Local Anesthetic Guidelines

Introduction to Tetracaine

• The American Academy of Pediatrics recommends a maximum dose of tetracaine for subcutaneous administration of 1.5 mg/kg without epinephrine, with a duration of action of 180-600 minutes 1, 2, 3
• The maximum safe dose of tetracaine can be calculated based on patient weight: Maximum dose (mg) = 1.5 mg/kg × patient weight (kg) 1, 2

Dosage and Administration

• The volume to administer can be calculated based on tetracaine concentration: Volume (mL) = Maximum dose (mg) ÷ Concentration (mg/mL), with available concentrations of 0.25-1% solutions, corresponding to:

1

• Dose reduction is required in certain populations: 30% reduction in infants younger than 6 months 1
• Comparison of maximum doses for other local anesthetics:

Monitoring and Toxicity Management

• Monitor vital signs during administration and watch for signs of systemic toxicity, including perioral numbness, tinnitus, seizures, and cardiovascular depression 1, 2
• If toxicity occurs, follow these steps:
• Patient factors such as age, weight, and hepatic/renal function should be considered when determining the dose of tetracaine, with dose reduction required in elderly and very young patients, and those with impaired hepatic or renal function 2
• Tetracaine is suitable for short to medium-length procedures due to its duration of action, and its extended duration in certain applications makes it versatile across various clinical settings, providing superior anesthesia compared to lidocaine for nasal procedures 1, 4
• Formulations of tetracaine, such as microencapsulated formulations, can increase the duration of action up to 4-fold 4