DESCRIPTION: The pharmacological/toxicological actions allergic-type reactions including anaphylactic nant hyperthermia should be available. Early formed, the type and amount of drug used, and Xylocaine (lidocaine HCl) Injections are sterile, of these metabolites are similar to, but less symptoms and life-threatening or less severe unexplained signs of tachycardia, tachypnea, the technique of drug administration. Adverse nonpyrogenic, aqueous solutions that contain potent than, those of lidocaine HCl. Approxi- asthmatic episodes in certain susceptible peo- labile blood pressure and metabolic acidosis reactions in the parturient, fetus and neonate a local anesthetic agent with or without epi- mately 90% of lidocaine HCl administered is ple. The overall prevalence of sulfite sensitivity in may precede temperature elevation. Success- involve alterations of the central nervous system, nephrine and are administered parenterally by excreted in the form of various metabolites, the general population is unknown and probably ful outcome is dependent on early diagnosis, peripheral vascular tone and cardiac function. injection. See INDICATIONS for specific uses. and less than 10% is excreted unchanged. The low. Sulfite sensitivity is seen more frequently in prompt discontinuance of the suspect triggering Maternal hypotension has resulted from Xylocaine solutions contain lidocaine HCl, primary metabolite in urine is a conjugate of asthmatic than in non-asthmatic people. agent(s) and institution of treatment, including regional anesthesia. Local anesthetics produce which is chemically designated as acetamide, 4-hydroxy-2,6-dimethylaniline. Anaphylactic reactions may occur following oxygen therapy, indicated supportive measures vasodilation by blocking sympathetic nerves. 2-(diethylamino)-N-(2,6-dimethylphenyl)-, The elimination half-life of lidocaine HCl fol- administration of lidocaine hydrochloride (see and dantrolene (consult dantrolene sodium Elevating the patient’s legs and positioning her monohydrochloride and has the molecular wt. lowing an intravenous bolus injection is typi- ADVERSE REACTIONS). intravenous package insert before using). on her left side will help prevent decreases in 270.8. Lidocaine HCl (C14H22N2O • HCl) has the cally 1.5 to 2 hours. Because of the rapid rate at In the case of severe reaction, discontinue the Proper tourniquet technique, as described in blood pressure. following structural formula: which lidocaine HCl is metabolized, any condi- use of the drug. publications and standard textbooks, is essen- The fetal heart rate also should be monitored tion that affects liver function may alter lidocaine tial in the performance of intravenous regional continuously, and electronic fetal monitoring is CH 3 HCl kinetics. The half-life may be prolonged anesthesia. Solutions containing epinephrine highly advisable. C2H5 PRECAUTIONS: two-fold or more in patients with liver dysfunc- General or other vasoconstrictors should not be used Epidural, spinal, paracervical, or pudendal tion. Renal dysfunction does not affect lidocaine for this technique. anesthesia may alter the forces of parturition NH CO CH2 N • HCl The safety and effectiveness of lidocaine HCl HCl kinetics but may increase the accumulation depend on proper dosage, correct technique, Lidocaine HCl should be used with caution in through changes in uterine contractility or C2H5 of metabolites. adequate precautions, and readiness for emer- persons with known drug sensitivities. Patients maternal expulsive efforts. In one study, para- CH 3 Factors such as acidosis and the use of CNS gencies. Standard textbooks should be con- allergic to para-aminobenzoic acid derivatives cervical block anesthesia was associated with Epinephrine is (-) -3, 4-Dihydroxy-␣- stimulants and depressants affect the CNS sulted for specific techniques and precautions (procaine, tetracaine, benzocaine, etc) have not a decrease in the mean duration of first stage [(methylamino) methyl] benzyl alcohol and levels of lidocaine HCl required to produce for various regional anesthetic procedures. shown cross-sensitivity to lidocaine HCl. labor and facilitation of cervical dilation. How- overt systemic effects. Objective adverse mani- ever, spinal and epidural anesthesia have also has the molecular wt. 183.21. Epinephrine Resuscitative equipment, oxygen, and other Use in the Head and Neck Area (C H NO ) has the following structural formula: festations become increasingly apparent with resuscitative drugs should be available for been reported to prolong the second stage of 9 13 3 increasing venous plasma levels above 6 mcg Small doses of local anesthetics injected into the labor by removing the parturient’s reflex urge to immediate use (see WARNINGS and ADVERSE head and neck area, including retrobulbar, den- OH free base per mL. In the rhesus monkey arterial REACTIONS). The lowest dosage that results bear down or by interfering with motor function. blood levels of 18 to 21 mcg/mL have been tal and stellate ganglion blocks, may produce The use of obstetrical anesthesia may increase in effective anesthesia should be used to avoid adverse reactions similar to systemic toxicity shown to be threshold for convulsive activity. high plasma levels and serious adverse effects. the need for forceps assistance. HO C CH2NHCH3 seen with unintentional intravascular injections Syringe aspirations should also be performed The use of some local anesthetic drug prod- of larger doses. Confusion, convulsions, respira- ucts during labor and delivery may be followed H INDICATIONS AND USAGE: before and during each supplemental injection HO tory depression and/or respiratory arrest, and by diminished muscle strength and tone for the Xylocaine (lidocaine HCl) Injections are indi- when using indwelling catheter techniques. Dur- cardiovascular stimulation or depression have cated for production of local or regional anes- ing the administration of epidural anesthesia, it is first day or two of life. The long-term significance Dosage forms listed as Xylocaine-MPF indi- been reported. These reactions may be due of these observations is unknown. Fetal brady- thesia by infiltration techniques such as per- recommended that a test dose be administered to intra-arterial injection of the local anesthetic cate single dose solutions that are Methyl cutaneous injection and intravenous regional initially and that the patient be monitored for cardia may occur in 20 to 30 percent of patients Paraben Free (MPF). with retrograde flow to the cerebral circulation. receiving paracervical nerve block anesthesia anesthesia by peripheral nerve block techniques central nervous system toxicity and cardiovas- Patients receiving these blocks should have Xylocaine MPF is a sterile, nonpyrogenic, such as brachial plexus and intercostal and by with the amide-type local anesthetics and may isotonic solution containing sodium chloride. cular toxicity, as well as for signs of unintended their circulation and respiration monitored and central neural techniques such as lumbar and intrathecal administration, before proceeding. be associated with fetal acidosis. Fetal heart rate Xylocaine in multiple dose vials: Each mL also be constantly observed. Resuscitative equip- should always be monitored during paracervical caudal epidural blocks, when the accepted When clinical conditions permit, consideration ment and personnel for treating adverse reac- contains 1 mg methylparaben as antiseptic pre- procedures for these techniques as described anesthesia. The physician should weigh the servative. The pH of these solutions is adjusted should be given to employing local anesthetic tions should be immediately available. Dosage in standard textbooks are observed. solutions that contain epinephrine for the test possible advantages against risks when con- to approximately 6.5 (5.0 to 7.0) with sodium recommendations should not be exceeded (see sidering a paracervical block in prematurity, hydroxide and/or hydrochloric acid. dose because circulatory changes compatible DOSAGE AND ADMINISTRATION). CONTRAINDICATIONS: with epinephrine may also serve as a warning toxemia of pregnancy, and fetal distress. Careful Xylocaine MPF with Epinephrine is a ster- Lidocaine HCl is contraindicated in patients adherence to recommended dosage is of the ile, nonpyrogenic, isotonic solution containing sign of unintended intravascular injection. An Information for Patients with a known history of hyper sensitivity to local intravascular injection is still possible even if When appropriate, patients should be informed utmost importance in obstetrical paracervical sodium chloride. Each mL contains lidocaine in advance that they may experience temporary block. Failure to achieve adequate analge- hydrochloride and epinephrine, with 0.5 mg anesthetics of the amide type. aspirations for blood are negative. Repeated doses of lidocaine HCl may cause significant loss of sensation and motor activity, usually sia with recommended doses should arouse sodium metabisulfite as an antioxidant and 0.2 in the lower half of the body, following proper suspicion of intravascular or fetal intracranial mg citric acid as a stabilizer. Xylocaine with WARNINGS: increases in blood levels with each repeated XYLOCAINE INJECTIONS FOR INFILTRATION dose because of slow accumulation of the drug administration of epidural anesthesia. injection. Cases compatible with unintended Epinephrine in multiple dose vials: Each mL fetal intracranial injection of local anesthetic also contains 1 mg methylparaben as antisep- AND NERVE