Anyone still using Lidocaine?

Editorial Team / Admin · Sep 16, 2005

Our cardiac stepdown clinical site rarely uses lidocaine anymore. Amiodarone has just about taken over. Just want to get others' perspectives on the current use of lidocaine. Thanks :)

Yes, we use it, but, less frequently, VickyRN.

In the rural areas here, it is still used VERY frequently.

I am teaching ACLS today and tomorrow. I will have half the physicians who will choose lidocaine.....

VickyRN, MSN, DNP, RN · Sep 16, 2005

Thanks, Siri! I was debating whether to continue its use in my lecture on dysrhythmias. You answered my question!

Editorial Team / Admin · Sep 16, 2005

Hey, Vicky,

I had 10 out of 14 to use Lidocaine today. FYI.:)

RN12345656 · Sep 17, 2005

Hey Vicki!

:redpinkhe

I work on a cardiac surgery stepdown floor in VA. We have been using Amio. ONLY for the last 3 years. Our code carts & Pyxsis are loaded with Lido, but we don't use it for our surgical pts.

When we have cardiac medicine overflow pts, we do use Lido 2/10 times (but that is just preference of the cardiologist.)

:barf01:

I think IV Amio is great, but po Amio is awful..many pts get SO sick with it!! GI upset is common with alot of meds, but po Amio is terrible (even on a full stomach!!!) One thing is for sure--Amio does potentiate coumadin. On some occasions I have seen anticoagulated pts whose PT/INR triples in 24hrs!!

stn2003, RN · Sep 17, 2005

I work on a Cardiac/Step-down unit and we still use Lidocaine up here, but it really depends on the supervising docs preference. I am still in school, and when I went through my cardiac rotation I remember being taught Lidocaine has been phased out, and now only Amio is used. Guess not though : P

Angie O'Plasty · Sep 17, 2005

Hey Vicki!
:redpinkhe
I work on a cardiac surgery stepdown floor in VA. We have been using Amio. ONLY for the last 3 years. Our code carts & Pyxsis are loaded with Lido, but we don't use it for our surgical pts.
When we have cardiac medicine overflow pts, we do use Lido 2/10 times (but that is just preference of the cardiologist.)
:barf01:
I think IV Amio is great, but po Amio is awful..many pts get SO sick with it!! GI upset is common with alot of meds, but po Amio is terrible (even on a full stomach!!!) One thing is for sure--Amio does potentiate coumadin. On some occasions I have seen anticoagulated pts whose PT/INR triples in 24hrs!!

Not only that, but pts who are on amio long-term can have some wicked bad side effects from it--lung damage, thyroid issues (anyone know if that's due to the iodine atoms in the amiodarone molecule?), liver problems, corneal deposits. It also tends to make people more sensitive to the sun and can occasionally cause blue-gray skin discoloration, and the half-life is something ridiculous like six months (not sure of the exact number). I'm not sure if that's so much of a concern with giving it IV for conversion of v-tach etc. as I do know it takes a while to "load" the patient with the drug when going on it long-term; I think it gets stored in fat cells. However, I'd be somewhat concerned that if a patient had a bad reaction to it, it might last a while just because the stuff hangs around so long, assuming enough is actually absorbed into the system on a one-shot deal like that. Does anyone know if that's an issue with using it in this manner? I'd be curious to know. Of course, in that situation one would be more concerned with getting the pt out of v-tach in the most effective way possible; better to be alive and have a yucky reaction than the alternative!

SEOBowhntr · Sep 18, 2005

We still use Lido on occasion, but a lot more Amio. I personally don't care much for Amio, but I think they lined the pockets of the AHA, as they sure did show up in a lot of the algorhythms(sp??) for ACLS all at once. I've seen multiple Pulmonary Toxicity problems causing recurrent pleural effusions, some really bad QT prolongation, (esp. back when we used to use Tequin) and lots of N/V or general malaise from Amio. I've never really liked in and if it were my choice for my own personal prescription, would choose most of the alternatives to Amio. Lido was a very effective and used drug for many years, but IS fading unfortunately.

Doug

Jubei · Sep 23, 2005

Our cardiac stepdown clinical site rarely uses lidocaine anymore. Amiodarone has just about taken over. Just want to get others' perspectives on the current use of lidocaine. Thanks :)

I agree about the Amiodarone. My cardiac unit uses that med, other blockers, and Digoxin mostly.

Dinith88 · Sep 23, 2005

I love amio... If not for some unfortunate side-effects it works very well...i think it's cool that it can tackle both atrial and ventricular dysrhythmias.

We do still use lido. MOst frequently we see it in AMI/ischemia induced PVC's/V-Tach because it's much less prone to causing hypotension (which could really make things BAD in MI/ischemia) than iv-amio loading...

Or...in any other 'short-duration' treatment of PVC's. If the patient's PVC's can be corrected w/(for example)reprofusion (ptca, etc), then it would be innapropriate to load someone on amio and risk the side effects...though i'm sure it's done.

On the other hand, if a patient has issues with chronic dysrhythmias (as seen in cardiomyopathies, Cor-pulmonale, etc...) amio is often-times the best drug...despite the risk of side effects.

In post cabg/valve/etc surgery, our surgeons are 'quick on the draw' with amio. PVC's/A-Fib/whatever, they like a quick resolution to anything that may adversley effect cardiac output... However, i'm not sure if they keep these people on amio long-term????

And in codes...anything goes. Amio-vs-lidocaine??? I'd probably go with amio...again because it can 'cool down' both venticles and atria...an 'all-around' advantage :)

And who cares about side effects if you're trying to keep someone from dying...