Lidocaine overdose
Lidocaine is a local anesthetic and antiarrhythmic agent. It is used in the form of a solution of lidocaine hydrochloride for intramuscular and intravenous administration in ampoules (in 1 ml - 20 or 10 mg of the active substance) and in the form of a 10% metered spray (4.8 mg of lidocaine in 1 dose).
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The effect of the drug is associated with the blockade of the formation of nerve impulses in sensory neurons and their further conduction along the nerve fibers. It is characteristic that lidocaine suppresses not only painful impulses, but any impulses arising in sensitive endings.
With intravenous administration, the effect occurs “on the needle”, 45–90 seconds after contact with the vein, with intramuscular administration - after 5–15 minutes. When a spray is applied to the skin or mucous membranes, the anesthetic effect develops on average within 15 minutes. The duration of action is from 10 minutes to one and a half hours, depending on the method of application.
It is used everywhere in various fields of medicine.
Intravenous and intramuscularly:
- conducting superficial, infiltration, conduction, epidural, spinal, intraligamentary anesthesia during surgical interventions and injuries;
- relief of ventricular arrhythmias;
- relief and prevention of recurrence of ventricular fibrillation, paroxysms of ventricular tachycardia.
Spray:
- in dentistry for the extraction of teeth and anesthesia of the gums when fixing prostheses;
- surgical treatment of superficial suppurative processes;
- suturing wounds;
- analgesia of mucous membranes and suppression of the pharyngeal reflex during endoscopic manipulations;
- excision of superficial neoplasms and defects of the mucous membrane;
- resection of nasal polyps;
- opening of the paratonsillar abscess;
- tonsillectomy and adenotomy (except for children under 8 years of age);
- before carrying out rectoscopy and, if necessary, replacing catheters in urology;
- anesthetizing the perineum to perform an episiotomy or suture;
- preparation of the operating field in obstetrics and gynecology;
- in ophthalmic practice for pain relief during short-term interventions on the conjunctiva and cornea, contact research methods.
Lidocaine is used with caution in children and adolescents under 18 years of age (due to slow metabolism, its accumulation is possible), persons over 65 years old, in the presence of chronic cardiac (II-III grade), renal or hepatic failure, cardiac arrhythmias, with a tendency to hypotension and bradycardia, in individuals with a history of epilepsy or seizures.
How much lidocaine is needed for an overdose?
The dosage is determined individually for each patient, it is recommended to use the minimum dose that causes a persistent analgesic effect. The volume of the injected solution is determined by the size of the tissue site to be anesthetized.
In adults, the maximum dose for a single parenteral administration is determined at the rate of 5 mg / kg of body weight, no more than 300 (according to some sources - 400) mg per hour. The maximum daily dose of Lidocaine is 2000 mg.
The maximum dose for children is 4 mg / kg per day. Children under 3 years of age receive no more than 1.25 ml, the frequency rate is no more than 4 times a day. In the case of intravenous administration - 1 mg / kg (usually not more than 50-100 mg).
When these doses are exceeded, an acute overdose develops.
Signs of overdose
In case of an overdose of lidocaine, the victims show symptoms of inhibition of the activity of the central nervous and cardiovascular systems. Characteristic is the progressive development of intoxication, a gradual increase in the severity of the process:
- tingling and "creeping" around the mouth;
- excessive sweating;
- pallor of the skin;
- chills;
- drowsiness or, conversely, psychomotor agitation, a state of agitation;
- numbness of the tongue;
- dizziness, headache;
- painful sensitivity to sounds and tinnitus;
- visual impairment (inability to focus the gaze, double vision);
- tremor, muscle twitching, sometimes turning into generalized convulsive seizures lasting from a few seconds to several minutes;
- episodes of spontaneous respiratory arrest;
- decrease in blood pressure, decrease in heart rate;
- violation of the heart rhythm, in severe cases - cardiac arrest.
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The risk of overdose increases with intravenous administration of the drug.
Acute overdose with lidocaine during spinal and epidural anesthesia during labor can lead to inhibition of the fetal heart rate, severe hypotension and depression of the respiratory center, up to respiratory arrest.
The US Food and Drug Administration (FDA) issued a Safety Notice on June 26, 2014, which provides information that a gel containing 2% lidocaine, previously recommended for teething pain relief in infants, it is dangerous, since its use has caused a number of hospitalizations and deaths.
First aid for overdose with lidocaine
If symptoms of an overdose appear, you must:
- Stop drug administration immediately.
- Give the victim a horizontal body position with a raised leg end.
- Provide access to fresh air (unbutton tight clothing, open windows).
Since lidocaine is not taken orally, gastric lavage, enterosorbents and laxatives are absolutely ineffective in this case.
Antidote
There are no specific antidotes to lidocaine.
When is medical attention required?
Medical care is needed in 100% of cases of overdose with lidocaine, since cardiac arrest and death are possible.
Of particular concern when using Lidocaine are:
- the appearance of neurological symptoms (loss of orientation in time and place, lethargy or excessive agitation, convulsions, etc.);
- change in heart rate, sudden drop in blood pressure;
- a state of oppressed consciousness, the patient's inaccessibility to contact;
- severe cyanosis of the skin and mucous membranes;
- breathing disorders.
After providing emergency care, if necessary, the victim is hospitalized in the specialized department of the hospital, where he receives special treatment:
- intubation, mechanical ventilation and oxygen therapy in case of coma and respiratory depression;
- intravenous administration of electrolyte solutions (sodium chloride, Lactasol, polarizing mixture) or plasma substitutes (Reomakrodex, Reopolyglyukin, Polyglyukin);
- anticonvulsants - intravenous diazepam, sodium thiopental;
- with bradycardia - m-anticholinergics (Atropine), vasoconstrictors (norepinephrine, phenylephrine).
Possible consequences
The consequences of an overdose with lidocaine can be:
- respiratory muscle paralysis;
- violation of intracardiac conduction;
- collapse;
- allergic reactions of varying severity, up to Quincke's edema;
- cardiac arrest, death.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
