Other Names

•Xylocaine

•Xylocard

Classification

  1b Antiarrhythmic  (Na Channel Blocker)

Action

•Suppression of PVC’s and re-entry arrhythmias

•Elevates the VF threshold

•Local anesthetic

Indications

•Treatment of acute ventricular tachyarrhythmias

•Mitigates the bronchospastic reactivity of the airways to the ETT in acute severe asthma and blunts the  intracranial pressure (ICP) response to intubation in cases of elevated ICP

•Local anesthetic prior to IV starts

Contraindications

•Hypersensitivity to the medication

•Bradycardic related PVC’s

•Idioventricular rhythms

Precautions

•Should be used with caution in CHF, AMI, hypoperfusion states, hepatic and renal insufficiency and with the elderly

Adverse Reactions

•CNS toxicity (seizures, agitation, confusion)

•Drowsiness, apprehension, vomiting, parenthesis

•Respiratory depression

•Anaphylactoid reactions

•Local thrombophlebitis

•Dizziness, euphoria

•With high doses – hypotension, bradycardia

•Local burning sensation at site of injection for local anesthesia

Interactions/Compatibility/Stability

•Incompatible with alkaline solutions (i.e. sodium bicarbonate)

•Compatible with all commercially available IV fluids

Special Considerations

•Decrease infusion rates by half in patients with CHF, liver disease, AMI, elderly and patients in shock

•Use infusion devices for all infusions

Dosages

•Preparations: IV: 100 mg/10 ml preload (10 mg/ml) 1%

•1 gm/250 D5W or NS premix at 4 mg/ml yield

•SC for IV starts: 2% nebules (without epinephrine) to a max of 0.5 ml

•Spray: 10 mg via Medical Directives

•Gel/Topical: 30 ml (20 mg/ml)

•Adult: Loading: 1.5 mg/kg IV over 2 - 3 minutes, may give additional bolus of 0.5 - 1 mg/kg every 5 – 10 minutes up to 5 mg/kg total or 400 mg

•Maintenance: Initiate at 2 mg/min if arrhythmias occur, give another bolus of 50 mg and increase infusion to 3 mg/min / if significant arrhythmias recurs, give another bolus of 50 mg and increase infusion to 4 mg/min

•Pediatric: 1 mg/kg slow IV or IO over 2 minutes, repeat every 5 minutes PRN to a maximum of 5 mg/kg or 200 mg

Kinetics

Onset:

   IV:             < 3 minutes

  ETT:           2 - 7 minutes

  Aerosol:     8 - 20 minutes

Peak:  

   IV:             1 - 2 minutes

  ETT:           < 5 minutes

  Aerosol:     10 - 20 minutes

Duration:   

   IV:             < 2 minutes

  ETT:           < 5 minutes

  Aerosol:     10 - 20 minutes

Want to help out?  Feel free to fill in a template for a medication that you use in your system and send it to me.  These templates are (and always will be) free for anyone to use.  Send it to Marc.