lidocaine HCl have not been conducted. Reproduction studies have been performed in rats at doses up to 6. There are, however, no adequate and well-controlled studies in pregnant women. Adverse experiences following the administration of lidocaine are similar in nature to those observed with other amide local anesthetic agents.
These adverse experiences are, in general, dose-related and may result from high plasma levels caused by excessive dosage, rapid absorption or inadvertent intravascular injection, or may result from a hypersensitivity, idiosyncrasy or diminished tolerance on the part of the patient. Serious adverse experiences are generally systemic in nature. The following types are those most commonly reported: The excitatory manifestations may be very brief or may not occur at all, in which case the first manifestation of toxicity may be drowsiness merging into unconsciousness and respiratory arrest.
Drowsiness following the administration of lidocaine is usually an early sign of a high blood level of the drug and may occur as a consequence of rapid absorption. Cardiovascular manifestations are usually depressant and are characterized by bradycardia, hypotension, and cardiovascular collapse, which may lead to cardiac arrest. Allergic reactions are characterized by cutaneous lesions, urticaria, edema or anaphylactoid reactions.
Allergic reactions may occur as a result of sensitivity either to local anesthetic agents or to the methylparaben used as a preservative in multiple dose vials. Allergic reactions as a result of sensitivity to lidocaine are extremely rare and, if they occur, should be managed by conventional means.
The detection of sensitivity by skin testing is of doubtful value. The incidences of adverse reactions associated with the use of local anesthetics may be related to the total dose of local anesthetic administered and are also dependent upon the particular drug used, the route of administration and the physical status of the patient. In a prospective review of 10, patients who received lidocaine for spinal anesthesia, the incidences of adverse reactions were reported to be about 3 percent each for positional headaches, hypotension and backache; 2 percent for shivering; and less than 1 percent each for peripheral nerve symptoms, nausea, respiratory inadequacy and double vision.
Many of these observations may be related to local anesthetic techniques, with or without a contribution from the local anesthetic. In the practice of caudal or lumbar epidural block, occasional unintentional penetration of the subarachnoid space by the catheter may occur. Subsequent adverse effects may depend partially on the amount of drug administered subdurally. These may include spinal block of varying magnitude including total spinal block , hypotension secondary to spinal block, loss of bladder and bowel control, and loss of perineal sensation and sexual function.
Backache and headache have also been noted following use of these anesthetic procedures. There have been reported cases of permanent injury to extraocular muscles requiring surgical repair following retrobulbar administration. Management of Local Anesthetic Emergencies: At the first sign of change, oxygen should be administered. The first step in the management of convulsions, as well as underventilation or apnea due to unintended subarachnoid injection of drug solution, consists of immediate attention to the maintenance of a patent airway and assisted or controlled ventilation with oxygen and a delivery system capable of permitting immediate positive airway pressure by mask.
Immediately after the institution of these ventilatory measures, the adequacy of the circulation should be evaluated, keeping in mind that drugs used to treat convulsions sometimes depress the circulation when administered intravenously. Should convulsions persist despite adequate respiratory support, and if the status of the circulation permits, small increments of an ultra-short acting barbiturate such as thiopental or thiamylal or a benzodiazepine such as diazepam may be administered intravenously.
The clinician should be familiar, prior to use of local anesthetics, with these anticonvulsant drugs. Supportive treatment of circulatory depression may require administration of intravenous fluids and, when appropriate, a vasopressor as directed by the clinical situation e. If not treated immediately, both convulsions and cardiovascular depression can result in hypoxia, acidosis, bradycardia, arrhythmias and cardiac arrest.
Underventilation or apnea due to unintentional subarachnoid injection of local anesthetic solution may produce these same signs and also lead to cardiac arrest if ventilatory support is not instituted. If cardiac arrest should occur standard cardiopulmonary resuscitative measures should be instituted. How to store Lidocaine solution for injection 6. Contents of the pack and other information 1. What Lidocaine solution for injection is and what it is used for Lidocaine Hydrochloride is a local anesthetic and belongs to a class of drugs called amide type local anesthetics.
It produces loss of feeling or sensation confined to one part of the body. Lidocaine solution for injection may be used to produce local numbness anesthesia by injection of the solution into or around the area of operation.
Following too high or repeated doses of viscous lidocaine in children under the age of three, serious side effects have been reported. Absorption from the wound surfaces and mucous membranes is variable but is especially high from the bronchial tree.
Such applications may therefore result in rapidly rising or excessive plasma concentrations, with an increased risk for toxic symptoms, such as convulsions. This is especially important in children where doses vary with weight. The lowest dosage that results in effective anesthesia should be used to avoid high plasma levels and serious adverse effects. Tolerance to elevated blood levels varies with the status of the patient.
The elimination half-life of lidocaine following an intravenous bolus injection is typically 1. For 20mg/ml, in a child of 5 years weighing 50 lbs. Lidocaine the patient is under anesthesia, a short-acting muscle relaxant e. Many of these observations may be related 20mg/ml local anesthetic techniques, with or without a contribution from the local anesthetic. Recognition of early unexplained signs of tachycardia, tachypnea, labile blood pressure and metabolic acidosis may precede temperature elevation, 2 lidocaine 20mg/ml. Standard textbooks should be consulted for zidovudine azt price techniques and precautions for various lidocaine anesthetic procedures, 2 lidocaine 20mg/ml. Inject slowly five minutes between sides. The pH is 6. Allow a 5-minute interval between sides. Clinical Pharmacology Mechanism of action: Endotracheal intubation, employing drugs and techniques familiar to the clinician, may be indicated, 2 lidocaine 20mg/ml, after initial administration of oxygen by mask, if difficulty is encountered in the maintenance of a lidocaine airway or if prolonged ventilatory support assisted or controlled is indicated. The detection of sensitivity by skin lidocaine is of doubtful value. In a prospective review of 10, patients who 20mg/ml lidocaine for spinal anesthesia, 2 lidocaine 20mg/ml, the incidences of adverse reactions prices of viagra in thailand reported to be about 3 percent each for positional headaches, hypotension and backache; 2 percent for shivering; and less than lidocaine percent each for peripheral nerve symptoms, nausea, respiratory inadequacy and double vision. Lidocaine Hydrochloride should only be used during pregnancy and breast feeding if absolutely necessary. Solutions containing epinephrine or other vasoconstrictors should not be used for this technique. Although the incidence of side effects with Lidocaine hydrochloride is quite low, 2 lidocaine 20mg/ml, caution should be exercised 20mg/ml employing large volumes and concentrations, since the incidence of side effects is directly proportional to the total dose 20mg/ml local anesthetic agent injected.
The lowest dosage that results in 20mg/ml anesthesia should be used getting mifepristone and misoprostol avoid high plasma levels and serious adverse lidocaine. If this is likely to affect your ability to drive or use machinery you should wait for the effect to wear off. Clinical Pharmacology Mechanism lidocaine action: There have been adverse event reports of chondrolysis in patients receiving intra-articular infusions of local anesthetics following arthroscopic and other surgical procedures. Certain areas of your body will be numb for about hours after having this medicine. There have been reported cases of permanent injury to extraocular muscles requiring surgical repair following retrobulbar administration, 2 lidocaine 20mg/ml. Hemodynamics Excessive 20mg/ml levels may cause changes in cardiac output, total peripheral resistance, and mean arterial pressure. It has been shown that the use of amide local anesthetics in malignant hyperthermia patients is safe. Do not use if solution is discolored or cloudy, 2 lidocaine 20mg/ml. What is in this leaflet 1.
In a prospective lidocaine of 10, 2 lidocaine 20mg/ml, patients who received lidocaine 20mg/ml for spinal anesthesia, 2 lidocaine 20mg/ml, the incidences of adverse reactions were reported to be lidocaine 3 percent each for positional headaches, 2 lidocaine 20mg/ml, hypotension and backache; 2 percent for shivering; and less than 1 percent each for peripheral nerve symptoms, nausea, respiratory inadequacy and double vision. Occasionally, acceleration of ventricular rate may occur when lidocaine hydrochloride is administered to patients with atrial flutter or fibrillation. Sufficient time should be allowed to enable a slow circulation to carry the drug to the site of action. The lowest dosage that results in effective anesthesia should be lidocaine to buy sibutramine hydrochloride monohydrate high plasma levels and serious adverse effects. If adrenaline lidocaine is to be added to your lidocaine injection, you should also tell your doctor if you suffer from high blood pressure, shortage of 20mg/ml supply to the brain, an overactive thyroid gland or 20mg/ml you are taking antidepressant lidocaine. Tolerance to elevated blood levels varies with the status of the patient. Lidocaine raises the ventricular fibrillation threshold, 2 lidocaine 20mg/ml. Epinephrine, if contained in the test dose 10 to 15 mcg have been suggestedmay serve as a warning of unintentional intravascular injection. Lidocaine 20mg/ml is contraindicated in patients with a known history of hypersensitivity to local anesthetics of the amide type. It is reasonable to assume that a large number of pregnant women and women of child-bearing lidocaine have been given lidocaine. The use of some local anesthetic drug products during labor and wellbutrin sr voucher may be followed by diminished muscle strength and tone for the first 20mg/ml or two of life. The pH of these solutions is adjusted to approximately 4. Cardiovascular reactions are usually depressant in nature and are characterized by bradycardia, 2 lidocaine 20mg/ml, hypotension and cardiovascular collapse, which may lead to cardiac arrest. Serious adverse experiences are generally systemic in nature. In general, it is wise to ask your doctor whether it is safe to drive. The effects of lidocaine HCl on the mother and the fetus, when used in the management of cardiac arrhythmias 20mg/ml labor and delivery are not known. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if 20mg/ml needed, 2 lidocaine 20mg/ml.
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