Side effects of lidocaine and cases of overdose. Insidious Lidocaine: friend or foe? Feeling dizzy after lidocaine

Dosage form: injection Compound:

1 ml solution for injection 20 mg/ml contains:

active substance- lidocaine hydrochloride (in terms of anhydrous substance) 20.0 mg;

Excipients- sodium chloride 6.0 mg, sodium hydroxide 1 M solution to pH 5.0-7.0. water for injection up to 1 ml.

Description: Clear colorless or slightly colored liquid. Pharmacotherapeutic group:Local anesthetic ATX:

N.01.B.B Amides

N.01.B.B.02 Lidocaine

C.01.B.B.01 Lidocaine

C.01.B.B Class Ib antiarrhythmic drugs

Pharmacodynamics:It is a short-acting local anesthetic of the amide type. Its mechanism of action is based on a decrease in the permeability of the neuron membrane for sodium ions. As a result, the rate of depolarization decreases and the excitation threshold increases. leading to reversible local numbness. applied in order to achieve conduction anesthesia in various parts of the body and control of arrhythmias. It has a rapid onset of action (about one minute after intravenous administration and fifteen minutes after intramuscular injection), rapidly spreads into the surrounding tissues. The action lasts 10-20 minutes and about 60-90 minutes after intravenous and intramuscular administration, respectively. Pharmacokinetics:

Absorption

Lidocaine is rapidly absorbed from the gastrointestinal tract, but due to the "first pass" effect through the liver, only a small amount of it reaches the systemic circulation.

Systemic absorption of lidocaine is determined by the site of administration and dose. The maximum concentration in the blood is achieved after intercostal blockade, then (in descending order of concentration), after injection into the lumbar epidural space, brachial plexus and subcutaneous tissues. The main factor determining the rate of absorption and concentration in the blood is the total dose administered, regardless of the site of administration. There is a linear relationship between the amount of lidocaine administered and the resulting maximum concentration of anesthetic in the blood.

Distribution

Lidocaine binds to plasma proteins, including ci-acid glycoprotein (AKG) and albumin. The degree of binding is variable, being approximately 66%. The plasma concentration of AKG in newborns is low, so they have a relatively high content of the free biologically active fraction of lidocaine. penetrates the blood-brain and placental barriers, probably through passive diffusion.

Metabolism

Lidocaine is metabolized in the liver, about 90% of the administered dose undergoes N- dealkylation to form monoethylglycine xylidide(MEGX) and glycinexylidide(GX ). both contribute to the therapeutic and toxic effects of lidocaine. Pharmacological and toxic effects MEGX and GX comparable to those of lidocaine. but less pronounced. GX has a longer half-life (about 10 hours) than , and can accumulate with repeated administration.

Metabolites resulting from subsequent metabolism are excreted in the urine.

breeding

The terminal elimination half-life of lidocaine after intravenous bolus administration in healthy adult volunteers is 1-2 hours. Terminal half-life GX is about 10 hours. MEGX - 2 hours.

Special patient groups

Due to its rapid metabolism, the pharmacokinetics of lidocaine may be affected by conditions that impair liver function. In patients with hepatic dysfunction, the half-life of lidocaine may increase by 2 or more times.

Impaired renal function does not affect the pharmacokinetics of lidocaine, but may lead to accumulation of its metabolites.

In newborns, there is a low concentration of AKG, so the connection with plasma proteins may decrease. Due to the potentially high concentration of the free fraction, the use of lidocaine in neonates is not recommended.

Indications: Local and regional anesthesia, conduction anesthesia for large and small surgical interventions. Contraindications:Hypersensitivity to the components of the drug and to amide-type anesthetics; atrioventricular (AV) blockade of the 3rd degree; hypovolemia. Carefully:Lidocaine should be administered with caution in patients with myasthenia gravis, epilepsy, congestive heart failure, bradycardia and respiratory depression, coagulopathy, complete and incomplete blockade of intracardiac conduction, convulsive disorders, Melkersson-Rosenthal syndrome, porphyria, as well as in the third trimester of pregnancy (see . section "Special Instructions"). Pregnancy and lactation:

Fertility

Data on the effect of lidocaine on human fertility are not available.

Pregnancy

Lidocaia is allowed to be used during pregnancy and breastfeeding. It is necessary to strictly adhere to the prescribed dosing regimen. In case of complications or a history of bleeding, epidural anesthesia with lidocaine in obstetrics is contraindicated.

Lidocaine has been used in a large number of pregnant women and women of childbearing age. No reproductive disorders have been registered, ie. there was no increase in the incidence of malformations.

Due to the potential to reach high concentrations local anesthetics the fetus after paracervical blockade may develop adverse reactions, such as fetal bradycardia. In this regard, in concentrations exceeding 1%. not used in obstetrics.

No adverse effects on the fetus have been found in animal studies.

Breast-feeding

Lidocaine passes into breast milk in small amounts, and its oral bioavailability is very low. So the expected amount coming from breast milk, very small, so potential harm very low for a child.

The decision on the possibility of using lidocaine during breastfeeding is made by the doctor.

Dosage and administration:

The dosage regimen should be selected based on the response of the patient and the site of administration. The drug should be administered at the lowest concentration and lowest dose that gives the desired effect. The maximum dose for adults should not exceed 300 mg. The volume of solution to be administered depends on the size of the anesthetized area. If there is a need to administer a large volume with a low concentration, then the standard solution is diluted saline solution(0.9% sodium chloride solution). Breeding is carried out immediately before the introduction.

For children, elderly and debilitated patients, the drug is administered in smaller doses, corresponding to their age and physical condition.

In adults and children 12-18 years of age, a single dose of lidocaine (with the exception of spinal anesthesia) should not exceed 5 mg / kg. at the maximum - 300 mg.

	10 mg/ml	20 mg/ml
Infiltration anesthesia:
Small interventions	2-10 ml (20-100 mg)
Big interventions	10-20 ml (100-200 mg)	5-10 ml (100-200 mg)

Conduction anesthesia	3-20 ml (30-200 mg)	1.5-10 ml (30-200 mg)
Anesthesia of fingers/toes	2-4 ml (20-40 mg)	2-4 ml (40-80 mg)
epidural, lumbar	25-30 ml (250-300 mg)

Caudal, chest block	20-30 ml (200-300 mg)

Regional anesthesia	Not more than 5 ml (50 mg)	Not more than 2.5 ml (50 mg)

Children under 1 year old

Experience in children under 1 year of age is limited. The maximum dose in children aged 1-12 years is 5 mg / kg body weight of a 1% solution.

Co-administration with epinephrine

To prolong the action of lidocaine and reduce its systemic action, it is possible to add ex tempore 0.1% solution of epinephrine in a ratio of 1:100,000 to 1:200,000.

Side effects:

Adverse reactions are described according to system organ classes MedDRA.

Like other local anesthetics, adverse reactions are rare and usually due to elevated plasma concentrations due to accidental intravascular administration, overdose, or rapid absorption from areas with abundant blood supply, or due to hypersensitivity, idiosyncrasy, or reduced patient tolerance. Systemic toxicity reactions are mainly manifested by the central nervous and (or) cardiovascular vascular system(see also section "Overdose").

Violations by immune system: hypersensitivity reactions (allergic or anaphylactoid reactions, anaphylactic shock) - see also skin and subcutaneous tissue disorders. Skin allergy testing is not considered unreliable.

Violations by nervous system and mental disorders: neurological signs of systemic toxicity include dizziness, nervousness, tremor, paresthesia around the mouth. numbness of the tongue, drowsiness, convulsions, coma. Reactions from the nervous system can be manifested by excitation or depression. Signs of stimulation of the central nervous system (CNS) may be short-lived or not occur at all, as a result of which the first manifestations of toxicity may be signs of CNS depression - confusion and drowsiness, followed by coma and respiratory failure.

To neurological complications spinal anesthesia include transient neurological symptoms such as pain in the lower back, buttocks and legs. These symptoms develop. usually within 24 hours of anesthesia and resolve within a few days. After spinal anesthesia with lidocaine and similar agents, isolated cases of arachnoiditis and cauda equina syndrome with persistent paresthesia, bowel and urinary tract dysfunction, or paralysis have been described. lower extremities. Most cases are due to hyperbaric lidocaine or prolonged spinal infusion.

Violations of the organ of vision: Blurred vision, diplopia, and transient amaurosis may be a sign of lidocaine toxicity.

Bilateral amaurosis may also result from accidental insertion into the optic nerve bed during ophthalmic procedures. After retro- and peribulbar anesthesia, inflammation of the eye and diplopia have been reported (see section "Special Instructions").

Violations of the organ of hearing and labyrinth: tinnitus, hyperacusis.

Violations by of cardio-vascular system: cardiovascular reactions are manifested by arterial hypothesia, bradycardia, inhibition of the contractile function of the myocardium (negative inotropic effect), arrhythmias, possible cardiac arrest or circulatory failure.

Violations by respiratory system, organs of the chest and mediastinum: shortness of breath, bronchospasm, respiratory depression, respiratory arrest.

Gastrointestinal disorders: nausea, vomiting.

Skin and subcutaneous tissue disorders: rash, urticaria, angioedema, swelling of the face.

Overdose:

Symptoms:Toxicity from the central nervous system is manifested by symptoms. growing in severity. First, paresthesia around the mouth may develop. numbness of the tongue, dizziness, hyperacusis and tinnitus. Visual impairment and muscle tremors or muscle twitches are indicative of more severe toxicity and precede generalized seizures. Then loss of consciousness and large convulsive seizures lasting from a few seconds to several minutes may occur. Convulsions lead to a rapid increase in hypoxia and hypercapnia due to increased muscle activity and respiratory failure. In severe cases, sleep apnea may develop. Acidosis enhances the toxic effects of local anesthetics. In severe cases, there are violations of the cardiovascular system. At high systemic concentrations, arterial hypotension, bradpcardia, arrhythmia and cardiac arrest can develop, which can be fatal.

Overdose resolution occurs due to redistribution of the local anesthetic from the central nervous system and its metabolism, it can proceed quite quickly (unless a very large dose of the drug has been administered).

Treatment:if there are signs of an overdose, the administration of the anesthetic should be stopped immediately.

Seizures, CNS depression, and cardiotoxicity require medical attention. The main goals of therapy are to maintain oxygenation, stop seizures, maintain adequate circulation and stop acidosis (if it develops). In appropriate cases, it is necessary to ensure the patency of the respiratory tract and prescribe, as well as establish assisted ventilation of the lungs (mask or using an Ambu bag). Maintaining blood circulation is carried out through the influence of plasma or infusion solutions. If long-term circulatory maintenance is required, vasopressors should be considered, but they increase the risk of CNS excitation. Seizure control can be achieved by intravenous administration of diazepam (0.1 mg/kg) or sodium thiopental (1-3 mg/kg). it should be borne in mind that anticonvulsants can also depress breathing and blood circulation. Prolonged seizures may interfere with ventilation and oxygenation of the patient, and therefore early endotracheal intubation should be considered. If the heart stops, start standard cardiopulmonary resuscitation.

The effectiveness of dialysis in the treatment of acute lidocaine overdose is very low.

Interaction:

The toxicity of lidocaine increases with its simultaneous use with cimetidiom and propranolol due to an increase in the concentration of lidocaine, which requires a decrease in the dose of lidocaine. Both drugs reduce hepatic blood flow. In addition, it inhibits microsomal activity.

Ranitidine slightly reduces the clearance of lidocaine, which leads to an increase in its concentration. An increase in the serum concentration of lidocaine can also be caused by antiviral agents (for example, ., lopinavir). Hypokalemia. caused by diuretics, can reduce the effect of lidocaine when they are used simultaneously (see section "Special Instructions").

Lidocaine should be used with caution in patients receiving other local anesthetics or agents structurally similar to amide-type local anesthetics (eg, antiarrhythmics, such as tocainide). since systemic toxic effects are additive. Selected studies drug interaction between lidocaine and class III antiarrhythmics (eg, amiodarone) have not been studied, but caution is advised.

In patients receiving concomitant antipsychotics that prolong or may prolong the OT interval (eg, pimozide, zotepine), prenylamine. (in case of accidental intravenous administration) or serotonin 5-HT3 receptor antagonists (eg, dolasetron), the risk of ventricular arrhythmias may be increased.

The simultaneous use of hipupristin / dalfopristin may increase the concentration of lidocaine and thus increase the risk of ventricular arrhythmias; their simultaneous use should be avoided.

In patients receiving concomitant muscle relaxants (eg, suxamethonium), the risk of increased and prolonged neuromuscular blockade may be increased. After the use of bupivacaip in patients treated with and, the development of cardiovascular insufficiency was reported: it is similar in structure to bupivacaine. and 5-hydroxytryptamia lower the seizure threshold for lidocaine. Opioids are likely to have a proconvulsant effect, which is supported by data that lowers the seizure threshold to fentanyl in humans.

The combination of opioids and antiemetics, sometimes used for sedation in children, may lower the seizure threshold for lidocaine and increase its CNS depressant effect.

The use of epinephrine together with lidocaine may reduce systemic absorption, but the risk increases dramatically with accidental intravenous administration. ventricular tachycardia and ventricular fibrillation.

The simultaneous use of other antiarrhythmics, β-blockers and blockers of "slow" calcium channels can further reduce AV conduction, ventricular conduction and contractility.

The simultaneous use of vasoconstrictors increases the duration of action of lidocaine.

The simultaneous use of lidocaine and ergot alkaloids (eg, ergotamine) can cause severe arterial hypotension.

Care must be taken when using sedatives, as they may interfere with the action of local anesthetics on the CNS.

Caution should be exercised with prolonged use of antiepileptic drugs (), barbiturates and other inhibitors of microsomal liver enzymes. since this may lead to a decrease in efficiency and. as a result, an increased need for vlidocaine.

On the other hand, intravenous administration of phenytoin may increase the inhibitory effect of lidocaine on the heart.

The analgesic effect of local anesthetics may be enhanced by opioids and clonidine.

Ethyl alcohol, especially with prolonged abuse, can reduce the effect of local anesthetics.

Lidocaine is not compatible with amphogericin B. methohexitone and nitroglycerin. With the simultaneous use of lidocaine with narcotic analgesics an additive effect develops, which is used during epidural anesthesia, however, it increases the depression of the central nervous system and respiration.

Vasoconstrictors (, methoxamine.) prolong the local anesthetic effect of lidocaine and may cause an increase blood pressure and tachycardia.

Use with monoamine oxidase inhibitors (, seleginin) probably enhances the local anesthetic effect of lidocaine and increases the risk of lowering blood pressure.

Guanadrel, guanethidine. mecamylamine, trimethaphan camsilate increase the risk of a pronounced decrease in blood pressure and bradycardia.

Anticoagulants (including sodium ardeparin, sodium danaparoid, heparin, etc.) increase the risk of bleeding. reduces the cardiotonic effect of digitoxin.

Lidocaine reduces the effect of antimyasthenic drugs, enhances and prolongs the effect of muscle relaxant drugs.

When treating the injection site with disinfectant solutions containing heavy metals, the risk of developing a local reaction in the form of pain and swelling increases. Mix with others medicines Not recommended.

Special instructions:

Regional and local anesthesia should be carried out by experienced specialists in an appropriately equipped room with the availability of equipment ready for immediate use and preparations necessary for monitoring cardiac activity and resuscitation. Anesthesia personnel. must be qualified and trained in the technique of performing anesthesia, must be familiar with the diagnosis and treatment of systemic toxic reactions, adverse events and reactions and other complications.

It should be used with caution in patients with myasthenia gravis, epilepsy, chronic heart failure, bradycardia, and respiratory depression, and in combination with drugs that interact with lidocaine and lead to increased bioavailability, potentiation of effects (eg, phenytoin), or prolongation of excretion ( for example, in hepatic or terminal kidney failure. at which metabolites of lidocaine can accumulate).

Patients receiving class III antiarrhythmic drugs (for example,) must be carefully monitored and ECG monitoring, since the effect on the heart may be potentiated.

There have been postmarketing reports of chondrolysis in patients who received long-term intra-articular infusion of local anesthetics after surgery. In most cases, chondrolysis was observed in shoulder joint. Due to the many contributing factors and the inconsistency of the scientific literature regarding the mechanism of the effect, a causal relationship has not been identified. Long-term intra-articular infusion is not a valid indication for the use of lidocaine. Intramuscular administration lidocaine may increase the activity of creatine phosphokinase. which can make it difficult to diagnose acute myocardial infarction.

It has been shown to cause porphyria in animals and should be avoided in individuals with porphyria.

When injected into inflamed or infected tissues, the effect of lidocaine may be reduced.

Before starting intravenous administration of lidocaine, it is necessary to eliminate hypokalemia, hypoxia and disturbance of the acid-base state.

Some local anesthesia procedures can lead to serious adverse reactions, regardless of the local anesthetic used.

Conduction anesthesia spinal nerves can lead to depression of the cardiovascular system, especially against the background of hypovolemia, therefore, when performing epidural anesthesia in patients with cardiovascular disorders, care should be taken.

Epidural anesthesia can lead to arterial hypotension and bradycardia. The risk can be reduced by prior administration of crystalloid or colloid solutions. It is necessary to stop arterial hypotension immediately.

In some cases, paracervical blockade during pregnancy can lead to bradycardia or tachycardia in the fetus, and therefore careful monitoring of the fetal heart rate is required (see section "Use during pregnancy and during breastfeeding").

Administration to the head and neck area may result in inadvertent arterial entry with cerebral symptoms, even at low doses.

Retrobulbar injection can rarely enter the subarachnoid space of the skull, resulting in serious/severe reactions including cardiovascular failure, apnea, seizures, and temporary blindness.

Retro- and peribulbar administration of local anesthetics carries a low risk of persistent oculomotor dysfunction. The main causes include trauma and/or local toxic effects on muscles and/or nerves.

The severity of such reactions depends on the degree of injury, the concentration of the local anesthetic and the duration of its exposure in the tissues. In this regard, any local anesthetic must be used at the lowest effective concentration and dose. Lidocaine injection solution is not recommended for use in neonates. The optimal serum lidocaine concentration to avoid toxicity such as convulsions and arrhythmias has not been established in neonates.

Intravascular administration should be avoided unless directly indicated. Use with caution:

In patients with coagulopathy. Therapy with anticoagulants (eg, heparin), nonsteroidal anti-inflammatory drugs (NSAIDs), or plasma expanders increases the tendency to bleed. Accidental damage to blood vessels can lead to severe bleeding. If necessary, check bleeding time, activated partial thromboplastin time (APTT) and platelet count;

Patients with complete and incomplete blockade of intracardiac conduction, since local anesthetics can inhibit AV conduction;

Patients with seizure disorders should be closely monitored for CNS symptoms. Low doses of lidocaine may also increase seizures. In patients with Melkersson-Rosenthal syndrome, allergic and toxic reactions from the nervous system in response to the administration of local anesthetics may develop more often; -Third trimester of pregnancy.

Lidocaine, solution for injection, 10, 20 mg/ml is not approved for intrathecal administration (subarachnoid anesthesia).

Influence on the ability to drive transport. cf. and fur.:Transient desensitization and/or motor block may occur after administration of local anesthetics. Until resolution of these effects, patients are advised not to administer vehicles and work with machinery. Release form / dosage:

Solution for injections 20 mg/ml.

Package:

2 ml in ampoules. 10 ampoules in a cardboard box along with instructions for use and an ampoule scarifier. 5 ampoules in a blister pack. 2 blister packs together with instructions for use and an ampoule scarifier in a pack of cardboard.

When using ampoules with a break point or ring, the ampoule scarifier is not inserted.

Storage conditions:

In a place protected from light at a temperature of 8 ° C to 25 ° C.

Avoid freezing.

Keep out of the reach of children.

Best before date:

Do not use after the expiry date stated on the packaging.

Conditions for dispensing from pharmacies: On prescription Registration number: P N000318/01 Date of registration: 19.11.2007 Expiration date: Perpetual Registration certificate holder:MOSHIMFARMPREPARATY them. N.A. Semashko, OJSC Russia Manufacturer: Information update date: 26.02.2018 Illustrated Instructions

In Omsk, in a children's hospital No. 3, a 10-year-old girl died after an injection of lidocaine. The cause of death is an allergic reaction.

in Moscow in private clinic the victim of lidocaine was a 36-year-old woman. A criminal case was initiated under the article "Illegal exercise medical activities or pharmaceutical activities.

In Kamchatka, investigators are checking the Aphrodite beauty salon where a 32-year-old woman lost her sight after being injected with lidocaine. She was admitted to the hospital with chemical burns to the corneas of both eyes.

At the medical center on Simferopolsky Boulevard in Moscow, 28-year-old Anastasia Chachina, who came to the clinic for liposuction, died. Before the operation, the girl was injected with a solution of lidocaine for pain relief, after which the patient lost consciousness. The doctors could not save Anastasia Chachina. Olga Yegorova, a 35-year-old resident of Ramenskoye, died from an injection of lidocaine in the Moscow region. She came to a small surgical operation. But as soon as the doctor gave the injection, Olga Egorova lost consciousness.

In Essentuki, 17-year-old Irina R. died after an injection of lidocaine. She came to city polyclinic for surgery to remove a mole. Immediately after the injection, she began to have convulsions. A few minutes later, the heart stopped. Another tragedy occurred in one of the private clinics in Pyatigorsk. The doctor applied lidocaine for anesthesia. As a result, 52-year-old Lyubov Yukhnovich began to have convulsions, and after a while her heart stopped.

An allergy test of the anesthetic, which was decided to be used for pain relief during surgery, must be carried out without fail, says allergist Nina Krasilova. -This procedure is called scarification. Three or four bloodless and painless strokes are made on the arm with a sharp instrument, the drug is dripped onto them. And after five minutes, watch the reaction.

But in a number of cases, tests were also made, and the patient was previously familiar with lidocaine. And suddenly death! In the doctor's office medical center In the city of Yakutsk, 40-year-old Christina Gaid, a well-known local journalist, died. She had hearing problems after a cold, and doctor Yevgeny Turkebaev suggested treatment. After an anesthetic injection of lidocaine, Christina Hyde fell into a coma, from which she never came out. But Dr. Turkebaev is an experienced doctor. He does dozens of interventions using lidocaine. Did you get a fake ampoule?

Dmitry Rusakov, husband of Christina Hyde:

Of course, Christina treated her teeth more than once with lidocaine. She was not allergic. After the forensic examination, they told me that she was quite healthy: there were no problems with the brain, heart, or other vital organs. They said that the examination will establish what dose of lidocaine she received. I applied to the ICR with a request to appoint an investigator with experience in investigating such cases.

According to information forensic medical examination the cause of death of Christina Gaid was cardiac arrest, - said Nadezhda Dvoretskaya, senior assistant to the head of the Investigative Department of the TFR in Yakutia.

But here's what's interesting. Since 2002, according to the recommendations of the World Health Organization, which are guided by Russian doctors, tests for lidocaine tolerance are not required. This is simply not necessary, since anaphylactic shock can occur from getting even a few drops of lidocaine under the skin. That is, the use of one of the most common painkillers - lidocaine - is "Russian roulette"? And there is still no antidote that can neutralize its negative effect ...

The medical community has long raised the issue of withdrawing lidocaine from circulation, - lawyer Lyudmila Alatyrtseva continues our conversation. - But still there is no full-fledged replacement for him. And this is used in clandestine laboratories.

Case in the city of Bratsk. The Investigative Committee joined the investigation of the incident, where five children aged from 4 months to 2 years were immediately admitted to intensive care after injections of antibiotics along with lidocaine. There are suggestions that lidocaine was fake.

Investigators are trying to figure out where the batch of lidocaine came from. And is there a connection between the case in Bratsk and the death of people under similar circumstances in other regions? Tragic cases were noted in Moscow, the Moscow region, Essentuki and Pyatigorsk.

During one of the latest special operations "Pharmacologist", which took place throughout the country, a batch of Hungarian-made lidocaine was seized in the Murmansk City Emergency Hospital. The lot number on the vials did not match the number on the packages. There was no certificate. Doctors from Murmansk sent a foreign "gift" to the manufacturing plant in Hungary. From Budapest they sent a conclusion: the drug is fake.

According to the Prosecutor General's Office, 15% of medicines sold in Russia are counterfeit and may pose a health hazard. Counterfeit drugs are not only freely sold in pharmacies, but also become the subject of public procurement of hospitals and clinics. However, not all of these violations end with the withdrawal of the drug from pharmacies and medical institutions.

On the website of Roszdravnadzor there is a section - "Search for drugs withdrawn from circulation." If the drug seems suspicious, the sale is suspended, and the drug is sent for examination. Based on the results of the examination, a decision is made. If everything is fine, it is returned to sale. According to Roszdravnadzor, specialists manage to check only about 16% of all medical preparations that are in circulation. That is why counterfeit drugs are still so at ease on pharmacy shelves. And that's why there are so many deaths from fake lidocaine.

Deputies of the State Duma asked the Ministry of Health to introduce mandatory allergen tests before injections in the provision of medical care. But if the drug is fake, how can these tests play any role?

Experts point out that criminal penalty for the use of counterfeit drugs are very severe. You can get up to 5 years in prison and fines up to two million rubles. But in real life, few people stop them.

Russian hospitals, polyclinics, beauty salons and private practitioners continue to purchase large quantities of lidocaine. What should ordinary patients do and how to replace suspicious lidocaine?

The answer is simple: you need to replace it with another anesthetic, says the doctor, candidate of medical sciences Yevgeny Betin (until recently he headed the psychiatric department at hospital No. 20 in Moscow). - Usually they opt for those medicines that have an anesthetic component in their composition, but at the same time differ in structure from the irritant. This drug may be novocaine. And if the patient has an allergy to lidocaine, or there are doubts about the authenticity of the drug, novocaine will be an excellent choice for a replacement.

Benzocaine can also replace lidocaine ,- considers Doctor of Medical Sciences, Professor Sergey Maksimov. - During orthodontic operations, both lidocaine and benzocaine are used to relieve pain. True, benzocaine is somewhat less water soluble than lidocaine, which means that it does not penetrate the tissues of the oral cavity as easily. However, when using a solution of lidocaine in the form of a gel, only about 30% of the drug gets into the gums. Both of these drugs have slightly different durations of action.

WHAT ARE THE MOST FAKE:

Abactal, ambrosol, amoxiclav, ampicillin, anaprilin, andipal, bisacodyl, bisoprolol, guttalax, dexamed, dexamethasone, detralex, diclofenac, cavinton, calpol, cardicat, cardiomagnyl, ketonal, claritin, levomycetin, lidocaine, lisinopril, linex, metformin, mildronate, nootropil, piracetam, preductal, prozerin, revalgin, triquilar, trichopolum, phenibut, furazolidone, chlorhexidine, chondroxide, cinnarizine.

Overdose of lidocaine - the cause is side effects this drug or its intolerance.

This medication is used for pain relief in various surgical interventions.

Therefore, before any operation, even tooth extraction, it is necessary to inform the doctor about the presence of any allergies to anesthetic drugs.

Description

Lidocaine is an anesthetic medication and is used for anesthesia in various local operations. In addition, the drug is used as an anesthetic if a person is prescribed any painful examination.

Lidocaine is available in several different forms:

solution for injection of various percentages,
gel for external use
spray for topical use,
drops in the eyes.

In medical institutions, as a rule, the drug is used in the form injection solution. Very often it is used in dentistry, for the prevention of disorders of the ventricles of the heart, for anesthesia in various injuries, spinal anesthesia during childbirth.

Action on the body

This drug is considered one of the best remedies that restore heartbeat and eliminate palpitations.

When administered, it begins to act after quite a short time. In this case, numbness of the treated area of the body occurs, the threshold of excitation becomes higher, and blocking of nerve conduction occurs.

The drug easily penetrates into nearby tissues. Its duration is approximately 60 minutes.

Most of the drug is metabolized in the liver and excreted by the kidneys.

Lidocaine easily reacts with other drugs. At the same time, it depresses the action of some of them, and strengthens some. Therefore, before using the medication, it is worth informing the doctor about the drugs taken in order to avoid a negative reaction of the body.

Alcohol intake should also be avoided. The combination of these two substances can cause respiratory arrest and even death.

Contraindications and use of the drug

The use of lidocaine is carried out in two directions - cardiology and anesthesia. In the first case, the indications for use are as follows:

therapy for ventricular arrhythmias,
use of an artificial pacemaker,
glycoside toxicity.

In anesthesia, lidocaine is used:

in surgery
gynecology,
dentistry,
ophthalmology,
blockade of nerve nodes.

It is not worth using injections of the drug at home, this can cause an overdose of lidocaine.

Like any medication, this drug also has certain contraindications.

These include:

drug sensitivity,
muscle weakness,
tumors in the brain
bleeding,
infections of the brain and nervous system.

In addition, the specialist must take into account the age of the patient, his well-being. With caution, the drug is used in people with poor blood clotting, during pregnancy, lactation.

Side effects when using lidocaine:

pain in the head,
dizziness,
loss of consciousness,
change in pressure to a higher or lower side,
nausea, vomiting,
allergies.

Before using this medication, any doctor should clarify with the patient information about his tolerability of lidocaine.

There are frequent cases when the minimum dose can lead to anaphylactic shock, just because the doctor did not ask the patient if he tolerates such anesthesia well.

Lidocaine overdose symptoms and signs

An overdose of lidocaine most often occurs as a result of medical errors.

As a rule, the doctor in this case simply incorrectly calculates the amount of medicine that needs to be administered to the patient.

The symptoms are as follows:

muscle weakness,
dizziness,
limb tremor,
loss of consciousness,
convulsions,
pressure drop,
vomiting, nausea.

If the specialist continues to administer the drug further, then a coma may occur. In addition, a severe overdose is fraught with respiratory arrest and death.

Therefore, an experienced specialist always monitors the condition of his patient during the administration of the drug.

First aid and treatment for overdose

Lidocaine overdose - what to do?

First aid is as follows:

If even the slightest signs are found, the administration of the drug should be stopped immediately.
The victim must be laid on his back.
He needs fresh air.
10 mg of diazepam is administered intravenously.

In case of poisoning with lidocaine at home, a person is also laid down, the windows are opened so that clean air enters. Then you should call a doctor.

With more severe symptoms treatment continues in a medical institution, resuscitation measures are used.

The danger of the drug

The consequences can be quite disappointing. With mild poisoning, a person quickly comes to his senses and recovers.

The danger of severe intoxication lies in the fact that there are violations of the cardiovascular system, brain, nervous system.

The biggest danger is that an overdose of this drug can cause a person's death.

Prevention of overdose with lidocaine is to warn the specialist in time about any contraindications for the use of this medication. In addition, at home, the use of this drug should be minimized, as well as in the presence of allergic reactions for medicine.

An overdose of lidocaine is not a very common occurrence. As a rule, experienced specialists always interview patients before surgery to identify any contraindications to the use of this remedy.

If you find any symptoms of drug poisoning, you should stop using it. In addition, you should not use it yourself at home.

An overdose of Lidocaine is formed when the concentration exceeds 300 mcg. Symptoms of poisoning are associated with disruption of the nervous and cardiovascular systems.

Characteristics of the drug

Lidocaine is available in solution and spray form. Has an anesthetic effect. It is typical for him:

rapid development of the desired effect;
the occurrence of numbness 1 minute after injection;
transformation in the liver;
high absorption rate from the gastrointestinal tract;
limited use in children under 1 year of age.

The maximum daily dose for adults is 0.3 g. If it is exceeded, intoxication develops. At the age of 1 to 12 years, the calculation of the drug is based on body weight, which is equal to 5 mcg / kg. The allowable amount per day is always taken into account. Anesthesia lasts for 10 or 20 minutes. At intravenous use 1 hour.

It enters the systemic circulation during intercostal blockade. Also with the introduction of Lidocaine into the epidural space, into the subcutaneous tissues and the plexus of the shoulder. The main condition providing an overdose is concentration. There is a linear relationship between its amount and the level of the drug in the blood.

Where applicable

The solution is used for regional, local and conduction anesthesia for various medical manipulations. Spray only for superficial. Applicable:

In dental practice:

extraction of teeth;
removal of stones;
mucosal suturing;
establishment of crowns;
anesthesia of the future injection site.

Gynecology:

small interventions on the vagina;
processing of the incision during the dissection of the perineum.

ENT scope:

against the background of electrocoagulation;
nose surgery.

Surgery:

superficial anesthesia of the skin;
when receiving burns, small scratches.

To achieve the effect, it is usually sprayed 2 times. In obstetric practice, they increase to 20. Depends on the indications. One press delivers 4.8 mg.

At the site of use of Lidocaine, there is often a tingling sensation within one minute. Allergic reactions are usually formed on this drug in the form of anaphylactic shock or angioedema.

Contraindications

Use with caution in people with severe pathology of the liver, kidneys, over the age of 60 years. It is forbidden:

Solution: AV blockade of the 3rd degree, the state of hypovolemia.
Spray: removal of tonsils and adenoids in children under 8 years of age.

Not used in the presence of intolerance.

During pregnancy and breastfeeding only as directed by a physician. Studies have noted that lidocaine passes into milk at low concentrations. It does not cause negative effects on the child. Teratogenic effect is not formed.

Mechanism of action

affects permeability. vascular wall, reducing it. As a result, sodium ions do not penetrate. This leads to a decrease in the rate of depolarization. On the contrary, the level of excitability increases. An anesthetic effect is formed, due to the obstacle to the spread of pain impulse along the nerve endings.

Causes of poisoning

Associated with high plasma concentrations of Lidocaine. It directly depends on the amount used. Overdose conditions:

hypersensitivity of the patient himself;
intolerance;
intravascular administration;
application to damaged areas of the skin;
rapid absorption from loci with abundant vascular system;
improper use.

You can only get poisoned by exceeding the permissible level.

The spray bottle must not be opened or heated. The drug should not get into the eyes, Airways. When applied to damaged skin, it is quickly absorbed.

Clinical picture of overdose

Lidocaine poisoning is accompanied by signs of toxic effects on the central nervous system. Characteristic:

numbness of the tongue;
feeling of crawling on the face;
severe dizziness;
increasing tinnitus.

Further symptoms appear with a severe degree. Accompanied by convulsions, respiratory failure. Muscle twitches precede the generalization of the process. Hypoxia progresses rapidly and acidosis develops. It enhances the effect of Lidocaine.

Symptoms from the cardiovascular system are formed at a high concentration of the drug. In the body occurs:

acute and sharp decrease in pressure;
arrhythmic myocardial contractions.

Death occurs from cardiac arrest, cessation of breathing.

An overdose of Lidocaine spray is accompanied by increased sweating, pallor skin, double vision. In severe cases, convulsions are characteristic.

Lethal dose

2 grams. The first signs of intoxication may begin to develop at 0.6 g and above.

First aid

Initial symptoms of poisoning: vomiting, agitation or euphoria, severe dizziness. Stop further use of Lidocaine. Necessary:

Help the victim to take a horizontal position.
Provide fresh air supply.
Take off warm clothes.
Turn sideways.

First aid for overdose is carried out immediately after the onset of these symptoms. It is important to call an ambulance, as there is a risk of developing seizures and cardiac arrest.

Antidote

There is no specific. With the appearance of large or small convulsive seizures, Phenazepam is administered. Cardiac arrest is an indication for resuscitation. Performed by compression chest and artificial respiration. Ratio 15:2.

Diagnostics

It is built on a characteristic clinic and connection with the introduction of Lidocaine. Usually this is enough to determine the principles of treatment. Overdose says:

severe lack of coordination;
convulsions, progressive decrease in pressure;
infrequent thready pulse;
profuse vomiting.

Symptoms come on quickly, within minutes.

Treatment Methods

Directions of therapy for overdose: 100% oxygenation, restoration of normal blood circulation, prevention of convulsive period. Includes:

Ensuring airway patency.
The introduction of drugs that affect the blood vessels. Vasoconstrictors are prescribed.
Use of anticonvulsants.
The use of m-anticholinergics.
Intubation, IVL according to indications.

In violation of the heart: an injection of epinephrine and resuscitation measures. Carrying out in the treatment of dialysis is ineffective.

Possible consequences

2 g of the solution caused the death of the victim. In case of an overdose, dangerous complications can develop:

change in conduction in the heart;
paralysis of muscles, including respiratory;
a sharp drop in blood pressure, which is dangerous by collapse;
severe allergic reactions.

The consequences may be irreversible. Neurological disorders occur with a prolonged state of hypoxia.

Prevention

Comes down to correct application drug. Necessary:

Consider the list of contraindications.
Pay attention to compatibility with other drugs.
Do not use in a child of 1 year of age.
Choose the right dosage.
If allergic, use other anesthetics.

Lidocaine is administered only by trained personnel. Be sure to have a first aid kit.

An overdose of lidocaine has been reported with misuse medicinal product. A similar medication is used as an anesthetic and antiarrhythmic agent.

With the introduction of an increased dosage, a violation of the nervous and cardiovascular systems occurs, adverse consequences develop.

How does an overdose manifest itself, what to do to help the victim?

How does lidocaine work?

Lidocaine is a fairly popular anesthetic. Available in the form of a solution in ampoules, spray, ointment, eye drops. On sale there are gels for teeth that have lidocaine in the composition. In medical institutions, an injection solution and lidocaine spray are used. How does lidocaine affect the human body? The drug has a certain effect, affecting the sensitivity.

Action:

It has an anesthetic effect at the local level, reducing the conduction of a nerve impulse,
Has an overwhelming effect on automatic action purkinje fibers,
Reduces the activity of sites that provoke the development of arrhythmia,
It has a blocking effect on the sodium channels of the membranes of neurons and cardiocytes.

The action of the drug when administered intravenously begins after ninety seconds, when injected into muscle tissue - in the period from five to fifteen minutes. When applying the spray, the desired effect appears fifteen minutes after use. The duration of action can reach one and a half hours. When is the use of lidocaine recommended? The drug is used in medicine in various fields.

Application:

Dental treatment,
Administration of anesthesia for different kind injuries,
Relief of certain pathological processes in the heart muscle,
Use as an anesthetic in various surgical interventions,
Application for interventions on the eyes.

Use with caution medicine in children under eighteen years of age, in adults over 65 years of age. Before use, it is recommended to warn a specialist about the presence of kidney or liver failure, malfunctions in the rhythm of the heart muscle, with a tendency to lower pressure. Lidocaine should not be used in pregnant and lactating women hypersensitivity to the remedy and in cases of occurrence of convulsive reactions in previous times of use.

When does an overdose occur?

What are the reasons for the development of lidocaine poisoning? There are several factors that contribute to the occurrence of drug overdose.

Factors:

Use in case of intolerance to components,
Increased patient sensitivity
Use on damaged areas of the skin,
Introduction into blood vessels
Accelerated absorption from an area with an increased number of vessels,
Inappropriate use.

An overdose is caused by the use of a substance in an increased dosage.

Dosage and symptoms of poisoning

How much lidocaine can be used? The dosage of the drug is selected individually for each patient. It is recommended to administer a minimum of the drug if given quantity allows you to achieve the desired effect.

The maximum volume in adults is no more than 300 (rarely 400) mg for sixty minutes. This is a single allowable dose. The highest rate per day can reach two thousand milligrams.

In children under three years of age, it is allowed to administer no more than 1.25 mg per kilogram of weight no more than four times a day. The maximum allowable value is 4 ml of lidocaine per kg in twenty-four hours. At excess of the specified quantities development of overdose is noted.

Overdose symptoms

How to determine the presence of an overdose? Intoxication with lidocaine is manifested by specific symptoms, signs of disruption of the central nervous system are diagnosed. What do you need to pay attention to?

Signs:

Tingling sensation on the skin around the lips,
Reinforced sweat compartment
Pale upper layer of the epidermis,
Feeling chilly
Lethargy or a state of arousal,
Pain in the head, spinning,
visual impairments,
Tremor of limbs, convulsive manifestations,
Low blood pressure, slow pulse
heart rhythm disorder,
Failures in the respiratory process,
Cardiac arrest, loss of consciousness, death.

The acute form of an overdose manifests itself rather quickly. The risk of poisoning increases with intravenous administration of the drug.

First aid and treatment

In most cases, an overdose develops in a medical facility. However, if symptoms of poisoning are detected from using the drug at home, you must immediately call a team of doctors.

Prior to arrival, the patient is provided with first aid, which includes a number of actions aimed at alleviating the condition.

What to do:

Stop injecting the drug
When applied externally, drugs are washed with cool water,
The patient is provided with rest, laid on a horizontal surface, tight clothing is unbuttoned, and fresh air is supplied.
Arriving doctors explain the situation to them and describe the actions taken (first aid provided).

There is no specific antidote for overdose with this drug. In a similar situation, 30% sodium thiosulfate is used, administered intravenously. Treatment is carried out in a medical institution, the actions are aimed at restoring the normal functionality of the body.

Actions:

Use of a ventilator, intubation,
The introduction of intravenous specific recovery solutions and plasma substitutes,
Anticonvulsants, M-anticholinergics are prescribed.
With a rare heartbeat, atropine is administered.

Overdose treatment is carried out until the full normalization of the functionality of all systems and organs.

When Medical Assistance Is Needed

In case of intoxication with lidocaine, contact medical institution required is required. With absence necessary assistance in case of an overdose, the patient may experience cardiac arrest, death. At some points, an overdose poses a danger to humans.

Dangerous:

impaired coordination, orientation, inhibited state,
Malfunctions of the cardiac system, a sharp change in blood pressure,
breathing problems
Blueness of the skin,
Violation of consciousness.

In such cases, medical assistance in case of an overdose is required.

Consequences and prevention

How does intoxication affect the body? The consequences of an overdose of lidocaine can be serious.

Complications:

violation of the respiratory process,
Development of poor conduction of the heart muscle,
Collapse,
Various allergic manifestations
Fatal outcome.

Overdose can be avoided if lidocaine is used strictly according to the instructions. It is required to choose the right dosage, do not use the drug in the presence of allergic reactions and in children under one year old. The lidocaine solution is administered by experienced staff.

An overdose of lidocaine poses a risk to human body. When signs of poisoning appear, it is necessary to quickly provide the required assistance to the victim and call the doctors.