Lidocaine-Induced Seizures: Risk Factors and Management

Clinical Manifestations and Risk Factors

Progression of toxicity can lead to confusion, slurred speech, and seizures in patients receiving lidocaine, particularly in those with cardiac failure, cardiogenic shock, acidemia, hypoalbuminemia, or concurrent use of medications that reduce lidocaine metabolism 1
Excessive dosage exceeding recommended limits (maximum dose with epinephrine: 7 mg/kg; without epinephrine: 4-4.4 mg/kg) can increase the risk of lidocaine-induced seizures in patients, as recommended by the American Academy of Pediatrics 2, 3

The American Academy of Pediatrics recommends using the lowest effective dose, reducing the rate by approximately 50% at 12-24 hours for infusions lasting >12 hours, and monitoring plasma levels when infusions continue beyond 24 hours to prevent lidocaine-induced seizures 1
Immediate discontinuation of lidocaine administration, airway management and ventilation with 100% oxygen, and seizure control with benzodiazepines (e.g., intravenous midazolam 0.1-0.2 mg/kg) are essential for managing lidocaine-induced seizures, as recommended by the American Academy of Pediatrics 1, 3