Bedside Snapshot

Use It For
Shock-refractory VF/pulseless VT; recurrent ventricular arrhythmias (second-line); local and regional anesthesia; IO infusion pain in awake patients
Adult Dose
  • VF/pVT: 1–1.5 mg/kg IV/IO, then 0.5–0.75 mg/kg. Differs from FDA label: bolus 50–100 mg (0.70–1.4 mg/kg)
  • Infusion: 1–4 mg/min
  • Infiltration: 4.5 mg/kg (max 300 mg) plain, 7 mg/kg (max 500 mg) with epinephrine, ideal weight
Pediatric Dose
VF/pVT: 1 mg/kg IV/IO, then 20–50 mcg/kg/min (no more than 20 in shock, heart failure or cardiac arrest). IO pain: 0.5 mg/kg (max 40 mg). Infiltration: same mg/kg limits on ideal weight, never above the adult max
Onset / Duration
IV/IO: within minutes; a bolus wanes within about 15 min; start an infusion if ongoing suppression is needed (not routine after ROSC). Infiltration: rapid; epinephrine slows absorption
Do Not Give / Hold If
Amide anesthetic allergy; Stokes-Adams, WPW or severe SA/AV block without a pacer; bradycardic escape rhythm. Stop for PR or QRS widening or CNS signs
Watch For
CNS toxicity: perioral numbness, tinnitus, metallic taste, then seizures; bradycardia, hypotension, wide QRS (ECG); methemoglobinemia (cyanosis, low SpO₂)
Reversal / Rescue
No antidote. LAST: stop lidocaine, oxygen, benzodiazepine for seizures; 20% lipid ~100 mL bolus if over 70 kg, 1.5 mL/kg if under 70 kg, then infusion (max ~12 mL/kg); epinephrine under 1 mcg/kg in arrest
Must Remember
Toxicity is cumulative: count IV, IO, local and topical milligrams together against the lowest applicable maximum. Infusions accumulate, so halve the rate after 24 hr

Indications

Emergency & Prehospital

  • Shock-refractory VF/pulseless VT: after defibrillation and epinephrine. AHA 2025 says lidocaine or amiodarone may be considered (adults COR 2b, B-R, children COR 2b, C-LD)
  • Recurrent polymorphic VT without QT prolongation (adults): IV lidocaine, amiodarone and measures to treat myocardial ischemia may be considered (AHA 2025 Part 9, COR 2b, C-LD)
  • Pain from IO infusion in an awake patient: preservative-free 2% lidocaine through the IO catheter before the flush (off-label; manufacturer guidance)
  • After ROSC from VF/pVT: Not routine. AHA 2025 Parts 9 and 11 make no post-ROSC lidocaine recommendation. If VF/pVT comes back, treat it then
  • Local anesthesia: wound infiltration and minor procedures

ED / ICU / Transport

  • Recurrent life-threatening ventricular arrhythmias: FDA-labeled IV use, as in acute MI or cardiac surgery. Bolus, then infusion. Prophylaxis in acute MI is not routine, because prophylactic lidocaine has little or no effect on mortality or VF. Sustained or recurrent VT/VF is what you treat
  • Electrical storm or ischemic VT: usually the second drug, added to amiodarone. Ischemic myocardium is where it works best (specialist decision)
  • Toxic wide-complex rhythms (AHA 2025 Part 10): lidocaine is reasonable for cocaine-associated wide-complex tachycardia or arrest (adults COR 2a, C-LD; children COR 2a, C-EO); it may be reasonable for life-threatening cardiotoxicity from class Ia or Ic sodium-channel blockers (COR 2b, C-EO) and for digoxin-related ventricular arrhythmias until digoxin-Fab is given (COR 2b, C-EO)
  • Regional anesthesia: peripheral nerve blocks, IV regional anesthesia (Bier block), epidural

Other Uses

  • Topical mucosal and airway anesthesia: jelly, viscous solution, spray
  • IV analgesic infusion: specialist perioperative protocols only (off-label). Lidocaine toxicity now commonly comes from this use
Stable Monomorphic VT: Lidocaine is not the first pick here. AHA 2025 Part 9 (COR 2b, B-R) names IV procainamide, amiodarone or sotalol for adults with wide-complex tachycardia, and lidocaine is not on that list. Part 9 finds its kinetics less effective for VT at tolerated rates than those three. Whether it beats placebo is unclear. Keep it as a second-line or ischemic-VT option. Unstable? cardiovert.

Dosing & Administration

The doses below follow AHA 2025 and the FDA labels. Where your agency's approved protocol differs, follow that protocol.

Available Forms

  • Prefilled syringe (antiarrhythmic): 20 mg/mL in 5 mL (100 mg), the form EMS and transport usually carry; also 10 mg/mL in 5 mL (50 mg).
  • Premixed infusion in D5W: 4 mg/mL in 500 mL (2 g) and 8 mg/mL in 250 mL (2 g).
  • Local anesthetic: 1% (10 mg/mL) and 2% (20 mg/mL), including preservative-free 2% 40 mg/2 mL ampuls; multiple-dose vials contain methylparaben. With epinephrine 1:100,000 or 1:200,000 (contains a sulfite).
  • Topical: viscous 2% oral solution (20 mg/mL), jelly, spray.
High-Alert Medication: The traps: 1% (10 mg/mL) versus 2% (20 mg/mL). Losing track of the cumulative dose. Adult mg/min versus pediatric mcg/kg/min infusions. Not halving the rate after 24 hr. Use premixed bags on a smart pump, and double-check concentration, rate and total dose independently.

Adult Dosing

IndicationDose & RouteRepeat / MaxNotes
VF/pulseless VT (shock-refractory)
1–1.5 mg/kg IV/IO push
AHA 2025: second dose 0.5–0.75 mg/kg. Max 200–300 mg in 1 hr (label)
High-alert AHA 2025: amiodarone 300 mg, then 150 mg, or lidocaine (COR 2b, B-R). IV first; IO if IV fails. Differs from FDA label: the label bolus is 50–100 mg (0.70–1.4 mg/kg) at 25–50 mg/min and does not address cardiac arrest.
Ventricular arrhythmia with a pulse (second-line)
1–1.5 mg/kg (usually 50–100 mg) IV at 25–50 mg/min
Repeat once after 5 min if needed; max 200–300 mg in 1 hr
High-alert Continuous ECG. Follow with an infusion. Cardiovert if unstable.
Maintenance infusion
1–4 mg/min IV (fixed adult rate; about 0.02–0.05 mg/kg/min in a 70 kg adult)
Max 4 mg/min; halve the rate after 24 hr
High-alert Rarely needed beyond 24 hr. Lower rate in liver disease, heart failure, shock, eGFR <30.
Local infiltration and nerve block
Lowest effective dose of 0.5–2% solution
Plain: 4.5 mg/kg (max 300 mg). With epinephrine: 7 mg/kg (max 500 mg)
Calculate on ideal body weight; cut 20–40% with risk factors (Special Populations). Aspirate, then inject in increments.
IO infusion pain, awake patient (off-label)
40 mg (2 mL of 2%) IO over 120 sec; dwell 60 sec; flush 5–10 mL NS
Then 20 mg IO over 60 sec as needed; count every dose toward the total lidocaine dose
Preservative-free, epinephrine-free 2% only. Prime the extension set (about 1 mL). Systemic analgesia if no relief.
IV regional anesthesia (Bier block)
0.5% plain solution
Max 4 mg/kg
Never with epinephrine; correct tourniquet technique is essential.

Pediatric Dosing

IndicationDose (per kg) & RouteMax Single / Max TotalNotes
VF/pulseless VT
1 mg/kg IV/IO loading dose
Never above the adult dose
High-alert PALS 2025 (COR 2b, C-LD): amiodarone 5 mg/kg or lidocaine 1 mg/kg.
Maintenance infusion
20–50 mcg/kg/min IV/IO
Max 50 mcg/kg/min; max 20 mcg/kg/min in shock, heart failure or after cardiac arrest
High-alert No controlled pediatric studies. The Hospira label (2026) cites AHA for a 1 mg/kg bolus and 20–50 mcg/kg/min; PALS 2025 gives the 1 mg/kg bolus but no infusion rate.
IO infusion pain (off-label)
0.5 mg/kg IO over 120 sec; dwell 60 sec; flush 2–5 mL NS
Max 40 mg first dose; repeat half the first dose (max 20 mg) over 60 sec
Preservative-free, epinephrine-free 2% only.
Local infiltration
Lowest effective dose; dilute solutions
Up to 4.5 mg/kg plain or 7 mg/kg with epinephrine (ideal body weight); never above the adult max
Label example: 75–100 mg (3.3–4.4 mg/kg) for a 23 kg 5-year-old. Reduce by 20% under age 1.
IV regional anesthesia
0.25–0.5% plain solution
Max 3 mg/kg
—
Infants under 6 months
Lowest effective dose; local infiltration and nerve blocks (LP, penile block) are routine
Infiltration max reduced by at least 20% (age under 1 is a LAST risk factor)
More prone to methemoglobinemia: watch SpO₂ and color; co-oximetry if cyanotic. Resuscitation doses per PALS.

See weight-based dosing and pediatric cardiac arrest.

Continuous Infusion

SettingExample ConcentrationStartTitrateUsual Range / Max
Adult
Premix 4 mg/mL (2 g/500 mL) or 8 mg/mL (2 g/250 mL) D5W (example, institution-specific)
1–4 mg/min after the bolus
To rhythm control and toxicity; halve after 24 hr
4 mg/mL: 15–60 mL/hr; 8 mg/mL: 7.5–30 mL/hr (1–4 mg/min)

Preparation & Administration

  • Bolus: 20 mg/mL syringe undiluted. With a pulse, give at 25–50 mg/min under ECG monitoring; in arrest, push and flush.
  • Infusion: premixed bag on a calibrated pump; add nothing to the premix.
  • Infiltration: aspirate before each injection; inject slowly in increments. No methylparaben vials for epidural or spinal use.
  • Line: Never through a blood transfusion set. Pseudoagglutination and hemolysis follow.
  • Endotracheal (ET): Older teaching only. Current AHA adult guidance says IV first, IO if IV fails. Use ET lidocaine only if your local protocol specifies a dose.

Renal and hepatic considerations: see Special Populations.

Contraindications & Precautions

Contraindications

  • Hypersensitivity to amide local anesthetics
  • IV antiarrhythmic use: Stokes-Adams syndrome, Wolff-Parkinson-White (WPW) syndrome, or severe sinoatrial, AV or intraventricular block without a pacemaker
  • Viscous oral solution for teething pain in young children

Precautions

  • Sinus bradycardia or incomplete heart block: ventricular ectopy may be protective. Raise the rate first (atropine, isoproterenol, pacing), or lidocaine may cause complete heart block.
  • Atrial fibrillation or flutter: the ventricular rate may speed up.
  • Liver disease, heart failure, shock, hypovolemia: clearance slows. Lower the doses and rates.
  • Methemoglobinemia risk: G6PD deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, infants under 6 months, oxidizing drugs.
  • Malignant hyperthermia susceptibility: MHAUS lists all local anesthetics as safe in MH-susceptible patients. Labels still advise having a standard MH protocol (dantrolene) available when general anesthesia may be needed.
  • Epinephrine-containing solutions: caution in end-artery areas and with sulfite sensitivity.

Hold / Reassess If

  • PR prolongation, QRS widening, or new or worsening arrhythmia: stop the infusion
  • Perioral numbness, metallic taste, tinnitus, confusion or twitching: stop and assess for toxicity
  • Symptomatic bradycardia or hypotension
  • Lidocaine level above 6 mcg/mL: reduce or stop
FDA Boxed Warning: Only the Lidocaine Viscous 2% oral solution carries this warning. In children under 3, the risks are seizures, cardiopulmonary arrest and death when it is not dosed exactly as directed. Not for teething pain. Injectable labels carry no boxed warning.
Toxicity May Skip the Warning Signs: The excitatory phase can be brief, or it can be absent. Then the first sign may be drowsiness, a seizure or cardiovascular collapse.

Adverse Effects & Toxicity

Common

  • Perioral numbness and tingling, metallic taste
  • Lightheadedness, dizziness, drowsiness
  • Tinnitus, blurred or double vision
  • Nausea and vomiting
  • Minor CNS symptoms in about 7% of IV analgesic infusions

Serious / Life-Threatening

EffectRecognitionManagement
Seizures, coma
Twitching, tremor, then convulsions; respiratory depression
Stop lidocaine; airway and oxygen; benzodiazepine
Cardiovascular depression
Bradycardia, hypotension, wide QRS, VF or asystole
Stop; ACLS with modified drugs; 20% lipid emulsion
Methemoglobinemia
Cyanosis or low SpO₂ not corrected by oxygen; may be delayed hours
Stop; oxygen; co-oximetry; methylene blue if severe
Anaphylaxis
Rare; urticaria, edema, shock
Epinephrine; standard anaphylaxis care

Overdose & Toxicity Management

  • Signs: CNS excitation then depression, followed by bradycardia, hypotension, wide QRS, ventricular arrhythmias and arrest.
  • Antidote: none specific. The rescue for local anesthetic systemic toxicity (LAST) is 20% lipid emulsion. Dialysis is of negligible value.

Local Anesthetic Systemic Toxicity (LAST): ASRA 2020 Checklist and AHA 2025 Part 10

  1. Stop the lidocaine and call for help: get the lipid emulsion and the LAST checklist.
  2. Airway: 100% oxygen and ventilation; hypoxia and acidosis worsen toxicity.
  3. Seizures: benzodiazepines should be used (AHA 2025 Part 10, COR 1, C-LD): midazolam or lorazepam; if only propofol is available, give low doses (e.g., 20 mg increments).
  4. Lipid emulsion 20%: give early for life-threatening toxicity (AHA 2025 Part 10, COR 1, C-LD); dosing in the table below. Use 20% emulsion only: propofol (10% emulsion) would give 10 to 20 times the induction dose.
  5. Arrest: LAST resuscitation differs from standard ACLS. High-quality CPR; epinephrine in smaller than normal doses (start with less than 1 mcg/kg). Avoid vasopressin, calcium channel blockers, beta-blockers and other local anesthetics (including lidocaine and procainamide).
  6. Arrhythmias (AHA 2025 Part 10): sodium bicarbonate is reasonable for life-threatening wide-complex tachycardia (COR 2a, C-EO). The ASRA checklist names no antiarrhythmic drug.
  7. Refractory: alert a center for cardiopulmonary bypass or ECMO early; AHA 2025 Part 10 says ECLS, including VA-ECMO, is reasonable for refractory cardiogenic shock (COR 2a, C-EO).
20% lipid emulsion for LAST, per the ASRA 2020 checklist and AHA 2025 Part 10 Table 4
PatientBolusInfusionStill Unstable
Over 70 kg
About 100 mL over 2–3 min
200–250 mL over 15–20 min
Repeat the bolus; double the infusion
Under 70 kg, including children
About 1.5 mL/kg over 2–3 min
About 0.25 mL/kg/min for up to 30 min; consider a pump if under 40 kg
Repeat the bolus; double the infusion (about 0.5 mL/kg/min)

Keep the lipid going for at least 15 min after hemodynamic stability, and never exceed about 12 mL/kg. Then observe: at least 2 hr after a seizure, 4–6 hr after cardiovascular instability, and as appropriate after cardiac arrest. Poison control: 1-800-222-1222.

Monitoring
ParameterWhen / How OftenTarget / Act If
Clinical: ECG
Continuous with any IV or IO antiarrhythmic dose
PR prolongation, QRS widening, new arrhythmia: stop the infusion
Clinical: BP and HR
Every 5 min during a bolus; regularly on infusion
Symptomatic bradycardia or hypotension: stop; atropine, pacing, vasopressor
Clinical: neurologic status
After each bolus, IO dose or local injection; hourly on infusion
Perioral numbness, tinnitus, confusion, twitching: stop; treat as early LAST
Clinical: SpO₂ and ventilation
Continuous after large or repeated doses
Low SpO₂ with cyanosis despite oxygen: methemoglobin by co-oximetry (blood gas)
Drug levels: lidocaine
Infusions over 24 hr, liver disease, heart failure, or suspected toxicity
Therapeutic 1.5–6 mcg/mL; above 6 mcg/mL: reduce or stop
Laboratory: liver panel, renal function
Baseline before an infusion
Hepatic impairment or eGFR <30: lower maintenance rate
Infusion safety: rate and total dose
Every handoff; at 24 hr
Halve the rate at 24 hr; document cumulative mg from every route

Interactions & Compatibility

Clinically Significant Interactions

Drug / ClassEffectWhat To Do
Other local anesthetics (bupivacaine, ropivacaine, tetracaine, topical lidocaine)
Additive systemic toxicity
Add up the total dose; monitor for LAST
Amiodarone, procainamide, phenytoin, propranolol
Additive or antagonistic cardiac effects; additive toxicity. Phenytoin, a CYP1A2/CYP3A4 inducer, may also lower lidocaine levels
Continuous ECG; watch for CNS toxicity; with phenytoin, higher lidocaine doses may be needed
Digoxin (digitalis toxicity)
Label caution when digitalis toxicity comes with AV block or a supraventricular arrhythmia
Use with caution; continuous ECG; monitor for toxicity. AHA 2025 (COR 2b, C-EO): lidocaine or phenytoin may be reasonable for digoxin ventricular arrhythmias until digoxin-Fab is given
Beta-blockers, cimetidine
Less hepatic blood flow and clearance; cimetidine raises levels 24–75% (Baxter label)
Lower infusion rates; monitor for toxicity
CYP1A2/CYP3A4 inhibitors (fluvoxamine, propofol)
Fluvoxamine cuts lidocaine clearance 41–60% (Baxter label); propofol raises levels
Monitor for toxicity; reduce dose
Oxidizing drugs (nitrates, nitroprusside, nitrous oxide, dapsone, sulfonamides, primaquine)
Methemoglobinemia
Monitor SpO₂ and color; co-oximetry if cyanotic
MAOIs, tricyclics, nonselective beta-blockers, ergots (with epinephrine-containing lidocaine)
Severe hypertension; bradycardia with nonselective beta-blockers
Avoid; use plain lidocaine or monitor closely

IV Compatibility

  • Diluent: supplied premixed in D5W. Add nothing to the premix.
  • Incompatible: amphotericin, cefazolin and phenytoin (precipitate).
  • Do not infuse through blood transfusion sets or with other drugs in the same tubing until compatibility is confirmed.
  • Verify with an institutional compatibility resource.

Special Populations
  • Pediatrics: There are no controlled pediatric studies. The antiarrhythmic labels give AHA dosing, and PALS dosing is the standard in arrest. Age under 1 is a LAST risk factor. See the Pediatric Dosing table.
  • Neonates: Under 6 months, infants are more prone to methemoglobinemia. Viscous oral lidocaine carries a boxed warning for children under 3.
  • Pregnancy: Decades of use have not identified a drug-associated risk of birth defects or miscarriage. It crosses the placenta. Regional blocks can cause maternal hypotension and fetal bradycardia. In maternal arrest, use standard doses.
  • Lactation: It passes into milk in low amounts (milk-to-plasma ratio 0.4–1.1), and it is poorly absorbed by mouth. No consistent harm has been reported. Breastfeeding may continue.
  • Older Adults: Start at the low end, because clearance is slower. Age over 70 is a LAST risk factor.
  • Renal Impairment: The premix label calls for no change if mild or moderate. With eGFR <30, clearance halves and the metabolite GX builds up, so lower the maintenance rate. The older syringe label reports no change in lidocaine kinetics, only metabolite buildup. It is not meaningfully dialyzable.
  • Hepatic Impairment: The half-life doubles or more. Lower the maintenance rate and limit repeat local doses.
  • Heart Failure / Shock: Less hepatic blood flow raises levels. Use lower rates.
  • Obesity / Dosing Weight: Local anesthetic maximums are set on ideal body weight. In an average adult, the label gives the antiarrhythmic bolus as 50–100 mg (0.7–1.4 mg/kg). Avoid large total-body-weight boluses.
  • Risk Factors for LAST: cut the local anesthetic max by 20% for one risk factor and by 40% for several. The risk factors are these: highly vascular site (intercostal, dental, penile), heart failure with reduced ejection fraction, end-stage renal disease, age under 1 or over 70, CYP inhibitors, low albumin, low muscle mass, hepatic failure (for repeat doses).

Field & Transport Considerations
  • Scope: IV/IO antiarrhythmic use by Paramedic, RN and critical-care transport is per local protocol. IO analgesic use and provider level vary by state and agency protocol.
  • Storage & Stability: Keep it at 20–25°C (68–77°F). Premix bags tolerate brief exposure up to 40°C (104°F). Keep them in the overwrap until use, and avoid prolonged vehicle heat.
  • Carried Concentration: The carried syringe is 100 mg/5 mL (20 mg/mL). Never give methylparaben or epinephrine-containing lidocaine IV or IO. Check 1% versus 2%.
  • Infusions in Transport: premix 4 or 8 mg/mL on a pump with a drug library; confirm concentration and start time at handoff; plan the rate reduction at 24 hr.
  • Handoff Essentials: each bolus time and dose, cumulative mg from all routes (IV, IO, local, topical), infusion rate and start time, rhythm response, any CNS symptoms.

Clinical Pearls
Lidocaine vs Amiodarone in Refractory VF: Equal options, per AHA 2025 (COR 2b, adults B-R, children C-LD).
  • Lidocaine: systemic arterial pressure does not change at usual therapeutic doses (Baxter label)
  • Amiodarone and procainamide can cause hypotension (AHA 2025 Part 9)
  • Amiodarone also covers AF and stable VT
  • Track either drug by its cumulative dose
Exam Discriminator: Wide Escape Rhythm: In bradycardia or heart block, a slow wide-complex escape rhythm is what keeps the patient alive. Lidocaine can abolish it and leave complete heart block or asystole. Reach for atropine or pacing to raise the rate instead.
Count the Whole Patient: Every IO dose, wound infiltration, airway spray and jelly goes into one total. Work out the max on ideal body weight before the first injection. Not after symptoms start.
The Infusion Accumulates: Clearance falls as the infusion runs. After 24 hr, the half-life can pass 3 hr. Halve the rate at 24 hr, even when the patient looks well.
LAST Arrest Is Different: Lipid emulsion goes in early. Epinephrine doses stay small. Skip the vasopressin. Never treat its arrhythmias with more lidocaine or procainamide. AHA 2025 supports sodium bicarbonate for life-threatening wide-complex tachycardia (COR 2a).

Pharmacology

Mechanism of Action

  • Na⁺ channel block (class Ib): It acts on His-Purkinje and ventricular muscle, giving less automaticity, a shorter refractory period and a higher VF threshold.
  • Little atrial or AV-nodal effect: it has no role in supraventricular arrhythmias.
  • Minimal hemodynamic effect at therapeutic levels. Toxic levels depress the myocardium.
  • Nerve membrane stabilization: it blocks impulse conduction, which is what makes local and regional anesthesia work.

Pharmacokinetics

RouteOnsetPeakDuration
IV/IO bolus
Within minutes; reassess at 5 min
—
Wanes within about 15 min; an infusion maintains levels if ongoing suppression is needed
Infiltration
Rapid; faster with higher concentration and volume
—
Longer with larger doses; epinephrine slows absorption
  • Half-life: 1.5–2 hr after a bolus. It runs 3 hr or more after infusions over 24 hr, and it doubles or more in liver dysfunction (Hospira label).
  • Metabolism: the liver, through CYP1A2 and CYP3A4. It depends on blood flow, so heart failure and shock slow it (Baxter label).
  • Active metabolites: MEGX and GX are similar but less potent. In severe renal impairment, clearance halves and GX builds up 1.5-fold (Baxter label).
  • Elimination: Renal. Less than 10% is excreted unchanged (Hospira label).
  • Protein binding / levels: 60–80% bound, mostly to alpha-1-acid glycoprotein. It crosses the blood-brain barrier and the placenta. Therapeutic is 1.5–6 mcg/mL. Objective adverse effects become more apparent above 6 mcg/mL (Hospira label).

Names & Classification
Generic Name
Lidocaine hydrochloride
Brand Names
Xylocaine, Xylocaine-MPF, Xylocaine with Epinephrine; many generics
Pharmacologic Class
Class Ib antiarrhythmic; amide local anesthetic
Therapeutic Class
Antiarrhythmic; local anesthetic
Controlled Substance
Not controlled
ISMP High-Alert
Yes: ISMP high-alert medication (antiarrhythmics, IV)
Look-Alike / Sound-Alike
Formulation mix-ups: 1% (10 mg/mL) vs 2% (20 mg/mL); plain vs with epinephrine; preservative-free vs methylparaben multiple-dose vials

Related

References
  1. Wigginton, J. G., Agarwal, S., et al. (2025). Part 9: Adult advanced life support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 152(16 Suppl 2), S538–S577. https://doi.org/10.1161/CIR.0000000000001376
  2. Lasa, J. J., Dhillon, G. S., et al. (2025). Part 8: Pediatric advanced life support: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 152(16 Suppl 2), S479–S537. https://doi.org/10.1161/CIR.0000000000001368
  3. Cao, D., Arens, A. M., Chow, S. L., et al. (2025). Part 10: Adult and pediatric special circumstances of resuscitation: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 152(16 Suppl 2), S578–S672. https://doi.org/10.1161/CIR.0000000000001380
  4. Hospira, Inc. (2026). Lidocaine hydrochloride injection, USP (Ansyr syringe), for acute management of ventricular arrhythmias: Prescribing information. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ad1ef0a8-88db-4648-c098-d009eaeb4e5b
  5. Baxter Healthcare Corporation. (2026). Lidocaine hydrochloride and 5% dextrose injection, USP: Prescribing information. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f21512ea-c7c3-4766-b976-b2c0b5616bf0
  6. Neal, J. M., Neal, E. J., & Weinberg, G. L. (2021). American Society of Regional Anesthesia and Pain Medicine Local Anesthetic Systemic Toxicity checklist: 2020 version. Regional Anesthesia & Pain Medicine, 46(1), 81–82. https://doi.org/10.1136/rapm-2020-101986
  7. Fettiplace, M. R. (2026). Morbidity and mortality from local anesthetics: localized and systemic toxicity. Current Opinion in Anaesthesiology, 39(5), 659–668. https://doi.org/10.1097/ACO.0000000000001683
  8. Fresenius Kabi USA, LLC. (2025). Xylocaine (lidocaine HCl injection) and Xylocaine with epinephrine (lidocaine HCl and epinephrine injection), for infiltration and nerve block: Prescribing information. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4dd52202-8eef-4136-92dd-ada573b7cf74
  9. Malignant Hyperthermia Association of the United States. (2026). Safe and unsafe anesthetics: safe anesthetic agents for MH patients, including all local anesthetics. Web page, accessed October 15, 2026. https://www.mhaus.org/healthcare-professionals/be-prepared/safe-and-unsafe-anesthetics/
  10. Martí-Carvajal, A. J., et al. (2015). Prophylactic lidocaine for myocardial infarction. Cochrane Database of Systematic Reviews, CD008553. https://doi.org/10.1002/14651858.CD008553.pub2
  11. Teleflex Incorporated. (2019). EZ-IO Intraosseous Vascular Access: Care, Maintenance, and Removal (MCI-2019-0394, revised 06/2019; IO lidocaine instructions). https://www.teleflex.com/global/clinical-resources/documents/MCI-2019-0394_VA_DS_EZ-IO_Intraosseus_Vascular_Access_LR.pdf
  12. Hospira, Inc. (2026). Lidocaine hydrochloride injection, USP, aqueous solutions for infiltration and nerve block: Prescribing information (effective August 5, 2026). DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3b2dd84e-cee8-4e58-d494-395a65a353a0

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