lidocain spinalanästhesie dosierung

Vielleicht möchten Sie diese später nochmals lesen. 1957, 2, 105-115 Acta Anaesthesiol Scand. An intravascular injection is still possible even if aspirations for blood are negative. Lidocaine HCl Injection, USP should also be used with caution in patients with impaired cardiovascular function since they may be less able to compensate for functional changes associated with the prolongation of A-V conduction produced by these drugs. Since amide-type local anesthetics are metabolized by the liver, Lidocaine HCl Injection, USP should be used with caution in patients with hepatic disease. Dosages in children should be reduced, commensurate with age, body weight and physical condition (see DOSAGE AND ADMINISTRATION). Himes studied 20 human patients (as well as dogs) anesthetized with nitrous oxide and halothane, and found that IV lidocaine reduced MAC requirements by between 10 and 28% [Himes RS Jr et al. Lidocaine is a local anaesthetic. Nach rund 15 min ist die maximale Anästhesieausbreitung erreicht. Lidocaine, or 2-(diethylamino)-N-(2,6-dimethyl phenyl)-acetamide, is an amide, which means it contains an amine bond like with amino acids. Spinal Anesthesia Using Lidocaine and Sufentanil and (Transient Neurological Symptoms) TNS. Although the incidence of side effects with Lidocaine HCl is quite low, caution should be exercised when employing large volumes and concentrations, since the incidence of side effects is directly proportional to the total dose of local anesthetic agent injected. The pharmacological/toxicological actions of these metabolites are similar to, but less potent than, those of Lidocaine HCl. Lumbar and caudal epidural anesthesia should be used with extreme caution in persons with the following conditions: existing neurological disease, spinal deformities, septicemia, and severe hypertension. In a prospective review of 10,440 patients who received Lidocaine HCl 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. The potential for toxicity depends upon the procedure performed, the type and amount of drug used, and the technique of drug administration. It has a rapid onset of action (about one minute following intravenous injection and fifteen minutes following intramuscular injection) and rapidly spreads through the surrounding tissues. Lidocaine HCl Injection, USP is not approved for this use (see WARNINGS and DOSAGE AND ADMINISTRATION). Syringe aspirations should also be performed before and during each supplemental injection when using indwelling catheter techniques. Preparations containing a vasoconstrictor should be used with caution in patients during or following the administration of potent general anesthetic agents, since cardiac arrhythmias may occur under such conditions. The detection of sensitivity by skin testing is of doubtful value. Lidocaine HCl INJECTIONS, USP FOR INFILTRATION AND NERVE BLOCK SHOULD BE EMPLOYED ONLY BY CLINICIANS WHO ARE WELL VERSED IN DIAGNOSIS AND MANAGEMENT OF DOSE-RELATED TOXICITY AND OTHER ACUTE EMERGENCIES THAT MIGHT ARISE FROM THE BLOCK TO BE EMPLOYED AND THEN ONLY AFTER ENSURING THE IMMEDIATE AVAILABILITY OF OXYGEN, OTHER RESUSCITATIVE DRUGS, CARDIOPULMONARY EQUIPMENT AND THE PERSONNEL NEEDED FOR PROPER MANAGEMENT OF TOXIC REACTIONS AND RELATED EMERGENCIES (see also ADVERSE REACTIONS and PRECAUTIONS). Animal reproduction studies are not always predictive of human response. Spinal anesthesia is a safe and reliable technique for surgery of the lower abdomen and lower limbs. Careful and constant monitoring of cardiovascular and respiratory (adequacy of ventilation) vital signs and the patient’s state of consciousness should be accomplished after each local anesthetic injection. The maximum individual dose should not exceed 4.5 mg/kg (2 mg/lb) of body weight, and in general it is recommended that the maximum total dose does not exceed 300 mg. For continuous epidural or caudal anesthesia, the maximum recommended dosage should not be administered at intervals of less than 90 minutes. Successful outcome is dependent on early diagnosis, prompt discontinuance of the suspect triggering agent(s) and institution of treatment, including oxygen therapy, indicated supportive measures and dantrolene (consult dantrolene sodium intravenous package insert before using). Serious adverse experiences are generally systemic in nature. 1% Lidocaine HCl Injection, USP solution should be stored at 20° to 25°C (68° to 77°F) [see USP Controlled Room Temperature]. Cardiovascular manifestations are usually depressant and are characterized by bradycardia, hypotension, and cardiovascular collapse, which may lead to cardiac arrest. ca. If local anesthetics must be used in these patients, close monitoring for symptoms and signs of methemoglobinemia is recommended. 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). It is available in plasters (or patches), sprays, and creams, as topical lidocaine. General consideration should be given to this fact before administering Lidocaine HCl to women of childbearing potential, especially during early pregnancy when maximum organogenesis takes place. Many drugs used during the conduct of anesthesia are considered potential triggering agents for familial malignant hyperthermia. Some experts note that 35 mg/kg is a more reasonable limit noting that the hepatic metabolism of lidocaine by means of CYP3A4 is saturable and once saturation occurs, absorption exceeds elimination, and plasma lidocaine concentrations increase precipitously {NEJM 340: 1471, 1999}, An excellent review of the issues surrounding determination of a maximal dose of local anesthetics can be found at {Rosenberg PH. At concentrations of 1 to 4 mcg of free base per mL 60 to 80 percent of Lidocaine HCl is protein bound. Approximately 90% of Lidocaine HCl administered is excreted in the form of various metabolites, and less than 10% is excreted unchanged. Advise patients or caregivers to seek immediate medical attention if they or someone in their care experience the following signs or symptoms: pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue. The physician should weigh the possible advantages against risks when considering a paracervical block in prematurity, toxemia of pregnancy, and fetal distress. Table 1 (Recommended Dosages) summarizes the recommended volumes and concentrations of Lidocaine HCl Injection, USP for various types of anesthetic procedures. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Studies of Lidocaine HCl in animals to evaluate the carcinogenic and mutagenic potential or the effect on fertility have not been conducted. With central neural blockade these changes may be attributable to block of autonomic fibers, a direct depressant effect of the local anesthetic agent on various components of the cardiovascular system. Patients who are administered local anesthetics are at increased risk of developing methemoglobinemia when concurrently exposed to the following drugs, which could include other local anesthetics: Examples of Drugs Associated with Methemoglobinemia: nitric oxide, nitroglycerin, nitroprusside, nitrous oxide, articaine, benzocaine, bupivacaine, Lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, tetracaine, cyclophosphamide, flutamide, hydoxyurea, ifosfamide, rasburicase, dapsone, nitrofurantoin, para-aminosalicylic acid, sulfonamides, Phenobarbital, phenytoin, sodium valproate, acetaminophen, metoclopramide, quinine, sulfasalazine. The authors concluded that sparing effect of lidocaine on anaesthetic requirements seems to be mediated by an anti-nociceptive action, “The current recommendations regarding maximum doses of local anesthetics presented in textbooks, or by the responsible pharmaceutical companies, are not evidence based (ie, determined by randomized and controlled studies). Lidocaine HCl should also be used with caution in patients with severe shock or heart block. 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. Patients with peripheral vascular disease and those with hypertensive vascular disease may exhibit exaggerated vasoconstrictor response. Br J Anaesth 89: 849, 2002]. It is also used to treat ventricular tachycardia. The pH of this solution is adjusted to approximately 6.5 (5.0 to 7.0) with sodium hydroxide and/or hydrochloric acid. Lidocaine HCl Injection, USP is indicated for production of local or regional anesthesia by infiltration techniques such as percutaneous injection and intravenous regional anesthesia by peripheral nerve block techniques such as brachial plexus and intercostal and by central neural techniques such as lumbar and caudal epidural blocks, when the accepted procedures for these techniques as described in standard textbooks are observed. Se liste over medicin, der indeholder Lidocain. Request full-text PDF. Resuscitative equipment and personnel for treating adverse reactions should be immediately available. For epidural anesthesia, only the following dosage form Lidocaine HCl Injection, USP is recommended: Although this solution is intended specifically for epidural anesthesia, it may also be used for infiltration and peripheral nerve block, provided it is employed as a single dose unit. Binding is also dependent on the plasma concentration of the alpha-1-acid glycoprotein. Vet Anaesth Analg, March 18, 2008 {E pub}], Studies of IV lidocaine as a MAC sparing agent in humans are sparse. Lidocaine is a synthetic aminoethylamide with local anesthetic and antiarrhythmic properties. Dosierung Lidocain. Supportive treatment of circulatory depression may require administration of intravenous fluids and, when appropriate, a vasopressor as directed by the clinical situation (eg, ephedrine). 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. Lidocaine HCl Injection, USP solution contains Lidocaine HCl, which is chemically designated as acetamide, 2-(diethylamino)-N-(2,6-dimethylphenyl)-, monohydrochloride and has the molecular wt. Information derived from diverse formulations, concentrations and usages reveals that Lidocaine HCl is completely absorbed following parenteral administration, its rate of absorption depending, for example, upon various factors such as the site of administration and the presence or absence of a vasoconstrictor agent. It is similar to bupivacaine (Marcaine), articaine (Zorcaine), and Mepivacaine (Carbocaine). 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. 100 mg, to be given as a bolus dose over a few minutes, followed immediately by (by intravenous infusion) 4 mg/minute for 30 minutes, then (by intravenous infusion) 2 mg/minute for 2 hours, then (by intravenous infusion) 1 mg/minute, reduce concentration further if infusion continued beyond 24 hours (ECG monitoring and specialist advice for infusion), following intravenous injection lidocaine has a … This solution contains no bacteriostatic agent. The long-term significance of these observations is unknown. “The current recommendations regarding maximum doses of local anesthetics presented in textbooks, or by the responsible pharmaceutical companies, are not evidence based (ie, determined by randomized and controlled studies). International Anesthesia Research Society, Systemic local anesthetics reduce MAC of volatile anesthetics in rats by approximately 40% [DiFazio CA et al. Methemoglobin levels may continue to rise; therefore, immediate treatment is required to avert more serious central nervous system and cardiovascular adverse effects, including seizures, coma, arrhythmias, and death. Journal of Clinical Anesthesia. 2007 Sep;51(8):1005-15; discussion 1016-7. doi: 10.1111/j.1399-6576.2007.01401.x. The intramuscular injection of Lidocaine HCl may result in an increase in creatine phosphokinase levels. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Local anesthetics are actually CNS depressants, thus tonic-clonic seizures are thought to be caused by depression of inhibitory pathways. The plasma binding of Lidocaine HCl is dependent on drug concentration, and the fraction bound decreases with increasing concentration. Can be resterilized by autoclaving. Lue tämä pakkausseloste huolellisesti, ennen kuin aloitat tämän lääkkeen käyttämisen, sillä se sisältää sinulle tärkeitä tietoja. Injection should be made slowly and with frequent aspiration. However, recent clinical studies demonstrated that intravenous perioperative administration of lidocaine can lead to better postoperative analgesia, reduced opioid consumption and improved intestinal motility. The onset of anesthesia, the duration of anesthesia and the degree of muscular relaxation are proportional to the volume and concentration (ie, total dose) of local anesthetic used. Lidocaine HCl stabilizes the neuronal membrane by inhibiting the ionic fluxes required for the initiation and conduction of impulses thereby effecting local anesthetic action. 12 mg Bupivacain) dadurch, daß der Wirbelkanal in Rückenlage seine beiden tiefsten Punkte in den Segmenten T 5 - 7 und S 2 hat (physiologische Kyphosen der Wirbelsäule).Weil der Durasack bereits Solutions containing epinephrine or other vasoconstrictors should not be used for this technique. Confusion, convulsions, respiratory depression and/or respiratory arrest, and cardiovascular stimulation or depression have been reported. Lidocaine is used to relieve nerve pain after shingles (infection with the herpes zoster virus).This type of pain is called post-herpetic neuralgia.Lidocaine helps to reduce sharp/burning/aching pain as well as discomfort caused by skin areas that are overly sensitive to touch. There are, however, no adequate and well-controlled studies in pregnant women. The rapid injection of a large volume of Lidocaine HCl Injection, USP through the catheter should be avoided, and, when feasible, fractional doses should be administered. Each mL contains Lidocaine hydrochloride, anyhydrous 10 mg; sodium chloride 7 mg. There is insufficient information to determine whether shorter infusion periods are not associated with these findings. Article. For example, in a child of 5 years weighing 50 lbs the dose of Lidocaine HCl should not exceed 75 to 100 mg (1.5 to 2 mg/lb). The oral LD50 of Lidocaine HCl in non-fasted female rats is 459 (346 to 773) mg/kg (as the salt) and 214 (159 to 324) mg/kg (as the salt) in fasted female rats. Can J Anaesth 55: 754, 2008], however the results of this study was complicated by different fentanyl dosages on induction (3 ucg/kg in the control group versus 1.5 ucg/kg in the lidocaine group). The elimination half-life of Lidocaine HCl following an intravenous bolus injection is typically 1.5 to 2 hours. It is difficult to recommend a maximum dose of any drug for children, since this varies as a function of age and weight. Der Nachweis von Lidocain in einer Urinprobe nach dem Rennen steht somit unter Strafe. Use preservative-free preparations for spinal or epidural anesthesia May be buffered 9:1 with sodium bicarbonate, to reduce pain on injection (e.g. Lidocaine is commonly used for regional anesthesia and nerve blocks. Debilitated, elderly patients, acutely ill patients, and children should be given reduced doses commensurate with their age and physical condition. To read the full-text of this research, you can request a copy directly from the author. Rather, decisions on recommending certain maximum local anesthetic doses have been made in part by extrapolations from animal experiments, clinical experiences from the use of various doses and measurement of blood concentrations, case reports of local anesthetic toxicity, and pharmacokinetic results” {Rosenberg PH. Inform patients that use of local anesthetics may cause methemoglobinemia, a serious condition that must be treated promptly. Protect from light. Note, however, that the absence of blood in the syringe does not guarantee that intravascular injection has been avoided. Reg Anesth Pain Med 29: 564, 2004, PMID 15635516}, Filed Under: Encyclopedia, L, Pharmacology. There have been adverse event reports of chondrolysis in patients receiving intra-articular infusions of local anesthetics following arthroscopic and other surgical procedures. Dialysis is of negligible value in the treatment of acute overdosage with Lidocaine HCl. 270.8. The time of onset of symptoms, such as joint pain, stiffness and loss of motion can be variable, but may begin as early as the 2nd month after surgery. Maternal hypotension has resulted from regional anesthesia. It should be kept in mind at such times that restlessness, anxiety, tinnitus, dizziness, blurred vision, tremors, depression or drowsiness may be early warning signs of central nervous system toxicity. This amide has a … Lidocaine HCl is contraindicated in patients with a known history of hypersensitivity to local anesthetics of the amide type. Usual dosage: See insert. The maximum recommended dose per 90 minute period of Lidocaine hydrochloride for paracervical block in obstetrical patients and non-obstetrical patients is 200 mg total. For children over 3 years of age who have a normal lean body mass and normal body development, the maximum dose is determined by the child’s age and weight. Lidocain wird von der Association of Racing Commisioners International (ARCI) als "class 2 foreign substance" eingestuft. Fetal bradycardia may occur in 20 to 30 percent of patients receiving paracervical nerve block anesthesia with the amide-type local anesthetics and may be associated with fetal acidosis. When used for local anaesthesia or in nerve blocks, lidocaine typically begins working within several minutes and lasts for half an hour to three hours. Lidocaine HCl Injection, USP is a sterile, nonpyrogenic, isotonic solution containing sodium chloride. atenolol, propranolol, amiodarone, verapamil, fentanyl, flecainide, hyoscyamine, ketamine, propofol, Inderal. Category. Resuscitative equipment, oxygen, and other resuscitative drugs should be available for immediate use (see WARNINGS and ADVERSE REACTIONS). Figyelmeztetések és óvintézkedések A Lidocain spray alkalmazása előtt beszéljen kezelőorvosával vagy gyógyszerészével. “The current recommendations regarding maximum doses of local anesthetics presented in textbooks, or by the responsible pharmaceutical companies, are not evidence based (ie, determined by randomized and controlled studies). The following types are those most commonly reported: CNS manifestations are excitatory and/or depressant and may be characterized by lightheadedness, nervousness, apprehension, euphoria, confusion, dizziness, drowsiness, tinnitus, blurred or double vision, nausea and vomiting, sensations of heat, cold or numbness, twitching, tremors, convulsions, unconsciousness, respiratory depression and arrest. Local anesthetic solutions containing antimicrobial preservatives (eg, methylparaben) should not be used for epidural or spinal anesthesia because the safety of these agents has not been established with regard to intrathecal injection, either intentional or accidental. However, increasing the volume and concentration of Lidocaine HCl Injection, USP may result in a more profound fall in blood pressure when used in epidural anesthesia. Adequate time should be allowed for onset of anesthesia after administration of each test dose. When larger volumes are required, only solutions containing epinephrine should be used except in those cases where vasopressor drugs may be contraindicated. Lidocaine HCl crosses the blood-brain and placental barriers, presumably by passive diffusion. Excessive blood levels may cause changes in cardiac output, total peripheral resistance, and mean arterial pressure. Last updated on Sep 1, 2019. Since it is not known whether amide-type local anesthetics may trigger this reaction and since the need for supplemental general anesthesia cannot be predicted in advance, it is suggested that a standard protocol for the management of malignant hyperthermia should be available. Lidocaine also may reduce post-operative analgesic requirements – a prospective, randomized study of 50 patients suggested that in addition to decreasing the requirement for volatile anesthetics, lidocaine may reduce PACU fentanyl requirements [Lauwick S et al. Lidocaine adalah obat untuk menghilangkan rasa sakit atau memberi efek mati rasa pada bagian tubuh tertentu (obat bius lokal).

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