title: Lignocaine for seizures - Neonatal Intensive Care Drug Manual
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  Neonatal Intensive Care Drug Manual
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  bet | 336/654 | Sana | 03.01.2022 | Hajmi | 1,5 Mb. | | #14803 |
  Lignocaine for seizures
  Revision Date : 27/02/2018
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  Approved: TC, KOH
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  Indication :
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  Persistent clinical and/or electrical seizure activity
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  Dose :
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  Loading dose – 2 mg/kg over 10 minutes
  6 mg/kg/hour for 6-12 hours depending on seizure response
  4 mg/kg/hour for 12 hours
  2 mg/kg/hour for 12 hours
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  Interval :
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  Infusion
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  Route :
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  IV
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  Total Daily Dose :
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  Note - levels above 9mg/L are less often encountered when 6mg/kg/hour is used for 6 hours rather than 12 hours.
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  Comments :
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  Lignocaine stabilises all potentially excitable membranes and prevents the initiation and transmission of nerve impulses. Lignocaine is metabolised in the liver. Metabolites (which may be possess activity) are renally excreted. Phenytoin, phenobarbitone, primidone and carbamazepine appear to enhance the metabolism of lignocaine possibly due to an induction of microsomal enzymes, but the significance is unknown. Phenytoin and lignocaine have additive cardiac depressant effects. Constant ECG monitoring is essential during intravenous administration of lignocaine. If signs of excessive depression of cardiac conductivity (e.g. prolongation of the PR interval or QRS complex), aggravation of arrhythmias or other severe reactions occur, lignocaine should be promptly discontinued. Patients with reduced hepatic blood flow or function, and those on prolonged infusions of lignocaine will have a longer half-life and a lower clearance. During congestive cardiac failure, clearance will be reduced and in renal failure, accumulation of lignocaine may occur. Such instances will require a reduction in dosage. Lignocaine may increase ventricular rate when it is administered to patients with atrial fibrillation. Ischaemia or necrosis may occur in patients with hypertensive vascular disease or with an exaggerated vasoconstrictor response. Contraindications: Known hypersensitivity to local anaesthetics of the amide type. Use with caution in hepatic disease, renal disease, congestive cardiac failure, marked hypoxia, severe respiratory depression, severe shock or hypovolaemia. Hypokalaemia, hypoxia and disorders of acid/ base balance should be corrected before treatment with lignocaine.
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  Supplied as :
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  Lignocaine Injection 100 mg/mL Steriamps (clear, colourless, sterile)
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  Dilution :
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  Bolus solution: dilute 2mL of 100mg/mL solution to 25mL to give an 8mg/mL solution. Take 1mL of this dilution and dilute with 7mL 0.9% sodium chloride to give a 1mg/mL solution. Give over 10 minutes.
  Infusion syringes: prepared in pharmacy containing 8mg/mL solution. If prepared after hours in the unit dilute 2mL of lignocaine 100mg/mL to 25mL with 0.9% sodium chloride to give an 8mg/mL solution.
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  Stability :
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  Steriamps for single use only. Discard unused portion. Infusion syringes are stable for 48 hours once prepared, but may only be used on patient for 24 hours.
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  Storage :
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  Steriamps: store below 25 deg. C. Infusion syringes: store in refrigerator until required for use, maximum of 24 hours at room temperature.
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  Compatibility :
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  0.9% sodium chloride, 5% Dextrose,10% Dextrose Compatible at the Y site only: amiodarone, ampicillin, caffeine citrate, calcium chloride, calcium gluconate, cefazolin, cefoxitin, cimetidine, dexamethasone, digoxin, dobutamine, dopamine, fentanyl, flumazenil, furosemide, heparin, hydrocortisone succinate, insulin, linezolid, morphine, nitroglycerin, penicillin G, potassium chloride, ranitidine, sodium bicarbonate, and sodium nitroprusside.
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  Incompatibility :
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  Milrinone, Phenobarbitone, Phenytoin,
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  Serum Levels :
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  Lignocaine levels are not performed at TCH. If required they can be sent away to RNS, ring specimen referrals on 42845. Levels above 9mg/L are associated with cardiac toxicity in adults, but there is little information regarding levels in neonates.
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  References:
  Lignocaine. In: NeoFax® System (electronic version). Truven Health Analytics, Greenwood Village, Colorado, USA. Available at: http://www.micromedexsolutions.com/ (cited: 06/03/2018).
  Lilley L, Legge D. Paediatric Injectable Guidelines.5th ed. Flemington, Vic: The Royal Children’s Hospital;2016
  Taketomo CK, Hodding JH, Kraus DM. Lexicomp® Pediatric & neonatal Dosage Handbook with International Trade Names Index. 24th ed. USA: Wolters Kluwer;2017
  Original version Date: 2014
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  Author: Neonatal Medicines Formulary Consensus Group
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  Current Version number: 2
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  Version Date: 24/11/2017
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  Risk Rating: Low
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  Due for Review: 24/11/2022
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  Approved by: DTC
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  Approval Date: TBA
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