Lidocaine Pediatric Dose — Resuscitation
Lidocaine is a class IB antiarrhythmic and local anesthetic that works by blocking voltage-gated sodium channels, stabilizing the cardiac membrane and suppressing ventricular ectopy. In the pediatric resuscitation setting, it is used in the management of ventricular arrhythmias, including ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT), particularly when amiodarone is unavailable. It may also be considered for hemodynamically significant ventricular tachycardia with a pulse.
Pediatric Dosing
- 1 mg/kg IV/IO bolus
Administer as a single IV/IO bolus. Repeat dosing and maintenance infusion rates are not specified in this source; consult your institutional protocol for guidance on subsequent doses.
Worked example: For a 20 kg child: 20 × 1 mg/kg = 20 mg total. For a 10 kg child: 10 × 1 mg/kg = 10 mg total.
Indications and Clinical Context
Lidocaine is indicated in pediatric resuscitation for ventricular fibrillation and pulseless ventricular tachycardia refractory to defibrillation, as an alternative antiarrhythmic when amiodarone is not available. PALS guidelines recognize lidocaine as an acceptable alternative in this context. It may also be considered for stable ventricular tachycardia with a pulse under appropriate clinical supervision.
Its rapid onset of action makes it suitable for use during active resuscitation. Clinical teams should consider the underlying etiology of the arrhythmia and any patient-specific factors when selecting antiarrhythmic therapy.
Administration and Monitoring
Administer lidocaine as an IV or IO bolus. The intraosseous route is appropriate when IV access cannot be rapidly established during resuscitation. Rapid bolus injection is standard during cardiac arrest situations.
- Monitor ECG continuously during and after administration for changes in PR interval, QRS duration, or worsening arrhythmia.
- Signs of lidocaine toxicity include CNS effects (seizures, altered mental status) and cardiovascular depression; monitor closely in non-arrest patients.
- Use with caution in patients with known hepatic impairment, as lidocaine undergoes extensive hepatic metabolism.
- Consult institutional protocol for maximum cumulative dose, repeat bolus intervals, and maintenance infusion parameters, as these are not specified in this source.
Disclaimer: This article is an educational reference summarizing standard pediatric dosing values. It is not a substitute for clinical judgment. Always verify doses against institutional protocols, the current edition of authoritative references (e.g., Lexicomp, Harriet Lane Handbook, PALS guidelines), the patient’s accurate weight, and any patient-specific factors (renal/hepatic function, allergies, comedications) before administration.