Prolonged seizures associated with the use of viscous lidocaine

Cardiac arrhythmias in neonates receiving lidocaine as anticonvulsive treatment

“…All infants received an initial loading dose of 2 mg/kg given in 10 min, followed by intravenous infusion of 6 mg/kg per h for 24 h, then tailed off stepwise and stopped within 48 h. It is necessary to rapidly tail off the infusion of lidocaine, as a prolonged administration of the drug may lead to accumulation of lidocaine and the two active metabolites monoethylglycinexylidide and glycinexylidide. This accumulation is held responsible for seizure recurrence [15,17,20]. The lidocaine concentration in blood is linearly correlated with the dose given [16].…”

“…One of the side-effects reported in the literature is recurrent seizure activity after lidocaine administration and this is attributed to accumulation of monoethylglycinexylidide, one of its major metabolites [5,15,17]. There is also one case report of a neonate who developed pupillary mydriasis secondary to a lidocaine overdose [1].…”

Development of an optimal lidocaine infusion strategy for neonatal seizures

“…Reported adverse events of the treatment are recurrent seizure activity [7,18,20], pupillary mydriasis (one case report) [3] and cardiac arrhythmias [21]. Van Rooij et al [21] reported the occurrence of cardiac arrhythmias, mainly in the form of bradycardia, in about 5% of the infants treated.…”

Are One or Two Dangerous? Lidocaine and Topical Anesthetic Exposures in Children

“…Patients may initially display agitation or confusion, that can progress to generalized tonicclonic seizures, respiratory depression, and coma (7). The resultant respiratory acidosis lowers the seizure threshold for local anesthetics and, therefore, lidocaine-induced seizures may be self-perpetuating and prolonged (8).…”

“…The onset of toxic side effects is related to both the concentration and onset of action of the medication used, method of administration, and the accumulation of toxic metabolites (8,11). The onset of action of lidocaine varies depending on the preparation.…”