#建議持續輸注 (IV pump) 之高警訊藥品

1. Local and regional anesthesia by infiltration, nerve block, epidural, or spinal techniques
2. Acute treatment of ventricular arrhythmias (eg, due to acute myocardial infarction [MI] or during cardiac manipulation [eg, cardiac surgery])

Antiarrhythmic Agent, Class Ib; Local Anesthetic

Onset of action:
(Single bolus dose) 45 to 90 seconds
Duration:
10 to 20 minutes
Distribution:
1. Vd: 1.5 ± 0.6 L/kg alterable by many patient factors; decreased in CHF and liver disease; crosses blood-brain barrier
2. Protein binding: 60% to 80% to alpha1 acid glycoprotein
Metabolism:
90% hepatic; active metabolites monoethylglycinexylidide (MEGX) and glycinexylidide (GX) can accumulate and may cause CNS toxicity
Half-life elimination:
Prolonged with congestive heart failure, liver disease, shock, severe renal disease
1. Initial: 7 to 30 minutes
2. Terminal (1) Infants, premature: 3.2 hours (2) Adults: 1.5 to 2 hours
Excretion:
Urine (<10% as unchanged drug, ~90% as metabolites)

1. Hypersensitivity to lidocaine or any component of the formulation or to another local anesthetic of the amide type
2. Adam-Stokes syndrome; Wolff-Parkinson-White syndrome; severe degrees of SA, AV, or intraventricular heart block (except in patients with a functioning artificial pacemaker)
3. premixed injection may contain corn-derived dextrose and its use is contraindicated in patients with allergy to corn or corn-related products

1. Adverse reactions in the fetus/neonate may affect the CNS, heart, or peripheral vascular tone. Fetal heart monitoring is recommended by the manufacturer.
2. Medications used for the treatment of cardiac arrest in pregnancy are the same as in the nonpregnant woman.

Lidocaine is present in breast milk.
Available guidelines consider lidocaine to be compatible with breastfeeding when used as an antiarrhythmic or local anesthetic.

Headache, shivering, radiculopathy

Anesthesia, local injectable:
Initial dose: 40 mg over 1 to 2 minutes; usual adult dose: 20 to 50 mg/dose
Ventricular arrhythmias (Ventricular tachycardia, hemodynamically stable):
1. Initial 1-1.5 mg/kg IV bolus; repeat with 0.5-0.75 mg/kg every 5 to 10 minutes as necessary (MAX cumulative dose: 3 mg/kg).
2. Follow with continuous infusion of 1 to 4 mg/minute or 20 to 50 mcg/kg/minute.

Anesthesia, local injectable:
Initial dose: 0.5 mg/kg over 1 to 2 minutes, follow with NS flush
Ventricular arrhythmias (Ventricular tachycardia, hemodynamically stable):
1. Loading dose: 1 mg/kg/dose; follow with continuous IV infusion; may administer second bolus if delay between initial bolus and start of infusion is >15 minutes.
2. Follow with continuous infusion: 20-50 mcg/kg/minute.

eGFR <30 mL/minute/1.73 m2: Administer lower maintenance infusion rate with close monitoring for toxicity.

1. Adults: Administer lower maintenance infusion rate with close monitoring for toxicity.
2. Infants, Children and Adolescents: Use with caution; reduce dose. Maximum rate of continuous IV infusion: 20 mcg/kg/minute.