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lidocaine: 1 mg/kg initially with continuous infusion of 20-50 mcg/kg/min after, given for refractory VF and pVT [2] [5] magnesium sulfate: 25–50 mg/kg diluted in 10 ml D5W (5% dextrose) and infused over 1–2 minutes, max 2g per dose, given for pulseless torsades de pointes (a type of ventricular tachycardia) [5]
Ventricular tachycardia (V-tach or VT) is a cardiovascular disorder in which fast heart rate occurs in the ventricles of the heart. [3] Although a few seconds of VT may not result in permanent problems, longer periods are dangerous; and multiple episodes over a short period of time are referred to as an electrical storm.
Lidocaine, also known as lignocaine and sold under the brand name Xylocaine among others, is a local anesthetic of the amino amide type. [10] It is also used to treat ventricular tachycardia and ventricular fibrillation .
Antiarrhythmic agents, also known as cardiac dysrhythmia medications, are a class of drugs that are used to suppress abnormally fast rhythms (tachycardias), such as atrial fibrillation, supraventricular tachycardia and ventricular tachycardia. Many attempts have been made to classify antiarrhythmic agents.
However, if a patient is confirmed to be in pulseless ventricular tachycardia "v-tach" or ventricular fibrillation "v-fib", then a shock is delivered immediately upon connection of the pads. In this application, electrical cardioversion is more properly termed defibrillation.
Mexiletine is an oral analogue of lidocaine. [6] It is a class IB antiarrhythmic which shorten the refractory period and action potential duration (APD). Decrease in APD more than that of ERP so there is increase ERP/APD ratio. [3] The drug has a bioavailability of 90%, and peak plasma concentrations are seen after 2–4 hours. [3]
The most common combination of agents used in tumescent anesthesia is lidocaine (0.05-0.10%) and epinephrine (1 ppm). [3] [4] [5] For lidocaine, total doses of 35 mg/kg [6] and 55 mg/kg [7] have been reported as reasonably safe high-end doses, in the context of liposuction.
This is because lidocaine selectively blocks Na channels in their open and inactive states and has little binding capability in the resting state. Class Ib agents are indicated for the treatment of ventricular tachycardia and symptomatic premature ventricular beats, and prevention of ventricular fibrillation.