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Dose & administration
Lidocaine should be administered intravenously and can be diluted in dextrose and normal saline solutions.

Dose per kg varies according to the duration after the first maintenance dose, and depends on the body temperature when administered:

  • Loading dose – 2 mg/kg over 10 minutes
  • Maintenance dose for normothermic infants: The loading dose is followed by 6 mg/kg/hour over 4 hours, 4 mg/kg/hour over 12 hours, and 2 mg/kg/hour over 12 hours.
  • Hypothermic infants: The loading dose is followed by 7 mg/kg/hour over 3.5 hours, 3.5 mg/kg/hour over 12 hours, and 1.75 mg/kg/hour over 12 hours.

Indications
Refractory seizures despite first-line treatments in term infants > 2.5kg.

Contraindications and special considerations (including incompatibilities)
Lidocaine is contraindicated in complete AV block III and wide QRS complex tachycardia. Further, risk factors for cardiotoxicity are unstable potassium serum levels, (congenital) cardiac dysfunction and concurrent phenytoin use.

Should not be used with phenytoin.

Compatible at terminal injection site with aminophylline, ampicillin, caffeine citrate, calcium (chloride and gluconate), dexamethasone, digoxin, dobutamine, dopamine, fentanyl, heparin, hydrocortisone, insulin, micafungin, morphine, penicillin G, potassium chloride, and sodium bicarbonate.

Adverse effects
Arrhytmias (rare).

Pharmacological aspects
Mechanism of action uncertain, probably acts as a membrane stabilizer.

Metabolized in liver into its active metabolites and excreted in urine.

Tends to accumulate in tissues with high blood flow and to redistribute later. T½ 200 minutes. Use should not be longer than the recommended schedule above.

References

  • Anticonvulsant treatment of asphyxiated newborns under hypothermia with lidocaine: efficacy, safety and dosing. Arch Dis Child - Fetal Neonatal Ed. 2013;98(4):F341–F345. PMID 23303304
  • Weeke LC, Toet MC, van Rooij LGM, et al. Lidocaine response rate in aEEG-confirmed neonatal seizures: Retrospective study of 413 full-term and preterm infants. Epilepsia. 2016;57(2):233–242. PMID 26719344
  • Weeke LC, Schalkwijk S, Toet MC, van Rooij LGM, de Vries LS, van den Broek MPH. Lidocaine-Associated Cardiac Events in Newborns with Seizures: Incidence, Symptoms and Contributing Factors. Neonatology. 2015;108(2):130–136. PMID 26111505
  • Lundqvist M, Ågren J, Hellström-Westas L, Flink R, Wickström R. Efficacy and safety of lidocaine for treatment of neonatal seizures. Acta Paediatr. 2013;102(9):863–867. PMID 23738612
  • Slaughter LA, Patel AD, Slaughter JL. Pharmacological treatment of neonatal seizures: a systematic review. J Child Neurol. 2013;28(3):351–364. PMID 23318696

Document version history
Created 2016-10-03 / André M. Graça

  • Upvote 2

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Recommended Comments

There is an additional study I would like to recommend by Weeke et al. They recommend an even lower dose of lidocaine because of PK modelling.

You can read up - for free here: https://onlinelibrary.wiley.com/doi/abs/10.1111/epi.13286

#FOAMNeo

Weight Bolus (mg/kg, 10 min) Infusion I (mg/kg/h) Infusion II (mg/kg/h) Infusion III (mg/kg/h) Duration of infusion (h) Total dosage (mg/kg)
Normothermia            
<2.5 kg 2 6 (4 h) 3 (12 h) 1.50 (12 h) 28 80
≥2.5 kg 2 7 (4 h) 3.5 (12 h) 1.75 (12 h) 28 93
Therapeutic hypothermia            
<2.5 kg 2 6 (3.5 h) 3 (12 h) 1.5 (12 h) 27.5 77
≥2.5 kg 2 7 (3.5 h) 3.5 (12 h) 1.75 (12 h) 27.5 89.5
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