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Acetamide local anesthetic
Prevention and control of pain in procedures involving the male and female urethra. Topical treatment of painful urethritis. Anesthetic lubricant for endotracheal intubation (oral/nasal).
For Surface Anesthesia of the Male Urethra:Usual: Slowly instill 15mL (300mg) into the urethra or until patient has a feeling of tensionApply penile clamp for several min at the coronaMay instill an additional dose of ≤15mL Prior to Sounding or Cystoscopy: Apply penile clamp for 5-10 min prior to procedureA total dose of 30mL (600mg) is usually required to fill and dilate the male urethraPrior to Catheterization: Smaller volumes of 5-10mL (100-200mg) are usually adequate for lubricationMax: No more than 600mg/12 hrsFor Surface Anesthesia of the Female Urethra:Slowly instill 3-5mL (60-100mg) into the urethraWait several min before performing urological procedureMax: No more than 600mg/12 hrs
For Endotracheal Intubation (Oral and Nasal):Apply moderate amount to the external surface of the endotracheal tube shortly before use; avoid the lumen of the tubeDo not use to lubricate endotracheal stylettesMax: No more than 600mg/12 hrs
Determine max dose of children for <10 years (normal lean body development) using standard pediatric drug formulas (Clark's rule)Max: 4.5mg/kg (2mg/lb)
Jelly: 2% (20mg/mL) [5mL, 30mL]
Safety and effectiveness depend on proper dosage, correct technique, adequate precautions, and readiness for emergencies. Management of serious adverse reactions may require the use of resuscitative equipment, oxygen, and other resuscitative drugs. Use with extreme caution in the presence of sepsis or severely traumatized mucosa in the area of application; risk of rapid systemic absorption. Repeated doses may cause significant increases in blood levels. Elderly, debilitated, acutely ill, and children should be given reduced doses commensurate with their age, weight, and physical condition. Tolerance to elevated blood levels varies with the status of the patient. Caution in patients with severe shock or heart block. Caution with known drug sensitivities. Avoid introducing product into lumen of endotracheal tube; the jelly may dry on the inner surface leaving a residue that narrows or occludes the lumen. Do not use to lubricate the endotracheal stylettes. May trigger familial malignant hyperthermia; have standard protocol for management available. Acidosis affects the CNS levels of lidocaine required to produce overt systemic effects.
Lightheadedness, nervousness, confusion, euphoria, dizziness, drowsiness, blurred vision, tremors, convulsions, respiratory depression, bradycardia, hypotension, urticaria, edema, anaphylactoid reactions.
CNS stimulants and depressants affect the CNS levels of lidocaine required to produce overt systemic effects.
Category B, caution in nursing.
Acetamide local anesthetic; stabilizes the neuronal membrane by inhibiting the ionic fluxes required for the initiation and conduction of impulses, thereby effecting local anesthetic action.
Absorption: Well-absorbed from GI tract. Rate and extent of absorption depends on concentration and total dose administered, the specific site of application, and duration of exposure. Distribution: Plasma protein binding (60-80%); crosses placenta, found in breast milk. Metabolism: Liver (rapid), oxidative N-dealkylation, ring hydroxylation, cleavage of amide linkage, conjugation; monoethylglycinexylidide and glycinexylidide (metabolites). Elimination: Urine (90% metabolites, <10% unchanged); T1/2=1.5-2 hrs (IV).
Assess for hypersensitivity to local anesthetics of the amide type or to other components of the drug, sepsis, presence of severely traumatized mucosa in the area of application, debilitation or acute illness, severe shock or heart block, known drug sensitivities, acidosis, pregnancy/nursing status, and possible drug interactions.
Monitor for signs/symptoms of hypersensitivity reactions, familial malignant hyperthermia, and other adverse reactions.
Inform that therapy may impair swallowing and enhance danger of aspiration if used in the mouth. Instruct not to ingest food for 60 min following use in mouth or throat area. Inform that numbness of tongue or buccal mucosa may enhance danger of unintentional biting trauma.