icant increases in blood levels with each repeated
dose because of slow accumulation of the drug or its metabolites. Tolerance to elevated blood levels varies with the status of the
patient. Debilitated, elderly patients, acutely ill patients, and children should be given reduced doses commensurate with their age and
physical condition. Lidocaine HCl should also be used with caution in patients with severe shock or heart block.
Lumbar and caudal epidural anesthesia should be used with extreme caution in persons with the following conditions: existing
neurological disease, spinal deformities, septicemia, and severe hypertension.
Local anesthetic solutions containing a vasoconstrictor should be used cautiously and in carefully circumscribed quantities in areas
of the body supplied by end arteries or having otherwise compromised blood supply. Patients with peripheral vascular disease and
those with hypertensive vascular disease may exhibit exaggerated vasoconstrictor response. Ischemic injury or necrosis may result.
Preparations containing a vasoconstrictor should be used with caution in patients during or following the administration of potent
general anesthetic agents, since cardiac arrhythmias may occur under such conditions.
Careful and constant monitoring of cardiovascular and respiratory (adequacy of ventilation) vital signs and the patient’s state of
consciousness should be accomplished after each local anesthetic injection. It should be kept in mind at such times that restlessness,
anxiety, tinnitus, dizziness, blurred vision, tremors, depression or drowsiness may be early warning signs of central nervous system
toxicity.
Since amide-type local anesthetics are metabolized by the liver, Xylocaine Injection should be used with caution in patients with
hepatic disease. Patients with severe hepatic disease, because of their inability to metabolize local anesthetics normally, are at greater
risk of developing toxic plasma concentrations. Xylocaine Injection should also be used with caution in patients with impaired
cardiovascular function since they may be less able to compensate for functional changes associated with the prolongation of A-V
conduction produced by these drugs.
Many drugs used during the conduct of anesthesia are considered potential triggering agents for familial malignant hyperthermia.
Since it is not known whether amide-type local anesthetics may trigger this reaction and since the need for supplemental general
anesthesia cannot be predicted in advance, it is suggested that a standard protocol for the management of malignant hyperthermia
should be available. Early unexplained signs of tachycardia, tachypnea, labile blood pressure and metabolic acidosis may precede
temperature elevation. Successful outcome is dependent on early diagnosis, prompt discontinuance of the suspect triggering agent(s)
and institution of treatment, including oxygen therapy, indicated supportive measures and dantrolene (consult dantrolene sodium
intravenous package insert before using).
Proper tourniquet technique, as described in publications and standard textbooks, is essential in the performance of intravenous
regional anesthesia. Solutions containing epinephrine or other vasoconstrictors should not be used for this technique.
Lidocaine HCl should be used with caution in persons with known drug sensitivities. Patien |
