Lignocaine

CLASS

  • local anaesthetic and membrane stabilising anti-arrhythmic

MECHANISM OF ACTION

  • binds selectively to refractory Na+ channels -> preferentially when cells are depolarised (ie. in ischaemia)

PHARMACEUTICS

  • clear, colourless solution, 0.5, 1, 1.5, 2% solution for injection of lignocaine hydrochloride (with or without adrenaline)

DOSE

  • bolus: 1mg/kg over 2 min
  • infusion: 4mg/min for 1 hours -> 2mg/min for 1 hour -> 1mg/min for 22 hours

Indications

1. LA
2. Ventricular dysrhythmias

ADVERSE EFFECTS

  • lightheadedness
  • hypotension
  • cardiovascular collapse
  • heart block
  • confusions
  • seizures

PHARMACOKINETICS

  • Absorption
  • Distribution – 70% protein bound, Vd 1L/kg, rapidly distributes to all body tissues
  • Metabolism – high hepatic extraction ratio
  • Elimination – urinary, t1/2 = 2 hrs

EVIDENCE

  • No longer apart of the Australasian Resuscitation Guidelines in Cardiac Arrest

CCC Pharmacology Series

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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