Comparison between effectiveness of intramuscular and intravenous lignocaine on ventricular arrhythmia complicating acute myocardial infarction.

Abstract

Forty-three patients with acute myocardial infarction were treated with lignocaine after developing certain ventricular tachyarrhythmias.Eighteen patients received intravenous treatment: 75 mg as an intravenous bolus immediately followed by an infusion of 2 mg/min, and 25 per cent solution given into the lateral vastus muscle should be investigated for its clinical effect. With this amount of the drug, satisfactory blood levels were achieved from between io to I5 minutes after the injection for up to go to I20 minutes. In the present study intramuscularly administered lignocaine has been compared with intravenously administered lignocaine in patients with ventricular tachyarrhythmia complicating acute myocardial infarction. Subjects and methodsPatients admitted to the coronary care unit because of proven or suspected acute myocardial infarction were taken into the study if they developed ventricular tachyarrhythmia of one or more of the following types: i) _ 5 ventricular ectopic beats/min; 2) paired ventricular ectopic beats; 3) multifocal ventricular ectopic beats; 4) R on T ventricular ectopic beats; and 5) ventricular tachycardia defined as 3 or more ventricular ectopic beats in sequence.

The Pharmacokinetics of Lignocaine and β-Adrenoceptor Antagonists in Patients with Acute Myocardial Infarction

“…Absorption from Intramuscular Sites Intramuscular administration of lignocaine results in rapid and effective antiarrhythmic action (Bellet et al 1971;Bernstein et al 1972;Cohen et al 1972;Fehmers & Dunning 1972;Ryden et al 1973). After intramuscular injection of lignocaine 200 to 300mg, peak concentrations averaging 2.2 to 3.2 mg/L are observed after 10 to 15 minutes, and plasma concentrations remain in the therapeutic range for 1 to 2 hours (Cohen et al 1972;Oltmanns et al 1982;Singh & Kocot 1976).…”

Efficiency of arrhythmia detection by nurses in a coronary care unit using a decentralised monitoring system.

“…A disadvantage of having a continuous electrocardiographic recording is that the nurses may look at the recording during the investigation. Though it cannot be totally ruled out, there are reasons for believing that this was of minor importance: the nurses were not aware that their accuracy was being tested; they were informed that the continuous electrocardiogram was only for purposes connected with the lignocaine study (Ryden et al, 1973), and that there was no reason to look at the continuous electrocardiogram if no arrhythmias were detected while monitoring the TV screens. Furthermore, as earlier indicated, the nurses routinely use a separate electrocardiographic recorder when they observe an arrhythmia on the TV screen needing further analysis.…”

“…Except for this antiarrhythmic treatment, the patients were managed according to the routine procedures of the CCU (Henning and Holmberg, 1971), and thus the demands on the nurses for arrhythmia detection and documentation were the same before and after lignocaine treatment. A detailed description, including pertinent clinical data of the patients, has been presented elsewhere (Ryden et al, 1973(Ryden et al, , 1975b. A multichannel ink-writing electrocardiograph with a paper speed of 10 mm/s (Mingograf-81, Siemens Elema AB, Sweden) was started as soon as the patient received lignocaine and recording was continued for at least 3 hours.…”