Lidocaine prior to IV start?

Specialties CRNA

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London88

301 Posts

JessicRN:

I do not know what procedure your husband had but i can assure you that the 0.5cc of lidocaine injected even if it went into the vein by accident would not cause a seizure. Whether it be 1% or 2% lidocaine the dose is not enough to cause a seizure. It takes on average greater than 7mg/kg for lidocaine to cause a seizure. 1cc of 1% lidocaine is only 10mg. Now maybe he had some type of block for his procedure that could cause a seizure after the local anesthetic was injected.

Yoga:

I hope you reconsider as your posts were very informative to SRNAs and to us CRNAs. However I do understand your frustration.

deepz

612 Posts

Specializes in Anesthesia.
it is sad this was a great thread until it got out of control. Guess the moderators were sleeping.

Well...?

My husband had lidocaine used on him to start an IV then to anethetize the area. He had a seizure.

"....Then to anesthetize the area"? Not sure what you mean unless it was a field block with a boatload of local. That might constitute an overdose, but it does take a lot of lido, as noted above.

Our ER does not use lidocaine for IV insertion ever.

1 -- ERs don't start IVs. People do.

2 -- 'Ever' is a long, long time.

deepz

MmacFN

556 Posts

Specializes in I know stuff ;).

I had stopped reading this thread and didnt realize yoga was leaving.

It is upsetting that this could happen. The fellow (im assuming yoga is a guy) has contributed decades of experience and political savvy. The loss of someone such as that may well end the crna forums all togeather.

susswood

144 Posts

My husband had lidocaine used on him to start an IV then to anethetize the area. He had a seizure.

Years ago, I accompanied a good friend to the hospital for her tonsilectomy. She sat in a chair while a resident started her IV. As he inserted the needle, she went pale, eyes rolled back, started to shake, and slumped over. The resident went screaming for a nurse while I stood next to my passed out friend (he thought she had a seizure). Her vagal response was very dramatic, and could have easily been mistaken for a seizure to someone who has never seen a real one. I have often heard people describing people having "seizures" when what is likely going on is vasovagal syncope which is often accompanied by clonic limb jerking.

JessicRN

470 Posts

Years ago, I accompanied a good friend to the hospital for her tonsilectomy. She sat in a chair while a resident started her IV. As he inserted the needle, she went pale, eyes rolled back, started to shake, and slumped over. The resident went screaming for a nurse while I stood next to my passed out friend (he thought she had a seizure). Her vagal response was very dramatic, and could have easily been mistaken for a seizure to someone who has never seen a real one. I have often heard people describing people having "seizures" when what is likely going on is vasovagal syncope which is often accompanied by clonic limb jerking.

It is in his chart , no lidocaine causes seizures I am pretty sure the doctor knows what a seizure is and so do I but your info is appreciated

susswood

144 Posts

lidocaine causes seizures I am pretty sure the doctor knows what a seizure is and so do I

Lidocaine does not cause seizures, unless given in toxic doses (5mg/kg).In fact, IV lidocaine can be used in the treatment of grand mal seizures due to its neuronal membrane stabilizing effects. Assuming your husband is normal sized person, he would have to have gotten about 350mg to cause toxic effects. The typical dose in a lidocaine skin wheal (.1-.5 ml of 1% lidocaine) is 1-5 mg.

I don't know how many seizures you or your husbands doctor has seen, but I have known MANY health care providers to mistakenly identify a "seizure" when it was in fact, not. I even worked with a neurosurgeon who thought my our patient was having a seizure when it was propofol induced myoclonus.

Anyhow, whatever happened, 1-5 mg of Lidocaine would not cause a seizure, and I can assure you that your husband's incident was caused by something else.

London88

301 Posts

5mg/kg of lidocaine w/out epinephrine is the maximum dose. However with epinephrine it is 7mg/kg. That is not to say that a pt cannot seize with the above doses but they would not be toxic from the dose that is given to start an IV.

MmacFN

556 Posts

Specializes in I know stuff ;).

Hey london!

Per AHA 3mg/kg is the max dose of lido. Is that dose related to something else anesthesia related?

5mg/kg of lidocaine w/out epinephrine is the maximum dose. However with epinephrine it is 7mg/kg. That is not to say that a pt cannot seize with the above doses but they would not be toxic from the dose that is given to start an IV.

London88

301 Posts

MmacFan

You are referring to an IV infusion of lidocaine for arrythmias. Go to any anesthesia source and you will see the dose of lidocaine for anesthesia purposes (which is not an intravenous administration) is 4-7 mg/kg. I am talking about the dose for a local infiltration or a peripheral nerve block.

MmacFN

556 Posts

Specializes in I know stuff ;).

hey

thanks london, cool. i dont know anything about the block meds!

good iNFO!

MmacFan

You are referring to an IV infusion of lidocaine for arrythmias. Go to any anesthesia source and you will see the dose of lidocaine for anesthesia purposes (which is not an intravenous administration) is 4-7 mg/kg. I am talking about the dose for a local infiltration or a peripheral nerve block.

JessicRN

470 Posts

Considering the fact that my husband was 240 lb and they had to anethetize his foot several times as the cyst turned out to be a tumor and was deep. Yes they should have stopped and done it under anethesia but they did not. I recieved a copy of his chart and it said medicated with Lidocaine X3 pt develop grandmal seizure lastiing 20 seconds? What looks like a duck quacks like a duck is probably a duck. Yes he probably did get overdose but his chart now says no Lidocaine. He did not tell them to do that either, they wrote it in.We are a little off topic here and it was my fault so I apoligize. Lets get back to Lido to start IV's

skipaway

502 Posts

Considering the fact that my husband was 240 lb and they had to anethetize his foot several times as the cyst turned out to be a tumor and was deep. Yes they should have stopped and done it under anethesia but they did not. I recieved a copy of his chart and it said medicated with Lidocaine X3 pt develop grandmal seizure lastiing 20 seconds? What looks like a duck quacks like a duck is probably a duck. Yes he probably did get overdose but his chart now says no Lidocaine. He did not tell them to do that either, they wrote it in.We are a little off topic here and it was my fault so I apoligize. Lets get back to Lido to start IV's

That makes more sense. I was under the impression that he'd been diagnosed with seizure activity after he received Lidocaine for an IV start. I hope he was ok.

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