Lidocaine and Cardioversion

[Pete495]

Here's a question. If you were giving propofol for a Cardioversion (synchronized), would you mix lidocaine to prevent burning in the IV site? Why or why not?

[MmacFN]

Hey there

When i emergently cardiovert patients I use etomidate. The times I have used diprivan we did not give a lido mix injection and Ive actually not had a patient complain. Most of my cardioversions were in extremis.

When i think about the reasons im cardioverting a patient it is often for the unstable (read: hypotensive) patient. So the clinical situation comes into consideration. Diprivan and lidocaine can cause hypotension not preferable in an unstable patient.

Now an elective cardioversion it seems to be quite common to mix lidocaine with diprivan. I dont know if its the standard but I have seen it done in the EP lab an numerous occasions.

In regards to the finer points of diprivan and lidocaine, i defer to those using the mixture commonly.

Here's a question. If you were giving propofol for a Cardioversion (synchronized), would you mix lidocaine to prevent burning in the IV site? Why or why not?

[yoga crna]

If your concern is pain on injection of propofol, why not try using it in an antecubital vein. I do most of my propofol inductions utilizing an antecubital vein and have never had a patient complain of pain on induction. I know this is not always possible, but when it is, consider it.

[subee, MSN, CRNA]

Hey there

When i emergently cardiovert patients I use etomidate. The times I have used diprivan we did not give a lido mix injection and Ive actually not had a patient complain. Most of my cardioversions were in extremis.

When i think about the reasons im cardioverting a patient it is often for the unstable (read: hypotensive) patient. So the clinical situation comes into consideration. Diprivan and lidocaine can cause hypotension not preferable in an unstable patient.

Now an elective cardioversion it seems to be quite common to mix lidocaine with diprivan. I dont know if its the standard but I have seen it done in the EP lab an numerous occasions.

In regards to the finer points of diprivan and lidocaine, i defer to those using the mixture commonly.

The two or three cc. of lidocaine that you mix with the diprivan are negligible in causing hypotension and not effective, either. If you want to use lidocaine, stop the iv flow and inject a few cc. of lidocaine in the port closest to the vein. Wait a minute and then inject the diprivan through the same port with the IV not running. Flush when you've finished pushing drugs. Don't know why this works except that the lidocaine has more contact time with the vein.

[Pete495]

All good points, but what about the effect of lidocaine as an antiarrythmic before or after your cardioversion? Lidocaine raises your vfib threshold, so I say it's okay to give, but I've been told by MDA's not to give it prior to cardioverting, but all I can see is its helpfulness, so I may be wrong. Nevertheless, I realize the small dose used for injection burning will probably not have much of an effect, however, they are still saying not to use it because it is an antiarrythmic, and it may uneccesarily cause another arrythmia.

[pghfoxfan]

I (an EP nurse) was always told that Diprivan increases Defibrillation Threshold (DFT's). But we still use it for all patients. My husband (who is a anesthetist) says it does not affect conduction time. So, who knows?