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LIDOCAINE B Lactation Yes (Caution) Trade Name: Xylocaine (Cardiac)
Class / Mechanism of Action
Antiarrhythmic
Suppresses automaticity of cardiac conduction tissue.
Indications
Labeled Indications: Acute treatment of ventricular arrhythmias from myocardial infarction (alternate to
amiodarone when amiodarone not available)
Unlabeled: (ACLS, 2015)
• Hemodynamically stable monomorphic VT and polymorphic VT
• Pulseless VT/VF (unresponsive to defibrillation, CPR, and vasopressor administration)
• Monomorphic VT secondary to drug, when amiodarone is not available
Contraindications
• Hypersensitivity to lidocaine or any component of the formulation
• Prophylactic use in AMI
• Bradycardia, severe degrees of SA, AV, or intraventricular heart block
• Wolff-Parkinson-White syndrome, Adam-Stokes syndrome
Adverse Reactions / Precautions
• Continuous EKG monitoring is necessary
• Increased ventricular rate may be seen when given to a patient in AFib
• At high doses, monitor closely for CNS toxicity, seizure, depression, and respiratory depression.
o D/C immediately if toxicity develops
• The elderly may have increased chance of CNS and cardiovascular side effects.
Dose and Administration: ADULT PEDIATRIC Always Reference BROSELOW Tape
Cardiac Arrest from VF/VT, (if Amiodarone is not VF/Pulseless VT, Wide Complex Tachycardia
available): (ACLS, 2015): (with pulses): (PALS, 2015)
IV, IO: IV, IO:
• Initial dose: 1-1.5mg/kg • Initial dose: 1mg/kg
• For refractory VF may give additional
0.5-0.75mg/kg IV push, repeat in 5 to 10
minutes
o Maximum of 3 doses or total of 3mg/kg
Perfusing Arrhythmia (if amiodarone is not
available): Stable VT, wide complex tachycardia, 2015 AHA ACLS guidelines state:
significant ectopy: "There is inadequate evidence to support the
IV, IO routine use of lidocaine after cardiac arrest.
• Doses ranging from 0.5-0.75mg/kg and up to However, the initiation or continuation of lidocaine
1-1.5mg/kg. Repeat 0.5-0.75mg/kg q5-10min. may be considered immediately after ROSC
o Maximum cumulative dose 3mg/kg from cardiac arrest due to VF/pVT"
Maintenance Infusion (Adults and Peds):
Flush after initiation of IO: IV, IO: Continuous Infusion
• May add 2-3mL Lidocaine 2%
(without epinephrine) to 5mL NS flush • 1-3mg/hr (or 20-50mcg/kg/min).
Local Anesthesia during Tube/Finger
Thoracostomy
• Draw 10mL 2% Lidocaine and locally
anesthetize incision area.
Decompression Illness/ Arterial Gas Embolism:
• 1.5mg/kg IV/IO

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