Theos-Talk Archives (April 2005 Message tt01763)

Interesting
INDICATIONS
AND USES 

Xylocaine (lidocaine HCl) Injections are indicated for production of local or regional anesthesia by infiltration techniques such as percutaneous injection and intravenous regional anesthesia by peripheral nerve block techniques such as brachial plexus and intercostal and by central neural techniques such as lumbar and caudal epidural blocks, when the accepted procedures for these techniques as described in standard textbooks are observed.  
DOSAGE AND ADMINISTRATION
Table 1 (Recommended Dosages) summarizes the recommended volumes and concentrations of Xylocaine Injection for various types of anesthetic procedures.The dosages suggested in this table are for normal healthy adults and refer to the use of epinephrine-free solutions. When larger volumes are required, only solutions containing epinephrine should be used except in those cases where vasopressor drugs may be contraindicated. 

These recommended doses serve only as a guide to the amount of anesthetic required for most routine procedures. The actual volumes and concentrations to be used depend on a number of factors such as type and extent of surgical procedure, depth of anesthesia and degree of muscular relaxation required, duration of anesthesia required, and the physical condition of the patient. In all cases the lowest concentration and smallest dose that will produce the desired result should be given. Dosages should be reduced for children and for the elderly and debilitated patients and patients with cardiac and/or liver disease. 

The onset of anesthesia, the duration of anesthesia and the degree of muscular relaxation are proportional to the volume and concentration (i.e., total dose) of local anesthetic used. Thus, an increase in volume and concentration of Xylocaine Injection will decrease the onset of anesthesia, prolong the duration of anesthesia, provide a greater degree of muscular relaxationand increase the segmental spread of anesthesia. However, increasing the volume and concentration of Xylocaine Injection may result in a more profound fall in blood pressure when used in epidural anesthesia. Although the incidence of side effects with lidocaine is quite low, caution should be exercised when employing large volumes and concentrations, since the incidence of side effects is directly proportional to the total dose of local anesthetic agent injected. 

For intravenous regional anesthesia, only the 50 mL single dose vial containing Xylocaine (lidocaine HCl) 0.5% Injection should be used. 

Epidural Anesthesia: For epidural anesthesia, only the following dosage forms of Xylocaine Injection are recommended: 

Although these solutions are intended specifically for epidural anesthesia, they may also be used for infiltration and peripheral nerve block, provided they are employed as single dose units. These solutions contain no bacteriostatic agent. 

In epidural anesthesia, the dosage varies with the number of dermatomes to be anesthetized (generally 2-3 mL of the indicated concentration per dermatome). 

Caudal and Lumbar Epidural Block: As a precaution against the adverse experience sometimes observed following unintentional penetration of the subarachnoid space, a test dose such as 2-3 mL of 1.5% lidocaine should be administered at least 5 minutes prior to injecting the total volume required fora lumbar or caudal epidural block. The test dose should be repeated if thepatient is moved in a manner that may have displaced the catheter. Epinephrine, if contained in the test dose, (10-15 µg have been suggested), may serve as a warning of unintentional intravascular injection. If injected into a blood vessel, this amount of epinephrine is likely to produce a transient "epinephrine response" within 45 seconds, consisting of an increase in heart rate and systolic blood pressure, circumoral pallor, palpitations andnervousness in the unsedated patient. The sedated patient may exhibit onlya pulse rate increase of 20 or more beats per minute for 15 or more seconds. Patients on beta
blockers may not manifest changes in heart rate, but blood pressure monitoring can detect an evanescent rise in systolic blood pressure. Adequate time should be allowed for onset of anesthesia after administration of each test dose. The rapid injection of a large volume of Xylocaine Injection through the catheter should be avoided, and, when feasible, fractional doses should be administered. 

In the event of the known injection of a large volume of local anesthetic solution into the subarachnoid space, after suitable resuscitation and if the catheter is in place, consider attempting the recovery of drug by draining a moderate amount of cerebrospinal fluid (such as 10 mL) through the epidural catheter. 
MAXIMUM RECOMMENDED DOSAGES 
Adults: For normal healthy adults, the individual maximum recommended dose of lidocaine HCl with epinephrine should not exceed 7 mg/kg (3.5 mg/lb) of body weight, and in general it is recommended that the maximum total dosenot exceed 500 mg. When used without epinephrine the maximum individual dose should not exceed 4.5 mg/kg (2 mg/lb) of body weight, and in general it is recommended that the maximum total dose does not exceed 300 mg. For continuous epidural or caudal anesthesia, the maximum recommended dosage shouldnot be administered at intervals of less than 90 minutes. When continuous lumbar or caudal epidural anesthesia is used for non-obstetrical procedures, more drug may be administered if required to produce adequate anesthesia. 

The maximum recommended dose per 90 minute period of lidocaine hydrochloride for paracervical block in obstetrical patients and non-obstetrical patients is 200 mg total. One half of the total dose is usually administered to each side. Inject slowly, five minutes between sides. (See also discussion of paracervical block in PRECAUTIONS.) 

For intravenous regional anesthesia, the dose administered should not exceed 4 mg/kg in adults. 

Children: It is difficult to recommend a maximum dose of any drug for children, since this varies as a function of age and weight. For children over3 years of age who have a normal lean body mass and normal body development, the maximum dose is determined by the child's age and weight. For example, in a child of 5 years weighing 50 lbs the dose of lidocaine HCl should not exceed 75-100 mg (1.5-2 mg/lb). The use of even more dilute solutions (i.e., 0.25-0.5%) and total dosages not to exceed 3 mg/kg (1.4 mg/lb) are recommended for induction of intravenous regional anesthesia in children. 

In order to guard against systemic toxicity, the lowest effective concentration and lowest effective dose should be used at all times. In some cases it will be necessary to dilute available concentrations with 0.9% sodium chloride injection in order to obtain the required final concentration. 

NOTE: Parenteral drug products should be inspected visually for particulatematter and discoloration prior to administration whenever the solution andcontainer permit. The injection is not to be used if its color is pinkish or darker than slightly yellow or if it contains a precipitate. 

THE ABOVE SUGGESTED CONCENTRATIONS AND VOLUMES SERVE ONLY AS A GUIDE. OTHER VOLUMES AND CONCENTRATIONS MAY BE USED PROVIDED THE TOTAL MAXIMUM RECOMMENDED DOSE IS NOT EXCEEDED. 

Trademarks herein are the property of the AstraZeneca Group 

© AstraZeneca 2000 

       

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krishtar <krishtar_a@brturbo.com.br> wrote:

Terrie.. Terrie...sometimes you´re really great!
"Leadbeater is an endorphin ride." ( !!!)

Glad we both agree about these points.
" Life uses no xylocaine" , isn´t it? ( That is mine)
Have a good night.

Krishtar

----- Original Message ----- 
From: thalprin 
To: theos-talk@yahoogroups.com 
Sent: Tuesday, April 26, 2005 10:07 PM
Subject: Theos-World Re: Mental Health issues - ancient meets modern - Krishtar pov




My pleasure, glad you enjoyed the link.

Krishtar, yes, I am by nature very frank, I treat myself with the 
same honesty, this being the case I do suppose that folks can feel 
flustered or insulted by such, but honestly that it not my intent - 

I forget folks are mentally/emotionally fragile a/o attached 
sometimes, another nice point, thanks.

Yes, I push buttons sometimes (perhaps, hehe, shock therapy) I 
suppose but it's often just such an efficient method/means of 
putting pretenses aside and getting an actual 
look/exampling/accounting into/of the reality a/o heart of the 
matter at hand.

I think you've quite nicely stated an enormous diff between HPB and 
Leadbeater raps - certainly I think Leadbeater is an endorphin ride.

Thanks for the view, enjoyed.

Terrie



--- In theos-talk@yahoogroups.com, "krishtar" 
wrote:
> Terrie and Mark
> Thanks Terrie for the link on Copts.
> 
> Mark I am still analysing all thet you are saying to form a whole 
idea that I can express later.
> 
> Terrie, your comments on Mark´s situation at one side (seem to ) 
lack a little compassion, they´re very cutting,direct but I also see 
that some truths also cutting and cruel...aren´t they?
> The explanations offered about the after-death states by the 
mahatmas and also by HPB herself are more difficult to accept, 
digest, than those given by many spiritualists such as Allan Kardec 
and Leadbeater, where it is very, as I once said, very romantic.
> My observation on the various situations where people claim to see 
things like masters and deceased ones, are a bit or a lot of 
psychic problems, not purely psychic capabilities.
> It´s sometimes easier to react roughly when a truth or plausible 
fact is shown at a objective POV. 
> Most of the people who start telling about their " paranormal" 
experiences expect congruity, not shock, and this way is very 
difficult to keep a conversation without shocking of opinions.
> One must be very honest and strong to admitt that some 
experiences are not mystical or occult, but what happens is the high 
attachment we have to the fenomenas that occur with us.
> We all like to dettach ourselves from the normality, from the 
average people´s experiences and we seize to these experiences as if 
they were something we really possess, even taking our illusions as 
realities.
> An illusion becomes more and more real to as as much as the more 
we get attached to it.
> Just my view.
> 
> Krishtar







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