Lidocaine Toxicity

 
Policy:
 
Lidocaine has long been used in the wetting solution for 
liposuction.  Adding either the incorrect amount or 
concentration of lidocaine can result in accidental overdose. 
 This facility utilizes a standardized guideline for 
preparing the solution.
 
The manifestations of Lidocaine overdose are variable and 
affect various organ systems. 
 
Systemic Manifestations of Lidocaine Overdose
 
Central Nervous System: 
 
Initial excitatory symptoms, lightheadedness, dizziness, 
tinnitus, blurred vision, etc., followed by twitching, 
convulsions and respiratory depression leading to cardiac 
arrest.
 
Cardiovascular System:  
 
Depressant manifestations, such as bradycardia, hypotension, 
and cardiovascular collapse, leading to cardiac arrest.
 
 
Delayed Effect of Epinephrine:  
 
A dilute solution of epinephrine (1:100,000) significantly 
delays the absorption of lidocaine from the infusate in the 
tumescent technique.  Lidocaine from operated tissue is 
slowly absorbed into the circulation.  This is an important 
consideration for outpatients who might go home before their 


 
lidocaine levels reach the maximum concentration.
 
Related factors: 
 
Factors causing raised levels of lidocaine include: renal 
disease, reduced cardiac output, hepatic disease, obesity, 
advanced age, hypovolemia, hypocalcemia, hypophosphatemia, 
and hypoalbuminemia. Medications that affect lidocaine levels 
include oral contraceptives, betablockers, tricyclic 
antidepressants, diet pills, and cimetidene. Pre-existing 
liver disease slows lidocaine breakdown.
 
Allergic Reactions:  
 
These are infrequent, but may include anaphylactoid collapse.
 
All members of the operating team should be familiar with the 
manifestations of local anesthesia toxicity, which can occur 
regardless of the total dose used.  As serum lidocaine levels 
increase into CNS toxic range from an overdose or accidental 
intravascular injection, patients may show the symptoms 
described below, but they do not invariably pass through all 
of these stages.  The first signs of toxicity might be CNS 
depression and obtundation.
 
Possible Presentations:
 
Complaints of metallic taste, restlessness, circumoral and 
tongue numbness, lightheadedness, tinnitus (blood serum level 
5 mg/cc)
 
Treatments: 
 

 
Stop Injecting.  Verify lidocaine concentration.
Administer 100% oxygen.  Monitor vital signs closely.
 
Possible Presentations:
 
Muscle twitching, visual disturbances, slurred speech (blood 
serum level 7-8mg/cc). 
 
Treatments:
 
Stop injecting. Verify lidocaine concentration.
Administer 100% oxygen.  Monitor vital signs closely.
Administer IV diazepam, 5mg/70-kg patient up to 20mg.
Assess adequacy of ventilation and assist if necessary.
 
Possible Presentations: 
 
Convulsions (blood serum level 10-12mg/cc).
 
Treatments:
 
Stop injecting. Verify lidocaine concentration.
Administer 100% oxygen.  Monitor vital signs closely.
Administer IV diazepam, 5mg/70-kg patient up to 20mg.
Assess adequacy of ventilation and assist if necessary.
Transfer of Patient.
 
Possible Presentations: 
 
Unconsciousness (blood serum level 10-12mg/cc).
 
Treatments:
 
 
 
Stop injecting. Verify lidocaine concentration.
Administer 100% oxygen.  Monitor vital signs closely.
Administer IV diazepam, 5mg/70-kg patient up to 20mg.
Assess adequacy of ventilation and assist if necessary.
Transfer of Patient.
 
 
Approved By Governing Board    
EP.13    
Control #299.0
GUPTA GASTRO