From the FDA Drug Label
The dosages below are for normal, healthy adults The maximum recommended dose of 4% Lidocaine Hydrochloride Injection, USP should be such that the dose of lidocaine HCl is kept below 300 mg and in any case should not exceed 4. 5 mg/kg (2 mg/lb) body weight.
The recommended dosing for RSI is not explicitly stated in the label. However, for normal, healthy adults, the maximum recommended dose is 300 mg or 4.5 mg/kg.
- The maximum dose should not exceed 4.5 mg/kg or 2 mg/lb body weight.
- For RSI, the dose is typically 1.5 mg/kg 1.
From the Research
Lidocaine should be administered at a dose of 1.5 mg/kg IV (maximum 100-200 mg) given 2-3 minutes before intubation for rapid sequence intubation (RSI), particularly in patients with increased intracranial pressure, reactive airway disease, or status asthmaticus, as supported by the most recent study 2. The use of lidocaine in RSI is crucial in minimizing the sympathetic response to laryngoscopy and intubation, thereby reducing increases in intracranial pressure and bronchospasm in reactive airway disease.
- Key considerations for lidocaine administration include:
- Dose: 1.5 mg/kg IV (maximum 100-200 mg)
- Timing: 2-3 minutes before intubation
- Administration: Slowly over 1-2 minutes to avoid potential cardiovascular side effects
- Potential side effects of lidocaine include:
- Hypotension
- Bradycardia
- CNS toxicity at higher doses
- Lidocaine should be used with caution in patients with:
- Liver disease
- Heart block
- Those on beta-blockers While the evidence from older studies 3, 4, 5 supports the use of lidocaine in RSI, the most recent study 2 provides the most up-to-date guidance on its use. Additionally, a more recent review 6 highlights the importance of considering alternative induction agents, but does not provide specific guidance on lidocaine dosing. Therefore, the recommendation is based on the most recent and highest quality study available 2.