Isolated cases of lidocainemg/ml and cardiac arrest have also been reported. Water for Injections E. Originally posted by agapelccc. The use of even more dilute solutions i.
However, because of the risk to both the mother and the fetus, 2 lidocainemg/ml, it lidocajne be attempted only by an experienced specialist anaesthetist. Cyclic antidepressants, MAO inhibitors: Causes prolonged and severe hypertension when lidocaine with epinephrine is used. Spinal anaesthesia always causes hypotension as a result of sympathetic blockade, 2 lidocainemg/ml.
It should never lidocainemg/ml used in patients with any condition resulting in hypovolaemia. Postoperative headache can be prevented by instructing the patient to lidocainemg/ml supine for 24 hours, 2 lidocainemg/ml. Obstetric practice Lumbar epidural block has largely replaced caudal epidural block for relief of pain in labour.
It requires less local anaesthetic, carries less risk of infection and is readily extended should lidocainemg/ml section become necessary. However, because of the risk to both the mother and the fetus, it should be attempted only by an experienced specialist anaesthetist. At therapeutic doses, 2 lidocainemg/ml, lidocaine has minimal hemodynamic effects in normal subjects and in patients with heart disease. Lidocaine has been shown to cause no, or minimal decrease in ventricular contractility, cardiac output, arterial pressure or heart lidocainemg/ml.
Oxidative Ndealkylation, 2 lidocainemg/ml, a major pathway of metabolism, results in the metabolites lidocainemg/ml and glycinexylidide. The primary metabolite in urine lidocainemg/ml a conjugate of 4-hydroxy-2, 6-dimethylaniline. The elimination half-life of lidocaine following an intravenous bolus injection is typically 1. There are data that indicate that the half-life may be 3 hours or longer following infusions of greater than 24 hours.
Because of the rapid rate at which lidocaine is metabolized, any condition that alters liver function, including changes in liver blood flow, which could result from severe congestive heart failure or shock may alter lidocaine kinetics. The half-life may be twofold or more greater in patients with liver dysfunction.
Renal dysfunction does not affect lidocaine kinetics, but may increase the accumulation of metabolites. The blood to plasma distribution ratio is approximately 0, 2 lidocainemg/ml. Objective adverse manifestations become increasingly apparent with increasing plasma levels above 6 mg free base per mL. The plasma protein binding of lidocaine is dependent on drug concentration lidocainemg/ml the fraction bound decreases with increasing concentration.
At concentrations of 1 to 4 mg free base per mL, 2 lidocainemg/ml, 60 to 80 percent of lidocaine is protein bound, 2 lidocainemg/ml. In addition to lidocaine concentration, the binding is dependent on the plasma concentration of lidocainemg/ml aacid glycoprotein. Lidocaine readily crosses the placental and blood-brain barriers. Dialysis has negligible effects on the kinetics of lidocaine.
Indications and Usage Lidocaine hydrochloride injection administered intravenously or intramuscularly, is specifically indicated in the acute management of ventricular arrhythmias such as those lidocainemg/ml in relation to acute myocardial infarction, 2 lidocainemg/ml, or during cardiac manipulation, such as cardiac surgery.
Contraindications Lidocaine hydrochloride is contraindicated in patients with a known history of hypersensitivity to local lidocainemg/ml of the amide type. Lidocaine hydrochloride should not be used in patients with Stokes-Adams syndrome, Wolff-Parkinson-White syndrome or with severe degrees of sinoatrial, atrioventricular or intraventricular block in the absence of an artificial pacemaker.
Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. The effects of lidocaine HCl lidocainemg/ml the mother and the fetus, 2 lidocainemg/ml, when used in the management of cardiac arrhythmias during labor and delivery are not known. Lidocaine readily crosses the placental barrier. It is not known whether this drug is excreted in human milk.
Because many drugs are excreted in human milk, caution should be exercised when lidocaine is administered to a nursing lidocainemg/ml. Adverse experiences following the administration of lidocaine are similar in nature lidocainemg/ml those observed with other amide local anesthetic agents.
Adverse experiences may result lidocainemg/ml high plasma levels caused by excessive dosage or may result from a hypersensitivity, 2 lidocainemg/ml, idiosyncrasy or diminished tolerance on the part lidocainemg/ml the patient. Serious adverse experiences are generally systemic lidocainemg/ml nature. The following types are those most commonly reported. The adverse experiences under Central Nervous Lidocainemg/ml and Cardiovascular System are listed, in general, in a progression from mild to severe, 2 lidocainemg/ml.
The excitatory reactions 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, 2 lidocainemg/ml.
Cardiovascular reactions are usually depressant in nature and are characterized by bradycardia, hypotension and cardiovascular collapse, 2 lidocainemg/ml, which may lead to cardiac arrest, 2 lidocainemg/ml. Allergic reactions as a result of sensitivity to lidocainemg/ml are extremely rare and, 2 lidocainemg/ml, if they occur, should be managed lidocainemg/ml conventional means.
There have been lidocainemg/ml cases of permanent injury to extraocular muscles requiring surgical repair following lidocainemg/ml administration. Although specific studies have not been lidocainemg/ml, lidocaine HCl has been used clinically without evidence of abuse of this drug or of psychological or physical dependence lidocainemg/ml a result of its use.
Overdosage of lidocaine Lidocainemg/ml usually results in signs of central nervous system or cardiovascular toxicity. Should convulsions or signs of respiratory depression and order ciprofloxacin no prescription develop, 2 lidocainemg/ml, the patency of the airway and adequacy of ventilation must be assured immediately.
Failure to achieve adequate analgesia with recommended doses should arouse suspicion lidocainemg/ml intravascular or fetal intracranial injection. Cases compatible with unintended fetal intracranial injection of local anesthetic solution have been reported following intended paracervical or pudendal block or lidocainemg/ml.
Babies so affected present with unexplained neonatal depression at birth, which correlates with high local anesthetic serum levels, and often manifest seizures within six hours.
Prompt use of supportive measures combined with forced urinary excretion of the local anesthetic has lidocainemg/ml used successfully to manage this complication, 2 lidocainemg/ml.
Case reports of maternal convulsions and lidocainemg/ml collapse following use of some local anesthetics for paracervical block in early pregnancy as anesthesia for elective abortion suggest that systemic absorption under these circumstances may be rapid. The recommended maximum dose of each drug should not be exceeded. Injection should be made slowly and with frequent aspiration. Allow a 5-minute interval between sides. It is not known whether this drug is excreted in human milk.
Because many drugs are excreted in human milk, 2 lidocainemg/ml, caution should be exercised when lidocaine is administered to a nursing woman.
Dosages in children should be reduced, commensurate with age, 2 lidocainemg/ml, body weight, and physical condition. Adverse experiences following the administration of lidocaine are lidocainemg/ml in nature to those observed with other amide local anesthetic agents. These adverse experiences are, 2 lidocainemg/ml, in general, dose-related and may result from high lidocainemg/ml 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. Lidocainemg/ml following types are those most commonly reported: The excitatory manifestations may be lidocainemg/ml brief or may not occur at all, 2 lidocainemg/ml, in which case the first manifestation lidocainemg/ml 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 lidocainemg/ml. Allergic reactions are characterized by cutaneous lesions, urticaria, 2 lidocainemg/ml, edema or anaphylactoid reactions.
Allergic reactions may occur as a result of sensitivity to local anesthetic agents. Allergic reactions as a result of sensitivity to lidocaine are extremely rare and, if they occur, lidocainemg/ml be managed by conventional means, 2 lidocainemg/ml.
The detection of sensitivity by skin testing is of doubtful value, 2 lidocainemg/ml. The incidences of adverse reactions associated with the use of local anesthetics may be related to the total dose of local anesthetic administered lidocainemg/ml 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 lidocainemg/ml 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, 2 lidocainemg/ml.
In the practice of caudal or lumbar epidural block, occasional unintentional penetration of the subarachnoid space by the catheter may lidocainemg/ml. Subsequent adverse effects may depend partially on the amount of drug administered subdurally.
These may include spinal block of varying magnitude including total spinal blockhypotension secondary to spinal lidocainemg/ml, 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, 2 lidocainemg/ml.
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