{"id":357,"date":"2013-05-06T06:26:32","date_gmt":"2013-05-06T06:26:32","guid":{"rendered":"https:\/\/surgerytoday.com\/education\/?p=357"},"modified":"2014-12-19T07:21:22","modified_gmt":"2014-12-19T07:21:22","slug":"lidocaine-info-important-for-my-surgical-practice","status":"publish","type":"post","link":"https:\/\/surgerytoday.com\/education\/lidocaine-info-important-for-my-surgical-practice\/","title":{"rendered":"Lidocaine Info Important For My Surgical Practice – Maximums and Toxicity"},"content":{"rendered":"

\"lidocaine<\/a><\/h2>\n

Lidocaine<\/h2>\n
    \n
  • Also known as Xylocaine and sometimes Lignocaine<\/span><\/li>\n
  • Local Anesthetic<\/li>\n
  • Antiarrhythmic drug – for ventricular arrhythmias (but Amiodarone is mostly used for this)<\/li>\n
  • The first Amino-Amide local anesthetic<\/li>\n
  • First marketed in 1949<\/li>\n
  • Alters signal conduction in neurons by blocking the fast voltage gated sodium channels in the neuronal cell membrane. \u00a0Thus prevents depolarization of the postsynaptic neuron.<\/li>\n<\/ul>\n

    Esters and Amide local anesthetics – way to remember which<\/h3>\n
      \n
    • Esters have only one “i” in the name: Procaine, Cocaine<\/span><\/li>\n
    • Amides have over two “i”s in the name: \u00a0Lidocaine, Bupivicaine, Prilocaine.<\/li>\n<\/ul>\n

      Contraindications to using Lidocaine<\/h3>\n
        \n
      • Porphyria – rare inherited or aquired disorders of enzymes which produce porphyrins and heme resulting in neurological complications (abdominal pain, vomiting, neuropathy) \u00a0or skin problems.<\/span><\/li>\n
      • Heme is one the best known porphyrin\u00a0the pigment in red blood cells and cofactor of the protein hemoglobin.<\/li>\n
      • Porphyrin means purple<\/li>\n<\/ul>\n

        Lidocaine overdose<\/h3>\n
          \n
        • can occur with topical creams<\/span><\/li>\n
        • Treatment with IV lipid emulsions can reverse the effects of lidocaine toxicity.<\/li>\n<\/ul>\n

          Adverse Effects<\/h3>\n
            \n
          • Rare<\/span><\/li>\n
          • Allergic reactions rare.<\/li>\n
          • CNS (central nervous system) and cardiovascular effects<\/li>\n
          • CNS at lower doses, cardiac at higher doses<\/li>\n
          • CNS: nervousness, tingling around mouth, tinnitus, tremor, dizziness, blurred vision, seizures, depression, loss of consciousness<\/li>\n
          • Cardiovascular effects: hypotension, bradycardia, arrhythmias<\/li>\n<\/ul>\n

            Insensitivity to Lidocaine<\/span><\/h3>\n
              \n
            • Genetic<\/span><\/li>\n
            • Exists in some patients with ADHD and Ehlers-Danlos syndrome<\/span><\/li>\n<\/ul>\n

              Lidocaine Safety and Toxic doses<\/h3>\n
                \n
              • Particular care in calculating maximum safe dose for young children<\/span><\/li>\n
              • Peak blood levels of lidocaine usually occur 10-25 minutes after injection – the point at which toxic effects are likely to be seen.<\/li>\n
              • Maximum safe dose of lidocaine without vasoconstrictor (ie. epinephrine) is 3-4.5 mg\/kg (duration of action 1 hour). \u00a0No more than 300 mg (30 cc’s of 1% Lidocaine) at once.<\/li>\n
              • Maximum safe dose of lidocaine with vasoconstrictor is 5-7 mg\/kg (duration of action 2-6 hours)<\/li>\n<\/ul>\n

                How to calculate Maximum safe doseage of Lidocaine<\/h3>\n
                  \n
                • You need to know that 1% Lidocaine solution is 10 mg\/mL<\/span><\/li>\n
                • Example Calculation for a 70 Kg man: \u00a0Lido 1% with Epi: \u00a0keep under 7 mg\/Kg. \u00a07×70 = 490 mg for 70 kg man. \u00a0Divide 490 mg by 10 mg\/ML = 49 ml.<\/li>\n<\/ul>\n

                  How is this important to our Plastic Surgical and Acupuncture practice?<\/h3>\n
                    \n
                  • We use lidocaine in plastic surgical procedures – topical and subcutaneous – for removal of moles, injection of fillers such as Juvederm, and sometimes for Botox.<\/span><\/li>\n
                  • I also use injected \u00a0lidocaine as part of some trigger point deactivation practices in acupuncture.<\/li>\n<\/ul>\n

                    Cosmetic Procedures at Surgical Artistry which may use Lidocaine<\/h2>\n
                      \n
                    • Liposuction – tumescent lidocaine<\/span><\/li>\n
                    • Mole removal – injected subcutaneous local lidocaine<\/li>\n
                    • Fillers – Juvederm – some formulations have lidocaine within the product<\/li>\n
                    • Fillers and Botox – sometimes we use topical lidocaine<\/li>\n
                    • Face Veins – sometimes we use topical lidocaine<\/li>\n
                    • Minor office surgeries – we use injected lidocaine in the subcutaneous level<\/li>\n<\/ul>\n

                       <\/p>\n","protected":false},"excerpt":{"rendered":"

                      Lidocaine Also known as Xylocaine and sometimes Lignocaine Local Anesthetic Antiarrhythmic drug – for ventricular arrhythmias (but Amiodarone is mostly used for this) The first Amino-Amide local anesthetic First marketed in 1949 Alters signal conduction in neurons by blocking the fast voltage gated sodium channels in the neuronal cell membrane. \u00a0Thus prevents depolarization of the […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,9,10,12,6],"tags":[132,133,127,131,130,129,38,42,128],"class_list":["post-357","post","type-post","status-publish","format-standard","hentry","category-acupuncture","category-botox","category-fillers","category-skin-care","category-veins","tag-duration","tag-epinephrine","tag-lidocaine","tag-lidocaine-maximum-dose","tag-maximum-dose","tag-safety","tag-skin-care-2","tag-surgical-artistry","tag-toxicity"],"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/surgerytoday.com\/education\/wp-json\/wp\/v2\/posts\/357","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/surgerytoday.com\/education\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/surgerytoday.com\/education\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/surgerytoday.com\/education\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/surgerytoday.com\/education\/wp-json\/wp\/v2\/comments?post=357"}],"version-history":[{"count":9,"href":"https:\/\/surgerytoday.com\/education\/wp-json\/wp\/v2\/posts\/357\/revisions"}],"predecessor-version":[{"id":1200,"href":"https:\/\/surgerytoday.com\/education\/wp-json\/wp\/v2\/posts\/357\/revisions\/1200"}],"wp:attachment":[{"href":"https:\/\/surgerytoday.com\/education\/wp-json\/wp\/v2\/media?parent=357"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/surgerytoday.com\/education\/wp-json\/wp\/v2\/categories?post=357"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/surgerytoday.com\/education\/wp-json\/wp\/v2\/tags?post=357"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}