Lidocaine 2% Epinephrine Normon Dosage
The lowest dosage and volume that results in effective anaesthesia should be used and should be based on the status of the patient and the type of regional anaesthesia intended. Lidocaine 2% Epinephrine Normon contains no antimicrobial agent and should be used only once and any residue discarded.
Lignocaine should be administered with great caution to patients with impaired cardiovascular function as they may be less able to compensate for functional changes associated with the prolongation of AV conduction produced by these drugs.
Adults: See table.
Recommended Doses: The previously suggested concentrations and volumes serve only as a guide. Toxic doses vary widely between patients and toxic effects may occur after any local anaesthetic procedure.
Careful observation of the patient must therefore be maintained. It is recommended that the dose of lignocaine at any one time should not exceed 7 mg/kg. However, the dose administered must be tailored to the individual patient and procedure, and the maximum doses here quoted should be used as a guide only.
Hypotension: During thoracic, lumbar and caudal epidural anaesthesia, a marked fall in blood pressure and/or intercostal paralysis may be seen, possibly due to the use of excessive doses, improper positioning of the patient or accidental disposition of the anaesthetic within the subarachnoid space. Hypotension and bradycardia may occur as a result of sympathetic blockade.
Test Dose: For epidural anaesthesia, a 3-5 mL test dose of a local anaesthetic solution preferably containing up to 15 mcg of adrenaline (eg, 3 mL of Xylocaine 2% with adrenaline 1:200,000) should be administered.
Verbal contact and repeated monitoring of heart rate and blood pressure should be maintained for 5 min after the test dose, after which, in the absence of signs of subarachnoid or intravascular injection, the main dose may be administered.
Use of a test dose containing adrenaline may have further advantages in that an intravascular injection of adrenaline will be quickly recognised by an increase in heart rate, usually within about 40 sec. To detect this, the heart rate and rhythm should be monitored with an electrocardiogram.
Prior to administration of the total dose, aspiration should be repeated. The main dose should be injected slowly, with continual assessment of the patient. If toxic symptoms or signs occur, the injection should be stopped immediately.
Children: A reduced dosage based on bodyweight or surface area should be used. The dosage should be calculated for each patient individually and modified in accordance with the physician's experience and knowledge of the patient.
In order to minimise the possibility of toxic effects, the use of Xylocaine 0.5% or 1% solutions is recommended for most anaesthetic procedures involving paediatric patients.
In children, early signs of local anaesthetic toxicity may be difficult to detect in cases where the block is given during general anaesthesia.
Elderly: A reduction in dosage may be necessary for elderly patients especially those with compromised cardiovascular and/or hepatic function.
In epidural anaesthesia, a smaller dose may provide adequate anaesthesia.
Impaired Hepatic Function: Although lignocaine is metabolised by the liver, dosage reduction for local anaesthesia is probably not warranted. However, caution should be exercised with repeated doses.
Impaired Renal Function: Impairment of renal function is unlikely to affect lignocaine clearance in the short-term (24 hrs). However, toxicity due to accumulation may develop with prolonged or repeated administration.
Lidocaine 2% Epinephrine Normon should be used cautiously in patients with hyperthyroidism, hypertension and cardiac arrhythmias. All vasopressors should be used cautiously in patients taking monoamine oxidase (MAO) inhibitors.
Lidocaine 2% Epinephrine Normon should not be administered concomitantly with other sympathomimetic drugs (such as isoproterenol) because of possible additive effects and increased toxicity.
Combined effects may induce serious cardiac arrhythmias. They may be administered alternately when the preceding effect of other such drug has subsided.
Administration of Epinephrine (Lidocaine (Lidocaine 2% Epinephrine Normon) 2% Epinephrine Normon) to patients receiving cyclopropane or halogenated hydrocarbon general anesthetics such as halothane which sensitize the myocardium, may induce cardiac arrhythmia.. When encountered, such arrhythmias may respond to administration of a beta-adrenergic blocking drug. Lidocaine 2% Epinephrine Normon also should be used cautiously with other drugs (e.g., digitalis, glycosides) that sensitize the myocardium to the actions of sympathomimetic drugs.
Diuretic agents may decrease vascular response to pressor drugs such as Epinephrine (Lidocaine (Lidocaine 2% Epinephrine Normon) 2% Epinephrine Normon).
Lidocaine 2% Epinephrine Normon may antagonize the neuron blockade produced by guanethidine resulting in decreased antihypertensive effect and requiring increased dosage of the latter.
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Information checked by Dr. Sachin Kumar, MD Pharmacology