in which this residue has caused the lumen to occlude. see also adverse reactions and dosage & administration .

led by an easy syringe-like action, until the patient has a feeling of tension or until about 15 ml (i.e., 300 mg of lidocaine hydrochloride) is instilled. a penile clamp is then applied for several minutes at the corona and then additional jelly (about 15 ml) is instilled. to save time, the injection is performed against the resistance of the sphincter, possibly assisted by asking the patient to strain as for defecation or to press as in voiding. the jelly will then pass into the posterior urethra. prior to sounding or cystoscopy, a penile clamp should be applied for 5 to 10 minutes to obtain adequate anesthesia. if the instrument is introduced immediately, a lubricant is unnecessary. otherwise some jelly can be expressed from the vial and applied to the instrument tip. about 30 ml (i.e., 600 mg) may be required to fill and dilate the male urethra. when it is desired to anesthetize only the anterior male urethra, as prior to catheterization, considerably smaller volumes, such as the contents from a 5 ml (i.e., 100 mg) or 10 ml (i.e., 200 mg) size vial, are usually adequate for lubrication. for surface anesthesia of the female adult urethra 3 to 5 ml of the jelly is instilled slowly into the urethra by gently expressing the contents of the vial. if desired, some jelly may be deposited on a cotton swab and introduced into the urethra. in order to obtain adequate anesthesia, several minutes should be allowed prior to performing urological procedures. lubrication for endotracheal intubation apply a moderate amount of jelly to the external surface of the endotracheal tube shortly before use. care should be taken to avoid introducing the product into the lumen of the tube. do not use the jelly to lubricate endotracheal stylettes. see warnings and adverse reactions concerning rare reports of inner lumen occlusion. it is also recommended that use of endotracheal tubes with dried jelly on the external surface be avoided for lack of lubricating effect. maximum dosage no more than 600 mg of lidocaine hydrochloride should be given in any 12 hour period. children it is difficult to recommend a maximum dose of any drug for children since this varies as a function of age and weight. for children less than ten years who have a normal lean body mass and a normal lean body development, the maximum dose may be determined by the application of one of the standard pediatric drug formulas (e.g., clark's rule). for example, in a child of five years weighing 50 lbs., the dose of lidocaine hydrochloride should not exceed 75–100 mg when calculated according to clark's rule. in any case, the maximum amount of lidocaine administered should not exceed 4.5 mg / kg (2 mg / lb) of body weight.

g, tremors, convulsions, unconsciousness, respiratory depression and arrest. the excitatory manifestations may be very brief or may not occur at all, in which case the first manifestation of toxicity may be drowsiness merging into unconsciousness and respiratory arrest. drowsiness following the administration of lidocaine is usually an early sign of a high blood level of the drug and may occur as a consequence of rapid absorption. cardiovascular system cardiovascular manifestations are usually depressant and are characterized by bradycardia, hypotension, and cardiovascular collapse, which may lead to cardiac arrest. allergic allergic reactions are characterized by cutaneous lesions, urticaria, edema or anaphylactoid reactions. allergic reactions may occur as a result of sensitivity either to the local anesthetic agent or to other components in the formulation. allergic reactions as a result of sensitivity to lidocaine are extremely rare and, if they occur, should be managed by conventional means. the detection of sensitivity by skin testing is of doubtful value.

inistration. lidocaine is also well-absorbed from the gastrointestinal tract, but little intact drug may appear in the circulation because of biotransformation in the liver. lidocaine is metabolized rapidly by the liver, and metabolites and unchanged drug are excreted by the kidneys. biotransformation includes oxidative n-dealkylation, ring hydroxylation, cleavage of the amide linkage, and conjugation. n-dealkylation, a major pathway of biotransformation, yields the metabolites mono-ethylglycinexylidide and glycinexylidide. the pharmacological / toxicological actions of these metabolites are similar to, but less potent than, those of lidocaine. approximately 90% of lidocaine administered is excreted in the form of various metabolites, and less than 10% is excreted unchanged. the primary metabolite in urine is a conjugate of 4-hydroxy-2,6-dimethylaniline. the plasma binding of lidocaine is dependent on drug concentration, and the fraction bound decreases with increasing concentration. at concentrations of 1 to 4 µg of free base per ml, 60 to 80 percent of lidocaine is protein bound. binding is also dependent on the plasma concentration of the alpha-i-acid glycoprotein. lidocaine crosses the blood-brain and placental barriers, presumably by passive diffusion. studies of lidocaine metabolism following intravenous bolus injections have shown that the elimination half-life of this agent is typically 1.5 to 2 hours. because of the rapid rate at which lidocaine is metabolized, any condition that affects liver function may alter lidocaine kinetics. the half-life may be prolonged two-fold or more in patients with liver dysfunction. renal dysfunction does not affect lidocaine kinetics but may increase the accumulation of metabolites. factors such as acidosis and the use of cns stimulants and depressants affect the cns levels of lidocaine required to produce overt systemic effects. objective adverse manifestations become increasingly apparent with increasing venous plasma levels above 6 µg free base per ml. in the rhesus monkey arterial blood levels of 18–21 µg / ml have been shown to be the threshold for convulsive activity.

gnment. 3) remove cap and expel air. * caution: improper engaging may cause glass breakage and subsequent injury. store at controlled room temperature 15° to 30°c (59° to 86°f). assembly 1 assembly 2 assembly 3