Drug of the week series week 6

General
1

A patient requires extraction under local anesthesia.
In which of the following situations is 2% lidocaine administration absolutely contraindicated?

  • Controlled hypertension
  • Uncontrolled hyperthyroidism
  • Severe heart block without pacemaker
  • Controlled diabetic patient
0 voters

What is more dangerous — incorrect dosage or ignoring contraindications? Share upur thoughts!

MBH/PS

2 Likes
2

Both carry extreme risks, but in this ignoring contraindications is generally more dangerous.

An incorrect dosage is a severe mistake of quantity, but ignoring a contraindication is a fundamental mistake of selection. “Forcing a drug into a biological system that is explicitly primed to crash from it is the fastest route to an irreversible medical emergency”.

3

The correct answer is:

Severe heart block without pacemaker

Lidocaine can depress cardiac conduction, so in patients with severe heart block (without a pacemaker), it may worsen the condition and become life-threatening.

5

Well, the answer would depend, I guess, on whether the lidocaine has 1:80,000 adrenaline or not. If the vasoconstrictor is present, it’s a contraindication because of the risk of a thyroid storm.