IV Lidocaine Administration

[Guest guest]

Am starting an extended ACLS course tomorrow and the following

controversy has arisen.

Should the initial loading dose of lidocaine in either VF/PVT or Stable

VT be reduced by 50% in patients over 70, or should only the

maintenance infusion be reduced?

One of our physicians favors reducing all lidocaine doses by 50% in

those over 70.

The only information I can find is in the 1992 JAMA article upon which

the current ACLS guidelines are based and in the ACLS manual, both of

which clearly state that the loading dose is not to be reduced but that

the maintenance infusion should be reduced in those with known hepatic

disease or over the age of 70. However, Tintinalli's 4th edition, page

396 states, without reference, that some have suggested reducing the

loading dose by one-half to one-third in those over 70. The chapter

bibliography contains nothing I can identify as being supportive.

A Medline search a while ago using " lidocaine toxicity in the elderly "

turned up 86 articles, 6 of which addressed the subject, but none of

which are later than 1986. So does anybody know of recent research

indicating that the loading dose should be reduced as well as the

maintenance dose?

How many are currently reducing all lidocaine administrations by

one/half in those over 70?

Gene Gandy

--

E. Gandy, JD, EMT-P

EMS Professions Program Director

Tyler Junior College

Tyler, TX

ggan@...

Check out our website at: http://www.tyler.cc.tx.us/emmt/

------------------------------------------------------------------------